Antipsychotic drug use and associations with neuropsychiatric symptoms in persons with impaired cognition: a cross-sectional study.
BACKGROUND
Neuropsychiatric symptoms (NPS) in cognitive disorders impair quality of life, increase caregiver stress, and may lead to earlier institutionalization and death. The objective of this study was to investigate the use of antipsychotics among persons with cognitive impairment in home care and residential care, and its associations with NPS and personal characteristics.


METHODS
Data were collected in the South Savo Hospital District area with 105 000 inhabitants, where 66 of 68 institutions providing long-term residential care and 20 of 21 municipal home care producers joined the study. Nurses recorded the current use of drugs, the activities of daily living (ADL), prevalence of diagnosed dementia, and assessed the cognitive status and the prevalence of recent NPS based on the item list of the Neuropsychiatric Inventory (NPI).


RESULTS
The study population was 1909 persons with cognitive impairment, and 1188 of them lived in residential care. Antipsychotics were used by 563 (29.5%) persons in the whole study population. In residential care 448 (37.7%) used antipsychotics and the corresponding figure in home care was 115 (15.9%). In the multivariate analysis, the antipsychotic use was associated with living in residential care, benzodiazepine use, and with NPS symptoms agitation/aggression (OR =1.70, 95% CI =1.16-2.48), disinhibition (OR =2.33, 95% CI =1.31-4.15), hallucinations (OR =2.77, 95% CI =1.69-4.55), and delusions (OR =1.71, 95% CI =1.01-2.91).


CONCLUSIONS
Antipsychotic use was common among persons with cognitive impairment. The results suggest that antipsychotics are commonly used to treat hyperactivity and psychotic symptoms, especially in residential care.
a South Savo Hospital District, Mikkeli Central Hospital , Mikkeli , Finland ;
Marja
M
Kuronen
b Primary Care, University of Helsinki and Helsinki University Hospital , Helsinki , Finland ;|c Unit of Primary Health Care, Kuopio University Hospital , Kuopio , Finland ;
Hannu
H
Kautiainen
a South Savo Hospital District, Mikkeli Central Hospital , Mikkeli , Finland ;
Pertti
P
Karppi
d School of Pharmacy, University of Eastern Finland , Joensuu , Finland ;|e Kuopio Research Center of Geriatric Care , Kuopio , Finland ;|f Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland ;
Sirpa
S
Hartikainen
g Department of Psychiatry , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.
Hannu
H
Koponen
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000523:psychology; D005260:Female; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care / Q000379:methods*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology
D014150:Antipsychotic Agents
Antipsychotics; cognitive impairment; hyperactivity; neuropsychiatric symptoms; residential care