Longitudinal medication usage in Alzheimer disease patients.
This study examined in detail patterns of cholinesterase inhibitors (ChEIs) and memantine use and explored the relationship between patient characteristics and such use. Patients with probable Alzheimer disease AD (n=201) were recruited from the Predictors Study in 3 academic AD centers and followed from early disease stages for up to 6 years. Random effects logistic regressions were used to examine effects of patient characteristics on ChEIs/memantine use over time. Independent variables included measures of function, cognition, comorbidities, the presence of extrapyramidal signs, psychotic symptoms, age, sex, and patient's living situation at each interval. Control variables included assessment interval, year of study entry, and site. During a 6-year study period, rate of ChEIs use decreased (80.6% to 73.0%) whereas memantine use increased (2.0% to 45.9%). Random effects logistic regression analyses showed that ChEI use was associated with better function, no psychotic symptoms, and younger age. Memantine use was associated with better function, poorer cognition, living at home, later assessment interval, and later year of study entry. Results suggest that high rate of ChEI use and increasing memantine use over time are consistent with current practice guidelines of initiation of ChEIs in mild-to-moderate AD patients and initiation of memantine in moderate-to-severe patients.
Zhu
Carolyn W
CW
*This Geriatric Research, Education, and Clinical Center (GRECC) and HSR&D Center for the Study of Health Care Across Systems and Sites of Care, James J. Peters VA Medical Center, Bronx †Brookdale Department of Geriatrics, Mount Sinai School of Medicine ∥Gertrude H. Sergievsky Center and the Department of Neurology, Columbia University Medical Center **Department of Psychology, Mount Sinai School of Medicine ‡Eli Lily & Company §Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, New York, NY ¶Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD ♯Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Livote
Elayne E
EE
Kahle-Wrobleski
Kristin
K
Scarmeas
Nikolaos
N
Albert
Marilyn
M
Brandt
Jason
J
Blacker
Deborah
D
Sano
Mary
M
Stern
Yaakov
Y
D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008559:Memantine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D018697:Nootropic Agents; D008559:Memantine