Journal of the American Medical Directors Association
Original StudyAntipsychotic Treatment Associated With Increased Mortality Risk in Patients With Dementia. A Registry-Based Observational Cohort Study
Section snippets
Methods
We studied patients diagnosed with dementia and registered at the time of diagnosis in the SveDem.24 SveDem was established in May 2007 with the goal to improve the quality of care of patients with dementia disorders in Sweden and contains information about the diagnostic work-up, medical treatment, and community support. Dementia was categorized into 8 diagnoses: AD, VAD, mixed dementia, dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), Parkinson's disease dementia, UNS dementia
Description of the Study Population
The results are presented as means (±standard deviation) for continuous variables (age, MMSE, CCI, number of drugs) or number of patients, and percentage for categorical variables (dementia type, sex, form of residency). The study sample contained 59% women and 41% men. The mean age was 79.7 (7.9) years and mean MMSE score was 20.9 (5.0) points. AD (31%) was the most common dementia diagnosis followed by UNS dementia (25%), VAD (19%), and mixed dementia (18%). LBD (4%), other types of dementia
Discussion
In our study, 4% of patients with newly established dementia diagnosis used APDs. Use of APDs was associated with risk for death, and these results are in line with previous studies showing higher death risk with APD use in patients with dementia.13, 14 However, when each specific dementia diagnosis was considered, we found differences in survival for patients with different diagnoses. More specifically, in patients with AD, a reduced death risk for typical APDs treatment compared with atypical
Conclusions and Implications
Although we cannot rule out the influence of residual confounding (eg BPSD), these results would seem to support studies that suggest cautious APD prescribing for patients with dementia.
Acknowledgments
The authors are grateful to (SveDem, www.svedem.se). We thank all patients, caregivers, reporting units, and coordinators in SveDem as well as SveDem steering committee. Special thanks to Johan Fastbom for extracting the data from the prescribed drug registry. We also thank the Margaretha af Ugglas' Foundation.
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2021, Journal of the American Medical Directors AssociationCitation Excerpt :PWD with higher income were less likely to receive antipsychotics. This finding is particularly important because previous studies have shown that the use of antipsychotics increases the mortality risk in PWD.28 Our study is in line with prior publications on the effects of SEP on health care; the difficulty is in identifying why these differences occur and how they can be addressed.
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SveDem is supported financially by the Swedish Brain Power network (http://swedishbrainpower.se), the Swedish Associations of Local Authorities and Regions, Gun och Bertil Stohnes Stiftelse, CIMED grant, Alzheimerfonden, and Swedish Research Council (Drn 2012-2291 and Drn 2016-02317), and by grants provided by the Stockholm County Council (ALF project). None of the sponsors had any involvement in the design of the study, the data collection and analysis, the writing of the report, or the decision to submit the paper for publication.
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work, no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
This study was approved by the regional ethical review board in Stockholm, Sweden. Ethical Number: 2015/2232-31/5.
The authors declare no conflicts of interest.