Ansart Manon, Epelbaum Stéphane, Houot Marion, Nedelec Thomas, Lekens Béranger, Gantzer Laurène, Dormont Didier, Durrleman Stanley
Sorbonne Universités UPMC Univ Paris 06 Inserm CNRS Institut du cerveau et la moelle épinière (ICM) - Hôpital de la Pitié-Salpêtrière Paris France.
Inria Paris Aramis project-team Paris France.
Alzheimers Dement (N Y). 2021 Sep 14;7(1):e12210. doi: 10.1002/trc2.12210. eCollection 2021.
We aim to understand how patients with Alzheimer's disease (AD) are treated by identifying in a longitudinal fashion the late-life changes in patients' medical history that precede and follow AD diagnosis.
We use prescription history of 34,782 patients followed between 1996 and 2019 by French general practitioners. We compare patients with an AD diagnosis, patients with mild cognitive impairment (MCI), and patients free of mental disorders. We use a generalized mixed-effects model to study the longitudinal changes in the prescription of eight drug types for a period 15 years before diagnosis and 10 years after.
In the decades preceding diagnosis, we find that future AD patients are treated significantly more than MCI patients with most psychotropic drugs and that most studied drugs are increasingly prescribed with age. At the time of diagnosis, all psychotropic drugs except benzodiazepines show a significant increase in prescription, while other drugs are significantly less prescribed. In the 10 years after diagnosis, nearly all categories of drugs are less and less prescribed including antidementia drugs.
Pre-diagnosis differences between future AD patients and MCI patients may indicate that subtle cognitive changes are recognized and treated as psychiatric symptoms. The disclosure of AD diagnosis drastically changes patients' care, priority being given to the management of psychiatric symptoms. The decrease of all prescriptions in the late stages may reflect treatment discontinuation and simplification of therapeutic procedures. This study therefore provides new insights into the medical practices for management of AD.
我们旨在通过纵向识别阿尔茨海默病（AD）患者诊断前后病史中的晚年变化，来了解AD患者的治疗方式。
我们使用了1996年至2019年期间法国全科医生跟踪的34782名患者的处方记录。我们比较了AD诊断患者、轻度认知障碍（MCI）患者和无精神障碍患者。我们使用广义混合效应模型来研究在诊断前15年和诊断后10年期间八种药物类型处方的纵向变化。
在诊断前的几十年里，我们发现未来的AD患者比MCI患者使用大多数精神药物的治疗频率显著更高，并且大多数研究药物的处方随着年龄增长而增加。在诊断时，除苯二氮䓬类药物外，所有精神药物的处方量均显著增加，而其他药物的处方量则显著减少。在诊断后的10年里，几乎所有类别的药物处方量都越来越少，包括抗痴呆药物。
未来AD患者与MCI患者在诊断前的差异可能表明，细微的认知变化被识别并作为精神症状进行治疗。AD诊断的披露极大地改变了患者的治疗，优先处理精神症状。后期所有处方的减少可能反映了治疗的中断和治疗程序的简化。因此，本研究为AD管理的医疗实践提供了新的见解。
