Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2023 Jan;71(1):89-97. doi: 10.1111/jgs.18119. Epub 2022 Nov 9.
Antiepileptics are commonly prescribed to nursing home residents with Alzheimer's disease and related dementias (ADRD) but there is little scientific support for their use in this population. It is unclear whether different antiepileptics are targeting different indications.
Using the Minimum Data Set and Medicare data, including Part D pharmacy claims, we constructed annual cohorts of residents with ADRD with long-term stays in nursing homes from 2015 to 2019. For each year, we measured the proportion of residents with ADRD in nursing homes nationwide with at least one antiepileptic prescription. We also measured trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Finally, we examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain.
Our study sample includes 973,074 persons living with ADRD who had a long-term stay in a nursing home, which was defined as at least 3 months. The proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5% in 2015 to 31.3% in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. Conversely, antipsychotic prescribing rates declined from 32.1% to 27.9% and opioid prescribing rates declined from 39.8% to 31.7%. The risk of valproic acid prescribing was 10.9 percentage points higher among residents with ADRD with disruptive behaviors, while the risk of being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain.
Antiepileptic prescribing among nursing home residents with ADRD is increasing, while antipsychotic and opioid prescribing is declining. Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways. Antiepileptic prescribing of questionable risk-benefit for dementia care warrants further scrutiny.
抗癫痫药常用于患有阿尔茨海默病和相关痴呆症（ADRD）的养老院居民，但在该人群中使用这些药物的科学依据有限。目前尚不清楚不同的抗癫痫药是否针对不同的适应症。
我们利用最小数据集和医疗保险数据（包括 Part D 药房理赔），构建了 2015 年至 2019 年在养老院长期居住的 ADRD 居民的年度队列。对于每一年，我们测量了全国范围内患有 ADRD 的养老院居民中至少有一份抗癫痫处方的比例。我们还测量了丙戊酸、加巴喷丁、抗精神病药和阿片类药物处方的趋势。最后，我们研究了根据是否存在行为障碍或报告疼痛，处方率的差异。
我们的研究样本包括 973074 名患有 ADRD 的长期居住在养老院的患者，这一定义为至少 3 个月。至少有一种抗癫痫药处方的 ADRD 居民比例从 2015 年的 29.5%增加到 2019 年的 31.3%，这主要是由于丙戊酸和加巴喷丁的处方率增加所致。相反，抗精神病药处方率从 32.1%下降到 27.9%，阿片类药物处方率从 39.8%下降到 31.7%。患有 ADRD 且存在行为障碍的患者使用丙戊酸的风险增加了 10.9 个百分点，而报告疼痛的 ADRD 患者使用加巴喷丁的风险增加了 13.9 个百分点。
患有 ADRD 的养老院居民的抗癫痫药处方正在增加，而抗精神病药和阿片类药物的处方正在减少。对存在行为障碍和/或报告疼痛的 ADRD 患者的抗癫痫药处方进行检查表明，两种最常见的抗癫痫药丙戊酸和加巴喷丁正在以不同的方式用于临床。对抗癫痫药在痴呆症治疗中的风险效益值得进一步审查。
