Hessmann Philipp, Dodel Richard, Baum Erika, Müller Matthias J, Paschke Greta, Kis Bernhard, Zeidler Jan, Klora Mike, Reese Jens-Peter, Balzer-Geldsetzer Monika
Int J Clin Pharmacol Ther. 2018 Mar;56(3):101-112. doi: 10.5414/CP203121.
The use of antidepressant drugs in dementia patients is associated with the risk of adverse events, and the evidence for relevant effects is scarce. We aimed to determine the associations between the prescription of antidepressants and patients' sociodemographic (e.g., age, gender, living situation) and clinical characteristics (e.g., disease severity, neuropsychiatric symptoms).
We included 395 institutionalized and community-dwelling patients with Alzheimer's disease (AD) across all severity stages of dementia in a cross-sectional study design. The patients' clinical characteristics comprised of cognitive status, daily activities, depressive symptoms, further neuropsychiatric symptoms, and health-related quality of life (HrQoL). We conducted multiple logistic regression analyses for the association between the use of antidepressant drugs and the covariates.
Approximately 31% of the participants were treated with antidepressant drugs, with a higher chance of being medicated for institutionalized patients (χ2-test: p = 0.010). In the bivariate analyses, the use of antidepressants was significantly associated with higher levels of care, lower cognitive and daily life capacity, higher extent of neuropsychiatric symptoms, and a lower proxy-reported HrQoL. Finally, multiple logistic regression models showed a significantly higher use of antidepressants in patients treated by psychiatrists and neurologists (OR 2.852, 95% CI: 1.223 - 6.652).
CONCLUSION: The use of antidepressant drugs in the study population was high, and the suitability of the treatment with antidepressants remains unclear. Participants with diminished cognitive and functional capacity, higher extent of neuropsychiatric symptoms, and those treated by neuropsychiatric specialists were more likely to be treated with antidepressants. The pharmaceutical treatment of patients with these clinical characteristics should be particularly considered in the daily care for dementia patients. Further longitudinal studies should evaluate the appropriateness of indications for antidepressants and the causative direction of correlations with the patients' clinical characteristics. .
在痴呆患者中使用抗抑郁药物与不良事件风险相关，而相关效应的证据稀缺。我们旨在确定抗抑郁药物处方与患者社会人口统计学特征（如年龄、性别、生活状况）及临床特征（如疾病严重程度、神经精神症状）之间的关联。
我们采用横断面研究设计，纳入了395名处于痴呆各个严重阶段的阿尔茨海默病（AD）机构化患者和社区居住患者。患者的临床特征包括认知状态、日常活动、抑郁症状、其他神经精神症状以及健康相关生活质量（HrQoL）。我们对使用抗抑郁药物与协变量之间的关联进行了多项逻辑回归分析。
约31%的参与者接受了抗抑郁药物治疗，机构化患者接受药物治疗的可能性更高（χ²检验：p = 0.010）。在双变量分析中，使用抗抑郁药物与更高的护理级别、更低的认知和日常生活能力、更高程度的神经精神症状以及更低的代理报告的HrQoL显著相关。最后，多项逻辑回归模型显示，精神科医生和神经科医生治疗的患者使用抗抑郁药物的比例显著更高（比值比2.852，95%置信区间：1.223 - 6.652）。
研究人群中抗抑郁药物的使用比例较高，抗抑郁药物治疗的适用性仍不明确。认知和功能能力下降、神经精神症状程度较高的参与者以及接受神经精神专科医生治疗的参与者更有可能接受抗抑郁药物治疗。在痴呆患者的日常护理中，应特别考虑对具有这些临床特征的患者进行药物治疗。进一步的纵向研究应评估抗抑郁药物适应症的适宜性以及与患者临床特征相关性的因果方向。
