The effects of commonly prescribed drugs in patients with Alzheimer's disease on the rate of deterioration.
BACKGROUND
Prescribed drugs in patients with Alzheimer's disease may affect the symptomatic progression of their disease, both positively and negatively.


OBJECTIVE
To examine the effects of drugs on the progression of disease in a representative group of patients with Alzheimer's disease.


METHODS
Patients with the diagnosis of probable Alzheimer's disease were recruited from the community. The prescribed drugs taken by 224 patients (mean age 82.3 years) were recorded at initial assessment and then correlated in logistic regression analysis with progression of the disease, defined as an increase of one point or more in the Global Deterioration Scale over the next 12-month period.


RESULTS
Patients who were taking antipsychotic drugs and sedatives had a significantly higher risk of deterioration than those who were taking none (odds ratios (ORs) 2.74 (95% confidence interval (CI) 1.17 to 6.41) and 2.77 (95% CI 1.14 to 6.73), respectively). Higher risk of deterioration was observed in those who were taking both antipsychotic and sedative drugs together (OR 3.86 (95% CI 1.28 to 11.7). Patients taking drugs licensed for dementia, drugs affecting the renin-angiotensin system and statins had a significantly lower risk of deterioration than those who were not taking any of these drugs (ORs 0.49 (95% CI 0.25 to 0.97), 0.31 (95% CI 0.11 to 0.85) and 0.12 (95% CI 0.03 to 0.52), respectively).


CONCLUSIONS
Our findings have implications for both clinicians and trialists. Most importantly, clinicians should carefully weigh any potential benefits of antipsychotics and benzodiazepines, especially in combination, against the risk of increased decline. Researchers need to be aware of the potential of not only licensed drugs for dementia but also drugs affecting the renin-angiotensin system and statins in reducing progression in clinical trials.
Ellul
J
J
Department of Neurology, University of Patras, 26500 Rio, Patras, Greece. ellul@otenet.gr
Archer
N
N
Foy
C M L
CM
Poppe
M
M
Boothby
H
H
Nicholas
H
H
Brown
R G
RG
Lovestone
S
S
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000188:drug therapy / Q000473:pathology*; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D000975:Antioxidants / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D018450:Disease Progression; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors
D000928:Antidepressive Agents; D000975:Antioxidants; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives