Uso de antipsicóticos en los pacientes con demencia en España: comparación con la prescripción de los inhibidores de la acetilcolinesterasa y de la memantina, y análisis de las asociaciones / Use of antipsychotics in patients with dementia in Spain: Comparison with prescription of acetylcholinesterase inhibitors and memantine and analysis of associations

Objetivo: Se ha analizado la prevalencia de antipsicóticos, inhibidores de la acetilcolinesterasa (IACE) y memantina en pacientes con demencia en España y la influencia de estas asociaciones en su prescripción. Método: Estudio descriptivo, retrospectivo y transversal de la base BIFAP de 2017 en los mayores de 65 años con demencia. Se recogieron las prescripciones de antipsicóticos, los IACE y la memantina. Para los antipsicóticos también se recogieron, la duración del tratamiento y el tiempo desde el diagnóstico de demencia, al de prescripción. Resultados: Se recuperaron 1.327.792 sujetos, 89.464 (6,73%) con demencia. El 31,76% tuvieron prescritos antipsicóticos; los más frecuentes: quetiapina (58,47%), risperidona (21%) y haloperidol (19,34%). Las prescripciones de IACE y memantina fueron más frecuentes en los menores de 84 años y las de antipsicóticos en los mayores de 85 años (p<0,001). Los antipsicóticos se mantuvieron una media de 1.174,5 días. En el 26,4% de los casos se prescribieron aislados, OR: 0,61 (IC 95%: 0,59-0,62), en el 35,85% asociados a IACE, OR: 1,26 (IC 95%: 1,22-1,30) y en el 42,4% a memantina, OR: 1,69 (IC 95%: 1,62-1,78); p<0,000). Desde el diagnóstico de demencia transcurrieron de 461 días (±1.576,5) cuando se prescribieron aislados; 651 días (±1.574,25) asociados a IACE y 1.224 (±1.779) a memantina. Conclusiones: Una tercera parte de los pacientes con demencia tuvieron prescritos antipsicóticos, mayoritariamente atípicos, más frecuentemente en los mayores de 85 años y durante periodos prolongados. La prescripción de IACE y memantina se asoció al incremento del riesgo de uso de antipsicóticos, pero paradójicamente, a la prolongación del tiempo hasta su prescripción.(AU)

ObjectiveWe have analyzed the prevalence of antipsychotics in patients with dementia in Spain, their age distribution and the influence of treatment with IACEs and memantine on their prescription. Method: Descriptive, retrospective and cross-sectional study of the 2017 BIFAP database in over 65 years of age with dementia. Prescriptions of antipsychotics, IACEs and memantine were collected. For antipsychotics were also collected, the duration of treatment and time from dementia diagnosis to prescription. Results: A total of 1,327,792 subjects were retrieved, 89,464 (6.73%) with dementia. Antipsychotics were prescribed in 31.76%; by frequency: quetiapine (58.47%), risperidone (21%) and haloperidol (19.34%). Prescriptions of IACEs and memantine were clustered in those younger than 84 years and antipsychotics in those older than 85 (P<.001). Antipsychotics were maintained for a mean of 1174.5 days. In 26.4% of cases they were prescribed alone, OR 0.61 (95% CI: 0.59-0.62), in 35.85% associated with IACEs, OR 1.26 (95% CI: 1.22-1.30) and in 42.4% with memantine, OR 1.69 (95% CI: 1.62-1.78) (P<.000). From the diagnosis of dementia, 461 days (±1576.5) elapsed when isolated drugs were prescribed; 651 days (±1574.25) associated with IACEs and 1224 (±1779) with memantine. Conclusions: One third of patients with dementia were prescribed antipsychotics, mostly atypical, more frequently in those older than 85 years and for prolonged periods. IACEs and memantine were associated with the risk of antipsychotic prescription, but paradoxically, with prolonged time to onset.(AU)

[Use of antipsychotics in patients with dementia in Spain: Comparison with prescription of acetylcholinesterase inhibitors and memantine and analysis of associations]. / Uso de antipsicóticos en los pacientes con demencia en España: comparación con la prescripción de los inhibidores de la acetilcolinesterasa y de la memantina, y análisis de las asociaciones.

OBJECTIVE: We have analyzed the prevalence of antipsychotics in patients with dementia in Spain, their age distribution and the influence of treatment with IACEs and memantine on their prescription. METHOD: Descriptive, retrospective and cross-sectional study of the 2017 BIFAP database in over 65 years of age with dementia. Prescriptions of antipsychotics, IACEs and memantine were collected. For antipsychotics were also collected, the duration of treatment and time from dementia diagnosis to prescription. RESULTS: A total of 1,327,792 subjects were retrieved, 89,464 (6.73%) with dementia. Antipsychotics were prescribed in 31.76%; by frequency: quetiapine (58.47%), risperidone (21%) and haloperidol (19.34%). Prescriptions of IACEs and memantine were clustered in those younger than 84 years and antipsychotics in those older than 85 (P<.001). Antipsychotics were maintained for a mean of 1174.5 days. In 26.4% of cases they were prescribed alone, OR 0.61 (95% CI: 0.59-0.62), in 35.85% associated with IACEs, OR 1.26 (95% CI: 1.22-1.30) and in 42.4% with memantine, OR 1.69 (95% CI: 1.62-1.78) (P<.000). From the diagnosis of dementia, 461 days (±1576.5) elapsed when isolated drugs were prescribed; 651 days (±1574.25) associated with IACEs and 1224 (±1779) with memantine. CONCLUSIONS: One third of patients with dementia were prescribed antipsychotics, mostly atypical, more frequently in those older than 85 years and for prolonged periods. IACEs and memantine were associated with the risk of antipsychotic prescription, but paradoxically, with prolonged time to onset.

