title: Use of Anti-Dementia Drugs in Relation to Change in Cognition, Behavior, and Functioning in Alzheimer's Disease over a Three-Year Period: Kuopio ALSOVA Study.
abstract: BACKGROUND
  Alzheimer's disease (AD) is characterized by deterioration in cognition, decline in physical function, and increase in behavioral disturbances. These symptoms are associated with dependence.
  
  
  OBJECTIVE
  We investigated the use of anti-dementia drugs in relation to change in cognition, function, and behavior over a 3-year period.
  
  
  METHODS
  Data were collected as part of the prospective follow-up ALSOVA study. All study participants (n = 236) had very mild or mild AD at baseline. All participants and their informal caregivers underwent annual clinical and medication assessments. Repeated measures logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with anti-dementia drug use and disease progression measures over time.
  
  
  RESULTS
  The overall prevalence of anti-dementia drug use remained stable (from 89% to 92%) during the follow-up period. The use of memantine and cholinesterase inhibitor-memantine combination treatment increased with disease severity. After adjustment for confounding, a one-point increase in the disease severity scale (CDR-SOB) was associated with 15.6% increased odds of memantine use. A one-point decrease in CERAD Neuropsychological battery (CERAD-NB) total score was associated with 2.4% increased odds of memantine use. The overall unadjusted rate of switching between anti-dementia drugs was 9.17 (95% CI 7.10 to 11.88) changes per 100 person-years.
  
  
  CONCLUSIONS
  Nearly 90% of newly diagnosed persons with AD were prescribed anti-dementia drugs. Use of memantine was found to be associated with disease progression. Switching and use of anti-dementia drugs was consistent with Finnish and European clinical practice guidelines for AD.
authors.affiliation: Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland.|Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Soili M
authors.initials: SM
authors.lastname: Törmälehto
authors.affiliation: Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Janne A
authors.initials: JA
authors.lastname: Martikainen
authors.affiliation: Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
authors.forename: Saku T
authors.initials: ST
authors.lastname: Väätäinen
authors.affiliation: Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.|School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Ilona T
authors.initials: IT
authors.lastname: Hallikainen
authors.affiliation: Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Hallikainen
authors.affiliation: Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.|Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.affiliation: Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.|Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Koivisto
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008559:Memantine / Q000627:therapeutic use; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000627:therapeutic use*; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D018697:Nootropic Agents; D008559:Memantine
keywords: ALSOVA, Alzheimer’s disease; cholinesterase inhibitor; dementia; drug utilization; memantine