Praxis für Neurologie und Psychiatrie, Berlin, Germany.
Faculty of Medicine, University of Paris 5, Paris, France.
J Alzheimers Dis. 2018;64(3):827-833. doi: 10.3233/JAD-180382.
The goal of the present retrospective study was to focus on the potential influence of polypharmacy on the initiation of antidementia therapy in patients diagnosed with dementia in general practices in Germany. The current study sample included patients diagnosed with dementia in 1,217 general practices in Germany between 2014 and 2016 (index date). The primary outcome measure was the rate of prescription of anti-dementia drugs within one year following the index date. The explanatory variable was the number of different drugs prescribed at baseline per patient. Independent variables included age, sex, and type of dementia. Logistic regression analyses were conducted to study the impact of the number of different drugs prescribed at baseline per participant on the odds of receiving anti-dementia therapy (in all patients and in patients diagnosed with Alzheimer's disease). The study included 21,888 patients with all-cause dementia. Mean age was 80.2 years (SD = 7.3 years) and 61.4% of the study population were women. Individuals receiving six drugs or more at baseline were significantly less likely to be prescribed anti-dementia treatment when compared to those without any drug at baseline (6- 9 drugs: odds ratio [OR] = 0.75;≥10 drugs: OR = 0.58). In the subgroup of patients with Alzheimer's disease, the odds of being prescribed anti-dementia therapy were lower in individuals with four drugs or more, compared to patients who had not been prescribed any drugs at baseline (4- 5 drugs: OR = 0.60; 6- 9 drugs: OR = 0.49;≥10 drugs: OR = 0.36). There is a negative association between polypharmacy and antidementia therapy initiation in general practices in Germany.
本回顾性研究的目的是关注德国一般实践中，多种药物治疗对诊断为痴呆的患者开始使用抗痴呆药物的潜在影响。本研究的样本包括 2014 年至 2016 年间在德国 1217 家一般实践中被诊断为痴呆的患者（索引日期）。主要结局指标为索引日期后一年内抗痴呆药物的处方率。解释变量为每位患者基线时开具的不同药物数量。自变量包括年龄、性别和痴呆类型。进行逻辑回归分析，以研究基线时每位患者开具的不同药物数量对接受抗痴呆治疗的可能性（所有患者和诊断为阿尔茨海默病的患者）的影响。研究共纳入 21888 例各种原因导致的痴呆患者。平均年龄为 80.2 岁（标准差=7.3 岁），研究人群中 61.4%为女性。与基线时未使用任何药物的患者相比，基线时使用 6 种或更多药物的患者接受抗痴呆治疗的可能性显著降低（6-9 种药物：比值比[OR]=0.75；≥10 种药物：OR=0.58）。在阿尔茨海默病患者亚组中，与基线时未开具任何药物的患者相比，使用 4 种或更多药物的患者接受抗痴呆治疗的可能性较低（4-5 种药物：OR=0.60；6-9 种药物：OR=0.49；≥10 种药物：OR=0.36）。在德国的一般实践中，多种药物治疗与开始抗痴呆治疗之间存在负相关。
