在一个综合性痴呆症护理项目中探索痴呆症患者开始使用抗精神病药物的情况。

Exploring Antipsychotic Initiation Among Persons Living With Dementia in a Comprehensive Dementia Care Program.

作者信息

Lee David R, Sassana-Khadka Grace, Romero Tahmineh, Yang Betsy, Serrano Katherine Sy, Centeno Andrea, Reuben David B

机构信息

Multicampus Program in Geriatric Medicine and Gerontology, Division of Geriatrics, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.

Rush Medical College, Rush University, Chicago, Illinois, USA.

出版信息

J Am Geriatr Soc. 2025 Jun 9. doi: 10.1111/jgs.19569.

DOI:10.1111/jgs.19569

PMID:40485369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12302055/

Abstract

BACKGROUND

Antipsychotic medications (APMs) are frequently prescribed for persons living with dementia despite limited benefits and increased risks. This study examined patient characteristics of those prescribed APMs, indications for initiation, and survival outcomes.

METHODS

This retrospective cohort study of community-dwelling patients enrolled in a comprehensive dementia care program (2012-2014) focused on 190 patients not on an APM at baseline, with survival analyses including 200 additional patients on an APM at program entry. Patients were followed for 2 years for APM initiation and until January 2024 for mortality. Baseline measures included patient and caregiver demographics, Mini-Mental State Exam (MMSE), Functional Activities Questionnaire (FAQ), Modified Caregiver Strain Index (MCSI), caregiver Patient Health Questionnaire-9 (PHQ-9), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Indications for APM initiation were abstracted from electronic health records. Logistic regression models examined associations between baseline characteristics and APM initiation. Survival was assessed using Kaplan-Meier estimates and Cox proportional hazards models.

RESULTS

Among 190 patients (mean [SD] age, 81.2 [8.4] years; 60% female, and 80% Alzheimer's or dementia not otherwise specified) who were not on APMs at program enrollment, 65 (34%) initiated and 125 (66%) did not initiate an APM. NPI-Q severity (AOR 1.10, 95% CI 1.04-1.16) and NPI-Q distress (AOR 1.06, 95% CI 1.02-1.10) were associated with APM initiation. Agitation and psychotic symptoms were the most common indications, with quetiapine being the most frequently prescribed APM. Median survival was 37.8 months (IQR 19.3-63.2) for patients on an APM at baseline, 63.1 months (IQR 28.4-86.8) for patients initiating an APM, and 68.9 months (IQR 50-97.9) for patients not initiating an APM (p < 0.001).

CONCLUSIONS

APM initiation was common despite enrollment in a comprehensive dementia care program that prioritizes non-pharmacologic strategies. Survival differences underscore the need for risk-benefit discussions of APMs and goals of care discussions with caregivers.

摘要

背景

尽管抗精神病药物（APMs）益处有限且风险增加，但仍经常为痴呆症患者开具此类药物。本研究调查了开具APMs患者的特征、用药起始指征及生存结局。

方法

这项对参加综合痴呆症护理项目（2012 - 2014年）的社区居住患者进行的回顾性队列研究，聚焦于190名基线时未使用APMs的患者，生存分析还包括另外200名项目入组时已使用APMs的患者。对患者随访2年以观察APMs的起始使用情况，并随访至2024年1月以观察死亡率。基线测量包括患者及照料者的人口统计学数据、简易精神状态检查表（MMSE）、功能活动问卷（FAQ）、改良照料者压力指数（MCSI）、照料者患者健康问卷 - 9（PHQ - 9）以及神经精神科问卷（NPI - Q）。APMs起始使用的指征从电子健康记录中提取。逻辑回归模型检验基线特征与APMs起始使用之间的关联。使用Kaplan - Meier估计值和Cox比例风险模型评估生存情况。

结果

在项目入组时未使用APMs的190名患者（平均[标准差]年龄，81.2[8.4]岁；60%为女性，80%为阿尔茨海默病或未另作说明的痴呆症）中，65名（34%）开始使用APMs，125名（66%）未开始使用。NPI - Q严重程度（比值比1.10，95%置信区间1.04 - 1.16）和NPI - Q困扰程度（比值比1.06，95%置信区间1.02 - 1.10）与APMs起始使用相关。激越和精神病性症状是最常见的指征，喹硫平是最常开具的APM。基线时使用APM的患者中位生存期为37.8个月（四分位间距19.3 - 63.2），开始使用APM的患者为63.1个月（四分位间距28.4 - 86.8），未开始使用APM的患者为68.9个月（四分位间距50 - 97.9）（p < 0.001）。