[Pharmacological treatment]. / Terapias farmacológicas.

Alzheimer's disease (AD) is a chronic degenerative and inflammatory process leading to synapticdysfunction and neuronal death. A review about the pharmacological treatment alternatives is made: acetylcholinesterase inhibitors (AChEI), a nutritional supplement (Souvenaid) and Ginkgo biloba. A special emphasis on Ginkgo biloba due to the controversy about its use and the approval by the European Medicines Agency is made.

[Risk/benefit assessment in the treatment of Alzheimer's disease. Drug interactions]. / Valoración del riesgo/beneficio en el tratamiento de la enfermedad de Alzheimer. A propósito de una interacción.

INTRODUCTION: Anticholinergic drugs reduce the efficacy of acetylcholinesterase inhibitors (AChEI) and are inappropriate in elderly patients. The aim of this study is to determine the prevalence rate of prescription AChEI drugs and anticholinergics in a Healthcare Area, to identify the affected patients, and to inform the attending physicians, in order to evaluate the suitability of treatments. MATERIAL AND METHODS: A descriptive cross-sectional observational study of prevalence. Patients on treatment with AChEI and any anticholinergic drug in the first quarter of 2015 were selected. The review of Duran et al. was used as reference to identify anticholinergics, assigning a score to each drug according to its anticholinergic potency. Physicians were provided with a report about the interaction, the list of affected patients, and recommendations. RESULTS: A total of 486 patients were included in the study, representing 59.0% of total patients with Alzheimer's disease in the Area. There were 66.0% women, and 86.8% of the patients were older than 75 years, and with a mean of 9.2 drugs per patient. The mean number of anticholinergic drugs was 1.6, and 38.3% of patients were prescribed various anticholinergic drugs, with 23.9% on high potency anticholinergic drugs. A statistically significant association was found between taking an anticholinergic and AChEI concomitantly (P=.000; OR: 3.9). CONCLUSIONS: The prevalence of interactions between AChEI and anticholinergic drugs is relevant, considering that it affects vulnerable members of the population. Providing physicians with information about the interaction could help them make clinical decisions, and could improve patient safety, as well as health outcomes.

Uso de plaguicidas inhibidores de acetilcolinesterasa en once entidades territoriales de salud en Colombia, 2002-2005 / The use of acetylcholinesterase inhibitors pesticides in eleven local health institutions, Colombia, 2002-2005

Introducción. Por ser los plaguicidas anticolinesterásicos una causa importante de intoxicación y de muerte por intoxicación en los países en vía de desarrollo, el Instituto Nacional de Salud implementó el Programa de Vigilancia Epidemiológica de Organofosforados y Carbamatos, del cual, este informe corresponde al período 2002-2005.Objetivo. Determinar la actividad de la acetilcolinesterasa en participantes con riesgo de exposición a plaguicidas organofosforados y carbamatos, e identificar los plaguicidas más utilizados en el área estudiada. Materiales y métodos. Es un estudio descriptivo de información reportada al Programa de Vigilancia Epidemiológica de Organofosforados y Carbamatos por once departamentos colombianos, los cuales realizaron la determinación de acetilcolinesterasa con el equipo Lovibond. Resultados. Participaron 28.303 personas con riesgo de exposición a plaguicidas; 81,4% eran hombres. El 9,3% de las determinaciones analíticas fueron anormales, con una prevalencia de anormalidad entre los hombres de 9,9% y de 7,0% en las mujeres. Presentaron mayor prevalencia de valores anormales los grupos de edad de 18 a 25 años (12,3%) y de 0 a 5 años (10,7%), y los oficios de jornalero (27,0%) y servicios generales del campo (26,1%). De los 975 participantes, en el departamento del Meta, 80% de los participantes presentaron niveles anormales de actividad de la enzima. Los plaguicidas más reportados fueron los organofosforados (39,7%) y carbamatos (16,6%). Conclusión. El incremento en la prevalencia de valores anormales de la acetilcolinesterasa y el riesgo de exposición infantil, hacen necesario disminuir el uso y la comercialización de plaguicidas de alto riesgo, y utilizar métodos menos tóxicos para el control de plagas.

Introduction. Due to the importance of acetylcholinesterase inhibiting chemicals as pesticides in developing countries, the Instituto Nacional de Salud in Colombia designed the organophosphate and carbamate epidemiological surveillance program for the period 2002-2005. Objective. The acetylcholinesterase activity was determined in study participants with a history of organophosphate and carbamate exposure and the most commonly used pesticides were identified in each study area. Materials and methods. The information was compiled from reports sent to the Instituto Nacional de Salud organophosphate and carbamate epidemiological surveillance program from each of 11 provinces in Colombia. The analytical determination of the biomarker was performed by acetylcholinestare activity determined with the Lovibond field equipment.Results. A total of 28,303 people were designated as having risk of exposure to pesticides. Most were men (81.4%). Abnormal determinations averaged 9.3% (9.9% in men and 7.0% in women). The 18-25 year old age group showed the highest prevalence of abnormal results (12.3%), followed by the group of 0-5 year olds (10.7%). The highest prevalence of abnormal acetylcholinesterase activity was in farm workers (27.0%), followed by general outdoor activities (26.1%). In the province of Meta, 80% of participants showed abnormal values of enzyme activity. The most commonly used pesticides were organophosphates (39.7%) and carbamates (16.6%).Conclusion. The increase in the prevalence of abnormal values of acetylcholinesterase activity and the risk of exposure to pesticides in children necessitates a lowering of use and commercialization of high risk pesticides, and a need for developing safer methods for pest management.