Antipsychotic polypharmacy among a nationwide sample of community-dwelling persons with Alzheimer's disease.
BACKGROUND
Antipsychotic polypharmacy (APP) is not recommended in treatment of behavioral and psychological symptoms of dementia (BPSD). There is lack of studies concerning prevalence of APP among persons with dementia.


OBJECTIVE
The objective of our study was to describe prevalence and risk factors associated with antipsychotic polypharmacy among antipsychotic users with Alzheimer's disease (AD).


METHODS
Data from nationwide MEDALZ-2005 cohort including all community-dwelling persons diagnosed with AD in Finland was utilized. Register-based data included prescriptions, comorbidities, and hospital discharge diagnoses. Users of antipsychotics during 2006-2009 were included (n = 9,803). The risk of starting antipsychotic polypharmacy was evaluated with Cox proportional hazards model.


RESULTS
Prevalence of antipsychotic polypharmacy was 8% (n = 750) among antipsychotic users (n = 9,803). Quetiapine and risperidone was the most common combination of two antipsychotics followed by combination of quetiapine and haloperidol. Antipsychotic polypharmacy was associated with younger age (HR 1.35 [Confidence Interval, CI, 1.16-1.56]), male gender (HR 1.18 [CI 1.02-1.38]), and history of psychiatric disorder (HR 1.50 [CI 1.26-1.78]) in the adjusted model.


CONCLUSIONS
In conclusion, we found higher prevalence of APP than previously reported among older populations. This is concerning since effectiveness of APP has not been demonstrated and APP is not recommended in the treatment of BPSD. Clinicians should pay more attention to avoid APP and use of antipsychotics to other indications than BPSD among persons with AD.
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Heidi
H
Taipale
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Marjaana
M
Koponen
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden National Institute for Health and Welfare, Helsinki, Finland.
Antti
A
Tanskanen
School of Pharmacy, University of Eastern Finland, Kuopio, Finland Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.
Anna-Maija
AM
Tolppanen
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
Jari
J
Tiihonen
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Sirpa
S
Hartikainen
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D012111:Residence Characteristics
D014150:Antipsychotic Agents
Alzheimer's disease; antipsychotic polypharmacy; antipsychotics; prescription register