Nørgaard Ane, Jensen-Dahm Christina, Gasse Christiane, Hansen Elsebet Steno, Waldemar Gunhild
Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
J Alzheimers Dis. 2017;56(2):707-716. doi: 10.3233/JAD-160828.
Antipsychotics and other psychotropics are frequently used to treat neuropsychiatric symptoms in patients with dementia, even though the evidence for effect is limited. Concerns have been raised about the safety of antipsychotics, but concomitant use of multiple psychotropic drug classes (psychotropic polypharmacy) may also pose a risk for patients.
To investigate the prevalence and predictors associated with use of psychotropic polypharmacy in patients with dementia.
A population-based study using nationwide registers. Patients with dementia were identified among all Danish residents ≥65 years on January 1, 2012. Data on prescriptions and comorbidity was included in the analysis. Overlapping prescriptions for different psychotropic drug classes were used to determine psychotropic polypharmacy. A multivariable logistic regression analysis was conducted to evaluate factors independently associated with the prescription of other psychotropic drug classes among patients already using antipsychotics.
Among all patients registered with dementia (34,553), 25.3% (8,728) used ≥2 psychotropic drugs. Among patients treated with antipsychotics 75.8% (5,403) used at least one other psychotropic drug during the antipsychotic treatment period. Nursing home residency, number of non-psychotropic medications used in 2011, and prior psychiatric diagnosis were associated with psychotropic polypharmacy among antipsychotic drug users. The most frequent combination of psychotropic drugs was antipsychotics and antidepressants.
Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may cause adverse events, and potential consequences for patients' safety call for further investigation.
抗精神病药物和其他精神药物经常用于治疗痴呆患者的神经精神症状，尽管其疗效证据有限。人们对抗精神病药物的安全性表示担忧，但同时使用多种精神药物类别（精神药物多药联用）也可能给患者带来风险。
调查痴呆患者中精神药物多药联用的患病率及其相关预测因素。
一项基于全国登记数据的人群研究。在2012年1月1日年龄≥65岁的所有丹麦居民中识别出痴呆患者。分析纳入了处方和合并症数据。使用不同精神药物类别的重叠处方来确定精神药物多药联用情况。进行多变量逻辑回归分析，以评估在已使用抗精神病药物的患者中与其他精神药物类别处方独立相关的因素。
在所有登记的痴呆患者（34,553例）中，25.3%（8,728例）使用了≥2种精神药物。在接受抗精神病药物治疗的患者中，75.8%（5,403例）在抗精神病药物治疗期间至少使用了一种其他精神药物。养老院居住情况、2011年使用的非精神药物数量以及既往精神科诊断与抗精神病药物使用者中的精神药物多药联用相关。最常见的精神药物组合是抗精神病药物和抗抑郁药物。
痴呆患者中精神药物联用很常见。住在养老院的患者接受抗精神病药物和其他精神药物联合使用的风险最高。精神药物联用可能导致不良事件，对患者安全的潜在影响需要进一步调查。
