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Do Acetylcholinesterase Inhibitors Prevent or Delay Psychotropic Prescribing in People With Dementia?: Analyses of the Swedish Dementia Registry
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2020 (English)In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 28, no 1, p. 108-117Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate whether acetylcholinesterase inhibitor (AChEI) use prevents or delays subsequent initiation of psychotropic medications in people with Alzheimer's disease (AD) and Lewy body dementia (LBD). Methods: Cohort study of 17,763 people with AD and LBD, without prior psychotropic use at time of dementia diagnosis, registered in the Swedish Dementia Registry from 2007 to 2015. Propensity score-matched regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent AChEI use and risk of psychotropic initiation. Results: Compared with matched comparators, AChEI users had a lower risk of antipsychotic ( HR: 0.85, 95%CI: 0.75-0.95) and anxiolytic (HR: 0.76, 95%CI: 0.72-0.80) initiation. In subanalyses, this association remained significant at higher AChEI doses, and in AD but not LBD. There were no associations between AChEI use and initiation of antidepressants or hypnotics. Conclusion: AChEI use may be assocObjectives

To investigate whether acetylcholinesterase inhibitor (AChEI) use prevents or delays subsequent initiation of psychotropic medications in people with Alzheimer's disease (AD) and Lewy body dementia (LBD).

Methods: Cohort study of 17,763 people with AD and LBD, without prior psychotropic use at time of dementia diagnosis, registered in the Swedish Dementia Registry from 2007 to 2015. Propensity score-matched regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent AChEI use and risk of psychotropic initiation.

Results: Compared with matched comparators, AChEI users had a lower risk of antipsychotic (HR: 0.85, 95%CI: 0.75–0.95) and anxiolytic (HR: 0.76, 95%CI: 0.72–0.80) initiation. In subanalyses, this association remained significant at higher AChEI doses, and in AD but not LBD. There were no associations between AChEI use and initiation of antidepressants or hypnotics.

Conclusion: AChEI use may be associated with lower risk of antipsychotic and anxiolytic initiation in AD, particularly at higher doses. Further investigation into aceytylcholinesterase inhibitors in behavioral and psychological symptoms of dementia management in LBD is warranted.

Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 28, no 1, p. 108-117
Keywords [en]
Dementia, psychotropics, Alzheimer's disease, Lewy body dementia, antipsychotics, behavioral and psychological symptoms of dementia
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-166836DOI: 10.1016/j.jagp.2019.06.008ISI: 000500700200014PubMedID: 31331724OAI: oai:DiVA.org:umu-166836DiVA, id: diva2:1382434
Funder
Swedish Research Council, 2016-02317Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-01646Available from: 2020-01-03 Created: 2020-01-03 Last updated: 2020-01-03Bibliographically approved

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Nordström, Peter

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Tan, Edwin C. K.Garcia-Ptacek, SaraNordström, Peter
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