Psychotropic Polypharmacy is Common in Alzheimer’s Disease

Up to half of people with Alzheimer’s disease (AD) use a psychotropic drug, and one in five uses two or more psychotropics concomitantly, according to a study conducted at the University of Eastern Finland.

Psychotropic Polypharmacy is Common in Alzheimer’s DiseasePsychotropic drug use was more common among persons with Alzheimer’s disease already five years before the diagnosis, and the difference to comparison persons without AD increased at the time of diagnosis. Four years after the diagnosis, psychotropic drug use was three times more common in persons with AD than in comparison persons.

Of psychotropic drugs, the use of antipsychotics was almost eight times more common among persons with Alzheimer’s disease than among comparison persons. There were no differences in the use of benzodiazepines and related drugs. The use of at least two psychotropics concomitantly was three times more common among persons with Alzheimer’s disease four years after the diagnosis.  The most common combination included an antidepressant together with either an antipsychotic or a benzodiazepine.

The use of first-line anti-dementia drugs, namely acetylcholinesterase inhibitors, was associated with a decreased risk of psychotropic polypharmacy, whereas memantine use was associated with an increased risk. The results were published in European Neuropsychopharmacology.

“Concomitant use of psychotropics is concerning, as previous studies have shown that there is a link between several adverse events and psychotropic drug use among older persons and persons with dementia,” says Professor Sirpa Hartikainen from the University of Eastern Finland.

Guidelines of care in many countries recommend prescribing an acetylcholinesterase inhibitor to persons with Alzheimer’s disease, if there is no contraindication for use.

This study was part of the nationwide register-based MEDALZ study conducted at the University of Eastern Finland. The study included all 70,718 persons diagnosed with Alzheimer’s disease in Finland during 2005-2011. Researchers from Utrecht University also contributed to this study.

 

Research article:

Orsel K, Taipale H, Tolppanen AM, Koponen M, Tanskanen A, Tiihonen J, Gardarsdottir H, Hartikainen S. Psychotropic drugs and psychotropic polypharmacy among persons with Alzheimer’s disease. European Neuropsychopharmacology, published online August 25, 2018. DOI: 10.1016/j.euroneuro.2018.04.005