title: The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease.
abstract: OBJECTIVE
  The use of psychotropic medications in Alzheimer's disease (AD) has been associated with both deleterious and potentially beneficial outcomes. We examined the longitudinal association of psychotropic medication use with cognitive, functional, and neuropsychiatric symptom (NPS) trajectories among community-ascertained incident AD cases from the Cache County Dementia Progression Study.
  
  
  METHODS
  A total of 230 participants were followed for a mean of 3.7 years. Persistency index (PI) was calculated for all antidepressants, selective serotonin reuptake inhibitors (SSRIs), antipsychotics (atypical and typical), and benzodiazepines as the proportion of observed time of medication exposure. Mixed-effects models were used to examine the association between PI for each medication class and Mini-Mental State Exam (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-Sum), and Neuropsychiatric Inventory - Total (NPI-Total) trajectories, controlling for appropriate demographic and clinical covariates.
  
  
  RESULTS
  At baseline, psychotropic medication use was associated with greater severity of dementia and poorer medical status. Higher PI for all medication classes was associated with a more rapid decline in MMSE. For antidepressant, SSRI, benzodiazepine, and typical antipsychotic use, a higher PI was associated with a more rapid increase in CDR-Sum. For SSRIs, antipsychotics, and typical antipsychotics, a higher PI was associated with more rapid increase in NPI-Total.
  
  
  CONCLUSIONS
  Psychotropic medication use was associated with more rapid cognitive and functional decline in AD, and not with improved NPS. Clinicians may tend to prescribe psychotropic medications to AD patients at risk of poorer outcomes, but one cannot rule out the possibility of poorer outcomes being caused by psychotropic medications.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. prosenb9@jhmi.ed
authors.forename: P B
authors.initials: PB
authors.lastname: Rosenberg
authors.forename: M M
authors.initials: MM
authors.lastname: Mielke
authors.forename: D
authors.initials: D
authors.lastname: Han
authors.forename: J S
authors.initials: JS
authors.lastname: Leoutsakos
authors.forename: C G
authors.initials: CG
authors.lastname: Lyketsos
authors.forename: P V
authors.initials: PV
authors.lastname: Rabins
authors.forename: P P
authors.initials: PP
authors.lastname: Zandi
authors.forename: J C S
authors.initials: JC
authors.lastname: Breitner
authors.forename: M C
authors.initials: MC
authors.lastname: Norton
authors.forename: K A
authors.initials: KA
authors.lastname: Welsh-Bohmer
authors.forename: I H
authors.initials: IH
authors.lastname: Zuckerman
authors.forename: G B
authors.initials: GB
authors.lastname: Rattinger
authors.forename: R C
authors.initials: RC
authors.lastname: Green
authors.forename: C
authors.initials: C
authors.lastname: Corcoran
authors.forename: J T
authors.initials: JT
authors.lastname: Tschanz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000188:drug therapy / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines