ABSTRACT
OBJECTIVES: Psychotropic drugs are usually prescribed to deal with behavioral and psychological symptoms of dementia, especially when nonpharmacologic approaches are not available or have limited efficacy. Poor outcomes and serious adverse events of the drugs used must be addressed, and risk-benefit ratios need to be considered. The aim of this longitudinal study was to describe the evolution of dispensation of psychotropic drugs in patients with Alzheimer's disease (AD) and to identify the associated demographic and clinical variables. METHODS: Longitudinal study using 698 cases with AD included in the Registry of Dementias of Girona in 2007 and 2008 and followed up during 3 years. Drugs were categorized according to the Anatomical Therapeutic Chemical classification. Binary logistic regression analyses were used to detect the variables associated with the use of antipsychotics, selective serotonin reuptake inhibitors (SSRIs), anxiolytics, and hypnotics. RESULTS: Of the patients, 51.2% consumed antipsychotics at least once during the three years of the study, whereas 73.3% and 58.2% consumed SSRIs and anxiolytics, respectively; 32.8% used hypnotics. Antipsychotic use was associated with a diagnosis of AD with delusions) [odds ratio (OR) = 5.7] and with increased behavior disorders (OR = 1.2). Patients with AD with depressed mood were more likely to be treated with SSRIs (OR = 3.1), while being a woman was associated with increased dispensation of anxiolytics (OR = 1.9) and SSRIs (OR = 2.2). CONCLUSIONS: Consumption of psychotropic drugs by the patients with AD registered in the Registry of Dementias of Girona is very high. Despite all the described adverse effects and recommendations of caution in their use, antipsychotics still are extensively used.
Subject(s)
Alzheimer Disease/drug therapy , Drug Utilization , Psychotropic Drugs/therapeutic use , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Longitudinal Studies , Male , Middle Aged , Odds Ratio , Registries , SpainABSTRACT
INTRODUCTION: Clinical evidence indicates that acetylcholinesterase inhibitors (AChEIs) are not efficacious to treat frontotemporal lobar degeneration (FTLD). The British Association for Psychopharmacology recommends avoiding the use of AChEI and memantine in patients with FTLD. METHODS: Cross-sectional design using 1092 cases with Alzheimer's disease (AD) and 64 cases with FTLD registered by the Registry of Dementias of Girona. Bivariate analyses were performed, and binary logistic regressions were used to detect variables associated with antidementia drugs consumption. RESULTS: The AChEIs were consumed by 57.6% and 42.2% of the patients with AD and FTLD, respectively. Memantine was used by 17.2% and 10.9% of patients with AD and FTLD, respectively. Binary logistic regressions yielded no associations with antidementia drugs consumption. CONCLUSIONS: There is a discrepancy regarding clinical practice and the recommendations based upon clinical evidence. The increased central nervous system drug use detected in FTLD requires multicentric studies aiming at finding the best means to treat these patients.
Subject(s)
Alzheimer Disease/drug therapy , Cholinesterase Inhibitors/therapeutic use , Frontotemporal Lobar Degeneration/drug therapy , Memantine/therapeutic use , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Registries , Regression AnalysisABSTRACT
Introducción. El Registro de Demencias de Girona (ReDeGI) es un dispositivo de vigilancia epidemiológica poblacional que registra los casos de demencia diagnosticados por los centros de referencia de la Región Sanitaria de Girona. Objetivo. Describir la frecuencia de los diagnósticos y sus características clínicas y sociodemográficas así como comparar las diferencias según los distintos subtipos de demencia. Pacientes y métodos. Registro consecutivo y estandarizado de los diagnósticos incidentes de demencia en dispositivos especializados de la Región Sanitaria de Girona desde 2007 a 2010. Resultados. Se registraron 2.814 casos, que representan una incidencia clínica de 6,6 casos por 1.000 personas/año. El 69,2% correspondió a demencias degenerativas primarias, el 18,9% a demencias secundarias a patología vascular, el 5,4% a otras demencias secundarias y el 6,5% a demencias no especificadas. La media de edad fue de 79,2 ± 7,6 años (rango: 33-99 años) y el 59,3% fueron mujeres. El tiempo medio entre el inicio de los síntomas y el diagnóstico clínico fue de 2,5 ± 1,7 años. La puntuación media en la escala de demencia de Blessed fue de 7,7 ± 4,5 puntos, y en el test minimental, de 17,6 ± 5,4 puntos. El 26,6% tenía antecedentes familiares de demencia y el 69,6% presentaba uno o más factores de riesgo cardiovascular. En el 60,6% de los casos fueron demencias leves, en el 28,5% moderadas y en el 10,9% graves. Conclusiones. La actividad de vigilancia epidemiológica realizada por el ReDeGi durante el período 2007-2010 ha permitido registrar información de gran validez externa útil para la planificación y gestión de los recursos sanitarios (AU)
Introduction. The Girona Dementia Registry (ReDeGi, from Spanish: Registro de Demencias de Girona) is a population based epidemiological surveillance mechanism that registers the cases of dementia diagnosed by the reference centres in he Girona Health District. Aim. To report on the frequency of the diagnoses and their clinical and sociodemographic characteristics, as well as to compare differences depending on the different subtypes of dementia. Patients and methods. The method used consisted in a consecutive standardised register of the diagnoses involving dementia in specialised procedures in the Girona Health District between 2007 and 2010. Results. A total of 2814 cases were registered, which represents a clinical incidence of 6.6 cases per 1000 persons/year. Of this total number, 69.2% were primary degenerative dementias, 18.9% were dementias secondary to a vascular pathology, 5.4% were other secondary dementias and 6.5% were non-specific dementias. The mean age was 79.2 ± 7.6 years (range: 33-99 years) and 59.3% were females. The mean time elapsed since the onset of symptoms and clinical diagnosis was 2.5 ± 1.7 years. The mean score on the Blessed dementia scale was 7.7 ± 4.5 points and in the minimental test it was 17.6 ± 5.4 points. A family history of dementia was present in 26.6% of cases and 69.6% presented one or more cardiovascular risk factors. In 60.6% of cases they were cases of mild dementia, 28.5% were moderate and 10.9% were severe cases. Conclusions. The epidemiological surveillance activity carried out by the ReDeGi throughout the period 2007-2010 has made it possible to record information that is extremely valuable for the planning and management of health care resources (AU)
