title: Depressive symptoms are associated with analgesic use in people with Alzheimer's disease: Kuopio ALSOVA study.
abstract: Neuropsychiatric symptoms of Alzheimer's disease (AD) such as depression may be associated with pain, which according to the literature may be inadequately recognized and managed in this population. This study aimed to identify the factors associated with analgesic use in persons with AD; in particular, how AD severity, functional status, neuropsychiatric symptoms of AD, co-morbidities and somatic symptoms are associated with analgesic use. 236 community-dwelling persons with very mild or mild AD at baseline, and their caregivers, were interviewed over five years as part of the prospective ALSOVA study. Generalized Estimating Equations (GEEs) were used to estimate unadjusted and adjusted odds ratios (ORs) for the factors associated with analgesic use over a five year follow-up. The proportion of persons with AD using any analgesic was low (13.6%) at baseline and remained relatively constant during the follow-up (15.3% at Year 5). Over time, the most prevalent analgesic changed from non-steroidal anti-inflammatories (8.1% of persons with AD at Year 1) to acetaminophen (11.1% at Year 5). Depressive symptoms (measured by the Beck Depression Inventory, BDI) were independently associated with analgesic use, after effects of age, gender, education, AD severity, comorbidities and somatic symptoms were taken into account. For every one unit increase in BDI, the odds of analgesic use increased by 4% (OR = 1.04, 95% confidence interval CI = 1.02-1.07). Caregiver depressive symptoms were not statistically significantly associated with analgesic use of the person with AD. Depressive symptoms were significantly associated with analgesic use during the five year follow-up period. Possible explanations warranting investigation are that persons with AD may express depressive symptoms as painful somatic complaints, or untreated pain may cause depressive symptoms. Greater awareness of the association between depressive symptoms and analgesic use may lead to safer and more effective prescribing for these conditions.
authors: Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland; Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia; University College London School of Pharmacy, London, United Kingdom.
authors: Julia Fiona-Maree
authors: JF
authors: Gilmartin
authors: Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors: Saku
authors: S
authors: Väätäinen
authors: Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors: Soili
authors: S
authors: Törmälehto
authors: Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia; Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors: J Simon
authors: JS
authors: Bell
authors: Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland.
authors: Eija
authors: E
authors: Lönnroos
authors: Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.
authors: Lotta
authors: L
authors: Salo
authors: Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland; School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland.
authors: Ilona
authors: I
authors: Hallikainen
authors: Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors: Janne
authors: J
authors: Martikainen
authors: Institute of Clinical Medicine, Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland; Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland.
authors: Anne M
authors: AM
authors: Koivisto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000523:psychology; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D017028:Caregivers / Q000523:psychology; D003863:Depression / Q000150:complications* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010146:Pain / Q000150:complications / Q000188:drug therapy* / Q000523:psychology
chemical_list: D000700:Analgesics