About 14% of older adults with dementia crammed prescriptions for a number of drugs that concentrate on the central nervous system (CNS), or the mind and spinal twine, in response to a latest examine. The usage of a number of drugs, referred to as polypharmacy, can improve the chance of significant unintended effects. Taking mixtures of CNS-active medicine can result in an elevated danger of falling, respiration points, and coronary heart issues. As well as, some CNS-active medicine can have an effect on considering and reminiscence — a facet impact that’s particularly troubling in individuals with dementia. The NIA-supported examine, led by researchers on the College of Michigan, was revealed in JAMA on March 9.
Drugs affecting the CNS are used to deal with melancholy and different psychological well being circumstances, stop seizures, and cut back ache. Older adults who’ve dementia typically have behavioral and psychological signs, resembling agitation or delusions. Well being care suppliers might prescribe CNS-active medicine to deal with these signs, however proof of the medicine’ effectiveness for the signs is restricted.
To raised perceive how many individuals with dementia obtained a mix of those medicine, researchers checked out Medicare claims knowledge on greater than 1 million adults ages 77 to 88 who had dementia. The researchers analyzed the quantity and timing of prescriptions crammed to estimate the quantity of people that possible took mixtures of the medicine.
The researchers discovered that 13.9% of those adults crammed prescriptions for 3 or extra CNS-active medicine for greater than 30 days in a row. Greater than half of these adults had the medicine for greater than 180 days. The researchers additionally discovered that individuals who have been prescribed a mix of CNS-active medicine had larger charges of insomnia, psychological well being circumstances, and ache not related to most cancers and seizure issues. Nonetheless, the researchers couldn’t, primarily based on the claims knowledge, decide whether or not the medicine have been prescribed to deal with these circumstances.
The researchers recognized some limitations of their examine that would level to areas for additional investigation. The examine might have overestimated the quantity of people that truly took the medicine as a result of it counted prescriptions crammed. The examine didn’t have a look at the explanations the medicine have been prescribed or their dosages. It additionally didn’t decide whether or not the adults who took a mix of CNS-active medicine had well being issues that the medicine might trigger, resembling falls.
This examine is the primary to look at the variety of adults with dementia who reside in the neighborhood — not in nursing properties — and take a mix of CNS-active medicine. Because the variety of adults residing with dementia will increase, higher understanding how these medicine are used, their results, and related dangers might assist well being care suppliers and dementia sufferers make safer, well-informed care choices.
This analysis was supported by NIA grant R01AG056407.
These actions relate to NIH’s AD+ADRD Research Implementation Milestone 1.B, “Quantify the exposome in current and new AD cohorts to realize a extra exact measure of environmental publicity components and their relationship to AD danger and particular person trajectories of illness development,” and 13.K, “Broaden analysis resulting in understanding of effectiveness and impacts of non-residential and residential care of PWD.”
Reference: Maust DT, et al. Prevalence of central nervous system-active polypharmacy among older adults with dementia in the US. JAMA. 2021;325(10):952-961. doi: 10.1001/jama.2021.1195.