Dementia and the Impact of Certain Medications

Recent data presented at the American Geriatrics Society (AGS) 2024 Annual Scientific Meeting highlights the widespread use of medications that negatively affect cognition among older adults with dementia. The study analyzed data from approximately 13 million individuals.

Medications such as anticholinergics, antipsychotics, benzodiazepines, and non-benzodiazepine sedatives (often referred to as “Z drugs”) are identified as potentially inappropriate medications (PIMs) for dementia patients by the American Geriatrics Society Beers Criteria. These medications, which can worsen dementia or cognition, are termed CogPIMs.

Key Findings and Analysis

Caroline M. Mak, a Doctor of Pharmacy candidate at the University at Buffalo, presented the study, emphasizing that while previous research has examined the prevalence of CogPIM use, data linking CogPIM use to healthcare utilization is lacking. Mak and her team conducted a cross-sectional analysis using data from the Medical Expenditure Panel Survey (MEPS) from 2011 to 2015, focusing on individuals over 65 with dementia.

The analysis revealed that during the study period, the prevalence of CogPIM use was 15.9% for benzodiazepines, 11.5% for anticholinergics, 7.5% for antipsychotics, and 3.8% for Z drugs. Notably, the use of benzodiazepines increased significantly from 8.9% in 2011 to 16.4% in 2015. Logistic regression analysis showed that individuals using Z drugs had more than double the odds of hospitalization (odds ratio 2.57), and antipsychotic use was also significantly associated with higher hospitalization rates.

Challenges and Implications

The study’s limitations include its cross-sectional design, reliance on self-reported data, and the absence of recent data. Despite these limitations, the findings underscore the frequent use of CogPIMs among older adults with dementia. The significant association of antipsychotics and Z drugs with increased hospitalization suggests the need for targeted interventions to mitigate medication-related harm.

Call for Increased Drug Awareness

Mak highlighted the importance of this research given the growing aging population and the increasing number of dementia patients. She stressed the need for clinicians to carefully consider medication use in these populations and avoid certain drugs when possible. While efforts are underway to reduce potential medication harm using the Beers criteria, Mak noted that a narrower focus on specific medications, as proposed in the Drug Burden Index (DBI), might be more effective. The CogPIMs fall within both the Beers criteria and DBI, representing medications that pose significant risks to older patients.

A Broader Initiative

This study is part of the broader efforts of Team Alice, a national deprescribing group inspired by the preventable medication harm that led to the tragic death of Alice Brennan. Team Alice, affiliated with the University at Buffalo, comprises various healthcare partners working to reduce medication harm through patient-driven interventions. By understanding the use of CogPIMs, the team aims to design better intervention strategies to prevent medication-related harm and promote successful aging.

Mak expressed surprise at the increase in benzodiazepine use during the study period, suggesting that some of this use might stem from short-term prescriptions for anxiety or insomnia following the loss of a loved one. The significant association between Z drug use and increased hospitalization further highlights the need for strategies to prevent such harm.

Future Directions for Dementia

Mak advocates for re-evaluating the appropriateness of anticholinergics, Z drugs, benzodiazepines, and antipsychotics in older patients with dementia. She hopes future studies will use more current data to continue monitoring CogPIM use trends.

A Call to Action

Shelly Gray, PharmD, from the University of Washington School of Pharmacy, underscored the study’s importance, noting that it focuses on community-dwelling older adults where most dementia patients live. Gray called for ongoing efforts to deprescribe medications that may impair cognition in dementia patients and recommended further research to understand medication use trends beyond 2015 for a more contemporary view.

This study highlights the need for increased awareness and targeted interventions to reduce the use of potentially harmful medications among older adults with dementia, aiming to prevent adverse health outcomes and promote better quality of life. Always consult with your health professional to assist you in making the best choices for your health.