Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia.

BACKGROUND: Neuropsychiatric symptoms in dementia patients are common and are often treated with psychotropic drugs. The aim of this study was to determine the prevalence and correlates of psychotropic drug use in Dutch nursing home patients with dementia. METHODS: Psychotropic drug use of 1322 patients on 59 dementia special care units (SCUs) in 25 nursing homes was registered. Drugs were categorized according to the Anatomical Therapeutical Chemical classification (ATC). The influence of age, gender, dementia stage measured by the Global Deterioration Scale (GDS), and type of neuropsychiatric symptoms on psychotropic drug use was analyzed using binomial logistic regression analysis. RESULTS: 63% of the patients used at least one psychotropic drug. Psychotropics in general and antipsychotics in particular were most frequently prescribed in GDS stage 6, and in patients aged between 65 and 75 years. Psychotropics in general were positively associated with depression, night-time behavior and agitation. Antipsychotic drug use was positively associated with psychosis, agitation and night-time behavior and was negatively associated with apathy. Anxiolytics were associated with age, psychosis, agitation and night-time behavior. Antidepressants were most frequently prescribed in GDS stage 6 and associated with female gender, agitation and depression. Sedatives were only associated with night-time behavior. CONCLUSION: Nursing home patients with dementia have a high prevalence of psychotropic drug use. In particular, the association with neuropsychiatric symptoms raises questions of efficacy of these drugs and the risk of chronic use.

Quantification of trunk rotations during turning and walking in Parkinson's disease.

OBJECTIVE: To develop a reliable, objective and sensitive measure of axial trunk rotations in PD, which can be applied in an ambulatory setting. METHODS: To quantify turning motion, two angular velocity transducers attached to the lower back measured angular velocity of the trunk in the yaw plane (i.e., around the longitudinal axis) and the roll plane (i.e., medio-lateral movements) in freely moving subjects who were instructed to walk and make various types of turning movements. RESULTS: Turn duration was longer in PD patients compared to controls. Peak yaw and peak roll angular velocities were lower in PD patients compared to controls during all turning tasks. CONCLUSIONS: This new approach to measure trunk sway during a simple turning task might serve as an instrument to objectively quantify turning while walking in PD. SIGNIFICANCE: It proves difficult to objectively assess turning performance based upon history taking or clinical examination alone. Objective and easy measurement of axial turning in PD might be used for clinical evaluation, but also in a domestic setting as outcome measure in intervention studies. Further research should focus on the clinical relevance of the new quantitative approach described in this paper, e.g., to detect freezing of gait episodes.