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P26. Genetics, prevention and treatment: Pharmacological treatment

Detailed programme, abstracts and presentations

P26.1. Reducing use of Risperidone in care home residents with dementia: Delivering person centred care using

QAZI Afifa, KISS Ilona

NELFT, Brentwood, United Kingdom

Background: A range of evidence published in recent years has suggested that antipsychotic medication is being inappropriately prescribed to people living with dementia in care homes to manage "challenging behaviour".

Rationale: Many patients with dementia in care homes are treated with Risperidone for BPSD (Behavioural and Psychological Symptoms in Dementia). It was noted that care home staff was asking for an increase in Risperidone prescription without fully exploring the cause of these behaviours.

Aim: To reduce the prescription of Risperidone by 5% in care home residents with dementia under the team between March- October 2017.

Methodology: Behaviour charts were implemented for patients with dementia presenting with BPSD, in order to identify any underlying precipitating and/or relieving factors. This was accompanied by care home staff training to improve their knowledge and skills about dementia care with a focus on using non-pharmacological interventions for behavioural disturbances. Prescriptions for Risperidone were measured before and after the intervention and a reduction by 5% in the prescription of Risperidone were achieved by using non pharmacological methods to control BPSD. QI methodology including process mapping, driver diagrams, multiple point data collection and PDSA cycles were used to achieve the desired result. Feedback from Staff and carers of people with dementia: The behaviour chart is user friendly and care home staff found it easy to use. The families of people with dementia were happy that staff was considering things that could be contributing to why their loved ones were presenting in a disturbed manner rather than relying on medication alone.

P26.2. Anticholinergic medication and benzodiazepine use and long-term cognitive decline and dementia

RICHARDSON Kathryn1, FOX Chris1, GROSSI Carlota1, MAIDMENT Ian2, LOKE Yoon1, ARTHUR Antony1, STEEL Nicholas1, MYINT Phyo3, CAMPBELL Noll4, BRAYNE Carol5, MATTHEWS Fiona6, ROBINSON Louise6, BOUSTANI Malaz7, SAVVA George1

1University of East Anglia, Norwich, United Kingdom, 2Aston University, Birmingham, United Kingdom, 3University of Aberdeen, Aberdeen, United Kingdom, 4West Lafayette, United States, 5University of Cambridge, Cambridge, United Kingdom, 6Newcastle University, Newcastle, United Kingdom, 7Indiana University, Bloomington, United States

Background: It is uncertain whether medications with short-term adverse cognitive effects, specifically anticholinergics and benzodiazepines, may be considered modifiable risk factors for long-term cognitive decline. Here we report findings from a 4-year UK Alzheimer Society funded project (AS-PG-2013-017) addressing this topic.

Methods: We performed various observational studies. We examined medication prescribing up to 20 years before dementia diagnosis using UK primary care records from 40,770 dementia cases matched to 283,933 controls. The MRC Cognitive Function and Ageing Study(CFAS) was used to examine medication use from 13,004 participants from England and Wales aged over 65 years and subsequent 10-year cognitive decline and objectively measured incident dementia. We examined medication use from 8,175 participant’s aged over 50 years and subsequent 4-year cognitive decline in The Irish Longitudinal Study on Ageing (TILDA). Finally, we conducted two systematic reviews of published literature on anticholinergic and benzodiazepine use and long-term cognitive decline and dementia.

Results: We observed a greater risk of dementia with anticholinergic use using primary care records (odds ratio=1.11, 95% confidence interval 1.08-1.14), and in CFAS (incidence rate ratio=1.28, 95% CI 0.82-2.00). Dementia incidence increased with longer-term anticholinergic use, but this varied by the type of anticholinergic medication.  Findings in CFAS and TILDA suggest a short-term effect of these medications on cognition.  We detected no association between long-term benzodiazepine use and dementia in the primary care records or CFAS. Both systematic reviews identified high risk of bias and substantial inconsistencies in the overall evidence regarding association between dementia and use of anticholinergics or benzodiazepines.

Conclusions: In the largest studies to date, our analyses suggest that benzodiazepines and anticholinergic medications affect cognition over the short-term. We observed no long-term dementia risk with benzodiazepine use, but small associations between certain anticholinergics (antidepressants, antiparkinsons, and urological drugs) and dementia that warrant further research.  

