(1110) Evaluating the Prescribing Patterns of Psychotropic Medications in Patients with Dementia

Objectives: Dementia is characterized as a group of conditions caused by damage to brain cells leading to deterioration in cognitive function. THIS DISEASE often REQUIRES a holistic network of MEDICAL AND SOCIAL ASSISTANCE to delay DISEASE ADVANCEMENT. As a result, individuals with dementia are often prescribed a multitude of psychotropic medications to address THEIR SYMPTOMS. THIS META-ANALYSIS WILL EXAMINE the prescribing patterns of psychotropic medications and their EFFECTS ON MANAGING SYMPTOMS OF DEMENTIA in older adults.

Methods: This META-ANALYSIS was performed using the following information databases: PubMed, Medline, Embase, AND the Cochrane Library. PUBLICATION SEARCHES INCLUDED LITERATURES FROM FEBRUARY 8, 2008 TO September 27, 2023. MESH TERMS LIKE DEMENTIA AND PSYCHOTROPIC MEDICATION WERE USED TO CONDUCT A BROAD SEARCH FOR ARTICLE RELEVANCE, AND SPECIFIC TERMS CONSISTED OF BEHAVIORAL PSYCHOLOGICAL SYMPTOMS OF DEMENTIA, BEHAVIORAL DISTURBANCES, CAREGIVER BURDEN, PRESCRIBING PATTERNS, NEUROPSYCHIATRIC INVENTORY, NPI, ANTIPSYCHOTICS, ANTIDEPRESSANTS, ANXIOLYTICS, AND SEDATIVES. Information WERE collected from COUNTRIES IN EUROPE, SOUTH AMERICA, AND THE MIDDLE EAST. TO BE ELIGIBLE FOR INCLUSION, PATIENTS HAD TO HAVE A DEMENTIA DIAGNOSIS PER THE DSM GUIDELINES. PUBLICATIONS MUST EVALUATE THE PRESCRIBING PATTERNS OF PSYCHOTROPIC MEDICATIONS INCLUDING BUT NOT LIMITED TO ANTIPSYCHOTICS (QUETIAPINE, CLOZAPINE, ETC.), ANTIDEPRESSANTS (SSRIS, SNRIS, TCAS, ETC.), ANXIOLYTICS (SSRIS, SNRIS, BENZODIAZEPINES), AND SEDATIVES (BARBITURATES, HYPNOTICS, BENZODIAZEPINES ETC.), AS MONOTHERAPY OR IN COMBINATION. STUDIES THAT EVALUATED THOSE WITH DEMENTIA WITH OR WITHOUT MEDICATION MANAGEMENT BY THE NEUROPSYCHIATRIC INVENTORY QUESTIONNAIRE (NPI-Q) WERE INCLUDED AS WELL. THE NPI-Q WAS THE CHOSEN STANDARDIZED MEASUREMENT OF THE FREQUENCY AND SEVERITY OF COMMONLY SEEN DEMENTIA SYMPTOMS. NPS (NEUROPSYCHIATRIC SYMPTOMS) INCLUDED: DELUSIONS, HALLUCINATIONS, AGITATION/AGGRESSION, ETC. FOR A TOTAL OF 12 CATEGORIES. THE EXTRACTED DATA INCLUDED THE NUMBER OF PATIENTS IN THE TRIAL, FREQUENCY OF PSYCHOTROPIC DRUG USE (PDU), AND OVERALL NPI-Q SCORES.

Results: 80 STUDIES WERE INITIALLY IDENTIFIED THROUGH A SEARCH OF ELECTRONIC DATABASES, AND 11 SOURCES WERE DEEMED ELIGIBLE FOR INCLUSION. THESE STUDIES INCLUDE 3 PROSPECTIVE, 1 RETROSPECTIVE, 2 COHORT STUDIES, 2 CROSS-SECTIONAL STUDIES, 1 RANDOMIZED CONTROL TRIAL, 1 SYSTEMATIC ANALYSIS, AND 1 LONGITUDINAL STUDY. WITHIN THE FIRST POPULATION OF 4171 PATIENTS, ANTIDEPRESSANTS WERE OBSERVED TO BE MOST FREQUENTLY PRESCRIBED CLASS OF PSYCHOTROPIC MEDICATIONS (28.1%), FOLLOWED BY ANTIPSYCHOTICS (20.8%), AND SEDATIVES (17.2%), AND ANXIOLYTICS (15.9%). WITHIN A SECOND POPULATION OF 2296 PATIENTS, THE DIFFERENCE IN THE MEAN NPI OF EACH OF THE 12 NPS WAS CALCULATED BETWEEN THE TWO POPULATIONS. OVERALL, 9 OUT OF THE 12 NPS HAD A DECREASE IN THE MEAN DIFFERENCE OF NPI, CORRELATING PDU TO A DECREASE IN THE FREQUENCY AND SEVERITY OF NPS IN DEMENTIA. INCREASED NPI VALUES MAY POTENTIALLY BE EXPLAINED BY ADVERSE EFFECTS OF DRUG THERAPY, FOR EXAMPLE, ABERRANT MOTOR BEHAVIOR IS A COMMON ADVERSE EFFECT OF MANY FIRST GENERATION ANTIPSYCHOTIC MEDICATIONS.

Conclusions: THIS META-ANALYSIS WAS CONDUCTED TO EXAMINE THE COLLECTIVE EVIDENCE REGARDING THE FREQUENCY AND PATTERNS OF PDU IN THE ELDERLY POPULATION WITH DEMENTIA, AS WELL AS THE DIFFERENCE IN NPI SCORES IN DEMENTIA PATIENTS WITH OR WITHOUT THE USE OF PSYCHOTROPIC MEDICATION. ANTIDEPRESSANTS WERE FOUND TO BE THE MOST COMMONLY PRESCRIBED CLASS OF PSYCHOTROPIC MEDICATIONS AMONG DEMENTIA PATIENTS (28.1%). DECREASES IN NPI SCORES BETWEEN PATIENTS WITHOUT AND WITH PDU PROVIDES IMPLICATIONS FOR FUTURE OPTIMIZATION IN APPROACHING DEMENTIA TREATMENT. AS A DECREASED NPI SCORE WAS OBSERVED IN 9 OUT OF 12 CATEGORIES, THERE ARE OPPORTUNITIES FOR ENHANCEMENT REGARDING INTERVENTIONS WHICH COULD POTENTIALLY DECREASE ALL 12 NPI CATEGORY SCORES TO MOST EFFICIENTLY TREAT DEMENTIA SYMPTOMS. OVERALL, THE FINDINGS SHOW GREAT PROMISE TOWARDS THE POTENTIAL OF PDU PRESCRIBING IN MANAGING ELDERLY PATIENTS WITH DEMENTIA.