Long-term use of antipsychotics among community-dwelling persons with Alzheimer壮s disease: A nationwide register-based study

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• 作者：Marjaana Koponen^a ; ^b ; ^{marjaana.koponen@uef.fi" class="auth_mail" title="E-mail the corresponding author} ; Heidi Taipale^a ; ^b ; ^c ; Antti Tanskanen^d ; ^e ; Anna-Maija Tolppanen^b ; ^c ; Jari Tiihonen^d ; ^e ; ^f ; Riitta Ahonen^b ; Sirpa Hartikainen^a ; ^b
• 关键词：Alzheimer壮s disease ; Antipsychotic drugs ; Pharmacoepidemiology
• 刊名：European Neuropsychopharmacology
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：25
• 期：10
• 页码：1706-1713
• 全文大小：466 K

文摘

Antipsychotics are recommended only for short-term treatment of severe behavioral and psychological symptoms of dementia. Our objective was to study the duration of antipsychotic use and factors associated with long-term use (365 days or over) among community-dwelling persons with Alzheimer壮s disease (AD) during a 7-year follow-up. This was a nationwide register-based cohort study including all community-dwelling residents in Finland diagnosed with AD in 2005 (n=7217). The follow-up for antipsychotic use started 3 years before the diagnosis of AD and we applied a 7-year washout period to ascertain truly incident antipsychotic use. Follow-up ended on institutionalization, death or at the end of study period (December 31, 2009). Duration of antipsychotic use was modeled from individual purchase histories recorded in the Finnish Prescription Register. During the 7-year follow-up, 34% (2287/6740) of persons initiated antipsychotic use. Median duration of the first antipsychotic use period was 219 (interquartile range 85–583) days. Of those who discontinued antipsychotic use (n=1303), 44% restarted use later. Among users with at least one year of follow-up time after initiating antipsychotic use, prevalence of long-term use was 57% (893/1563). Long-term use was associated with initiation of use after AD diagnosis and choice of antipsychotic. Duration of use was more likely to be shorter among haloperidol users and longer among quetiapine users compared with risperidone users. In conclusion, long-term use of antipsychotics is frequent among community-dwelling persons with AD. Duration of use is not in line with the guidelines recommending time-limited use of antipsychotics.