Effect of medications on physical function and cognition in nursing home residents with dementia.
OBJECTIVE
To assess the effectiveness of medications used in the management of Alzheimer's disease and related dementias (ADRD) on cognition and activity of daily living (ADL) trajectories and to determine whether sex modifies these effects.


METHODS
Two-year (2007-2008) longitudinal study.


METHODS
Medicare enrollment and claims data linked to the Minimum Dataset 2.0.


METHODS
Older nursing home (NH) residents with newly diagnosed ADRD (n = 18,950).


METHODS
Exposures included four medication classes: antidementia medications (ADMs), antipsychotics, antidepressants, and mood stabilizers. Outcomes included ADLs and cognition (Cognitive Performance Scale (CPS)). Marginal structural models were employed to account for time-dependent confounding.


RESULTS
The mean age was 83.6, and 76% of the sample was female. Baseline use of ADMs was 15%, antidepressants was 40%, antipsychotics was 13%, and mood stabilizers was 3%. Mean baseline ADL and CPS scores were 16.6 and 2.1, respectively. ADM use was not associated with change in ADLs over time but was associated with a slower CPS decline (slope difference: -0.09 points/year, 99% confidence interval (CI) = -0.14 to -0.03). Antidepressant use was associated with slower declines in ADL (slope difference: -0.36 points/year, 99% CI = -0.58 to -0.14) and CPS (slope difference: -0.12 points/year, 99% CI = -0.17 to -0.08). Sex modified the effect of both antipsychotic and mood stabilizer use on ADLs; female users declined most quickly. Antipsychotic use was associated with slower CPS decline (slope difference: -0.11 points/year, 99% CI = -0.17 to -0.06), whereas mood stabilizer use had no effect.


CONCLUSIONS
Despite the observed statistically significantly slower declines in cognition with ADMs, antidepressants, and antipsychotics and the slower ADL decline found with antidepressants, it is unlikely that these benefits are of clinical significance.
Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland.
Sarah K
SK
Dutcher
Gail B
GB
Rattinger
Patricia
P
Langenberg
Pankdeep T
PT
Chhabra
Xinggang
X
Liu
Paul B
PB
Rosenberg
Jeannie-Marie
JM
Leoutsakos
Linda
L
Simoni-Wastila
Loreen D
LD
Walker
Christine S
CS
Franey
Ilene H
IH
Zuckerman
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000503:physiopathology*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D012737:Sex Factors; D016896:Treatment Outcome
D011619:Psychotropic Drugs
Alzheimer's disease; activities of daily living; cognition; dementia; nursing home; psychotropic medication