Taipale Heidi, Koponen Marjaana, Tanskanen Antti, Tolppanen Anna-Maija, Tiihonen Jari, Hartikainen Sirpa
From the *Kuopio Research Centre of Geriatric Care and †School of Pharmacy, University of Eastern Finland, Kuopio, Finland; ‡Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; and §National Institute for Health and Welfare, Helsinki; and ∥Research Centre for Comparative Effectiveness and Patient Safety (RECEPS) and ¶Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
J Clin Psychopharmacol. 2014 Aug;34(4):435-40. doi: 10.1097/JCP.0000000000000133.
Use of antipsychotics for treatment of behavioral and psychological symptoms of dementia is frequent among persons with Alzheimer disease (AD). Doses used in long-term therapy have not been previously reported. We describe antipsychotic doses used among community-dwelling persons with AD and investigate factors associated with high-dose use. The MEDALZ-2005 (Medication use and Alzheimer disease) cohort is a nationwide sample including all persons with clinically diagnosed AD at the end of year 2005 in Finland (n = 28,093). Data including prescriptions, comorbidities, and hospital discharge diagnoses were collected from nationwide registers. Antipsychotic doses in monotherapy were investigated during 2006 to 2009. Among 8920 antipsychotic users, 4% (n = 336) used antipsychotics with high dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics. High-dose use was associated with younger age (<80 years) (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.15]), male sex (OR, 1.52; CI, 1.21-1.91), history of psychiatric disorder (OR, 3.25; CI, 2.54-4.15), and inversely associated with Charlson Comorbidity Index score (score 1: OR, 0.74; CI, 0.57-0.97; score ≥2: OR, 0.68; CI, 0.47-0.97). In conclusion, the majority of persons with AD used antipsychotics with low or medium dose. Typical antipsychotics were more often used with high dose than atypical antipsychotics, which indicates a need for precise dosing instructions in the treatment of behavioral and psychological symptoms of dementia. Clinicians should regularly assess dosing levels especially among men and those with history of psychiatric disorder.
在阿尔茨海默病（AD）患者中，使用抗精神病药物治疗痴呆的行为和心理症状很常见。此前尚未报道过长期治疗中使用的剂量。我们描述了社区居住的AD患者使用抗精神病药物的剂量，并调查与高剂量使用相关的因素。MEDALZ - 2005（药物使用与阿尔茨海默病）队列是一个全国性样本，包括2005年底在芬兰临床诊断为AD的所有患者（n = 28,093）。数据包括处方、合并症和医院出院诊断，均从全国性登记处收集。对2006年至2009年期间单一疗法中的抗精神病药物剂量进行了调查。在8920名抗精神病药物使用者中，4%（n = 336）使用高剂量抗精神病药物。典型抗精神病药物比非典型抗精神病药物更常高剂量使用。高剂量使用与年龄较轻（<80岁）（比值比[OR]，1.71；95%置信区间[CI]，1.36 - 2.15）、男性（OR，1.52；CI，1.21 - 1.91）、精神病史（OR，3.25；CI，2.54 - 4.15）相关，与查尔森合并症指数评分呈负相关（评分1：OR，0.74；CI，0.57 - 0.97；评分≥2：OR，0.68；CI，0.47 - 0.97）。总之，大多数AD患者使用低剂量或中等剂量的抗精神病药物。典型抗精神病药物比非典型抗精神病药物更常高剂量使用，这表明在治疗痴呆的行为和心理症状时需要精确的给药说明。临床医生应定期评估给药水平，尤其是在男性和有精神病史的患者中。
