Trends in Medication Use Over 11 Years in Patients Presenting to a Rural and Remote Memory Clinic.
BACKGROUND
Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients at initial presentation to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed.


METHODS
The first 444 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient's initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman's correlation) was conducted to examine trends in medication use over time.


RESULTS
Patients were on a mean of 5.18 medications (standard deviation, 3.46). Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the 11 years of this study (Spearman's correlation coefficient =-0.64, p=0.035). The prevalence of drugs acting on the central nervous system trended toward an increase, but this was not statistically significant. Sixty-three patients (14.2%) presented to the RRMC already taking a cholinesterase inhibitor.


CONCLUSIONS
The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.
1College of MedicineUniversity of Saskatchewan,Saskatoon,Saskatchewan,Canada.
Ryan
R
Verity
2Division of NeurologyUniversity of Saskatchewan,Saskatoon,Saskatchewan,Canada.
Andrew
A
Kirk
3Canadian Centre for Health and Safety in Agriculture,Saskatoon,Saskatchewan,Canada.
Debra
D
Morgan
3Canadian Centre for Health and Safety in Agriculture,Saskatoon,Saskatchewan,Canada.
Chandima
C
Karunanayake
D000368:Aged; D000369:Aged, 80 and over; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders / Q000188:drug therapy* / Q000209:etiology; D057567:Memory, Long-Term / Q000187:drug effects*; D012424:Rural Population / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric
D018680:Cholinergic Antagonists
Alzheimer’s; clinical pharmacology; cognitive impairment; degenerative diseases; dementia; memory; neurological practice; quality of care