Kindstedt Jonas, Lövheim Hugo, Gustafsson Maria
Department of Medical and Translational Biology, Umeå University, 901 87, Umeå, Sweden.
Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
Drugs Real World Outcomes. 2025 May 31. doi: 10.1007/s40801-025-00501-1.
People with Lewy body dementia (LBD) experience pronounced psychotic symptoms but are extremely sensitive to side effects from antipsychotic treatment. In comparison, acetylcholinesterase inhibitors (AChEIs) are a safer treatment option for managing cognitive and neuropsychiatric symptoms and should ideally be the first-line treatment according to review literature. This study described the pharmacological treatment of LBD-associated neuropsychiatric symptoms among older people by comparing dispensing records of antipsychotic drugs and AChEIs.
This study included people with records of antipsychotic drugs dispensed in 2019 according to the Swedish Prescribed Drug Register, which functioned as an indicator of neuropsychiatric symptoms, who had been registered with LBD in the Swedish registry for cognitive/dementia disorders according to basal registrations from 2007 to 2020. We then determined the proportions of individuals with and without dispensing records of AChEIs prescribed before their index antipsychotic prescription fill of 2019, by comparing prescribing dates. Age, sex and nursing home residency were included as independent variables in a multiple logistic regression model to analyse associations between demographic factors and first-line treatment with AChEIs.
In total, 362 individuals with symptoms of LBD had filled at least one prescription for any antipsychotic drug in 2019. There were 114 people (31.5%) who had been prescribed antipsychotics as first-line treatment instead of AChEIs, and among them, 60 individuals had been diagnosed with LBD after the index antipsychotic prescribing date. First-line treatment with AChEIs was more common among males (odds ratio, OR, 1.65 [95% CI 1.03-2.62]) and nursing home residents (2.51 [1.59-3.96]).
Antipsychotics were utilized as first-line treatment instead of AChEIs among almost one-third of antipsychotic users with symptoms of LBD. It is important to consider emerging psychotic symptoms among older people as possible manifestations of LBD to ensure early and appropriate pharmacological treatment.
路易体痴呆（LBD）患者会出现明显的精神症状，但对抗精神病药物治疗的副作用极为敏感。相比之下，乙酰胆碱酯酶抑制剂（AChEIs）是治疗认知和神经精神症状的更安全选择，根据综述文献，理想情况下应作为一线治疗药物。本研究通过比较抗精神病药物和AChEIs的配药记录，描述了老年人中与LBD相关的神经精神症状的药物治疗情况。
本研究纳入了根据瑞典处方药登记系统在2019年有抗精神病药物配药记录的患者，该记录作为神经精神症状的指标，这些患者根据2007年至2020年的基础登记在瑞典认知/痴呆症登记系统中被登记为LBD患者。然后，通过比较处方日期，我们确定了在2019年首次开具抗精神病药物处方之前有和没有AChEIs配药记录的个体比例。年龄、性别和养老院居住情况作为独立变量纳入多元逻辑回归模型，以分析人口统计学因素与AChEIs一线治疗之间的关联。
2019年，共有362名有LBD症状的患者至少开具了一张抗精神病药物处方。有114人（31.5%）被作为一线治疗开具了抗精神病药物而非AChEIs，其中60人在首次开具抗精神病药物处方日期之后被诊断为LBD。AChEIs一线治疗在男性（优势比，OR，1.65 [95% CI 1.03 - 2.62]）和养老院居民中（2.51 [1.59 - 3.96]）更为常见。
在近三分之一有LBD症状的抗精神病药物使用者中，抗精神病药物被用作一线治疗而非AChEIs。将老年人新出现的精神症状视为LBD的可能表现很重要，以确保早期和适当的药物治疗。