P26.3. Antiepileptic drug use and the risk of stroke among community-dwelling persons with Alzheimer’s disease: A matched cohort study

SARYCHEVA Tatyana1, LAVIKAINEN Piia2, TAIPALE Heidi2, TIIHONEN Jari3, TANSKANEN Antti4, HARTIKAINEN Sirpa2, TOLPPANEN Anna-Maija2

1University of Eastern Finland, Kuopio, Finland, 2Kuopio, Finland, 4Stockholm, Sweden, 4PhiLic, Stockholm, Sweden

Background and Purpose: Persons with Alzheimer’s disease (AD) are more predisposed to seizures than older people in general, and use of antiepileptic drugs (AEDs) is more frequent. AED use has been linked to higher risk of vascular events in general population; however, it is not evident whether the same association is in persons with AD. The aim of the study was to assess the risk of stroke associated with incident AED use among persons with AD.

Methods: The MEDALZ cohort includes all Finnish persons who received a clinically verified AD diagnosis (N=70718) in 2005‒2011. Persons with previous strokes were excluded. For each incident AED user (n=5617) one non-user was matched according to sex, age and time since AD diagnosis. Analyses were conducted with Cox proportional hazards models and inverse probability of treatment weighting (IPTW).

Results:  Compared with non-use, AED use was associated with an increased risk of stroke (IPTW hazard ratio (HR): 1.37; 95% CI: 1.07‒1.74). The risk was strongest during the first 90 days (Adjusted HR: 2.36, 95% CI: 1.25‒4.47) of AED use. The association was more evident with ischemic strokes (IPTW HR: 1.34, 95% CI: 1.00‒1.79) than hemorrhagic ones (IPTW HR: 1.44, 95% CI: 0.86‒2.43). Use of older AED was associated with similar risk of stroke as newer AED use.

Conclusions:  AED use was related to an increased risk of stroke, regardless of AED type. AED use for other indications than epilepsy should be limited to those without other pharmacotherapy options. 

P26.4. Early and late onset dementia: A retrospective study assessing differences in drug treatment and outcomes

ZAFEIRIDI Paraskevi, MCMICHAEL Alan, MCGUINNESS Bernadette

Queen's University Belfast, Belfast, United Kingdom

Early Onset Dementia (EOD) concerns dementia in people less than 65 years old and accounts for approximately 5% of all dementia cases (Alzheimer’s Society, 2015). There are more than 40000 people with EOD in the United Kingdom, with more than 1000 living in Northern Ireland (Alzheimer’s Society & Marie Curie, 2015). Research demonstrates that less than 1% of dementia cases are caused from a genetic factor (Tellechea et al., 2017), while frequent causes include Alzheimer’s disease, vascular diseases, Huntington’s disease, traumatic brain injury, brain tumour, HIV, diabetes, chronic alcoholism and chronic drug abuse (McMurtray, Clark, Christine, & Mendez, 2006; Werner, Stein-Shvachman, & Korczyn, 2009; Zilkens, Davis, Spilsbury, Semmens, & Bruce, 2013). This study aims to explore differences between EOD and late onset dementia (LOD) in relation to pharmacological treatment, associated comorbidities and hospitalization rates in approximately 13,000 people in Northern Ireland. Retrospective analyses of data from national databases will be performed with variables including medication and dosage, common comorbidities, and the care needs for people with EOD and LOD. These results will be in line with dementia experts supporting the need to adjust healthcare services and practices to meet the needs of people with EOD (Alzheimer’s Society & Marie Curie, 2015) since current services focus mainly on LOD.

P26.5. Assessing the rate of anticholinergic drug prescriptions for dementia patients in Northern Ireland

MCMICHAEL Alan, ZAFEIRIDI Evi, MCGUINNESS Bernadette

Queen's University Belfast, Belfast, United Kingdom

Research has shown that patients with dementia are more likely to be on numerous medications. Some of these medications have anticholinergic properties. Anticholinergic drugs block the neurotransmitter acetylcholine, which aids muscle activation. Many drugs which are prescribed in routine clinical practice have anticholinergic properties. For instance, first generation antihistamines, antidepressants and antipsychotics are all classified as anticholinergic drugs. Research has consistently shown that individuals who use anticholinergic drugs are significantly more likely to experience acute cognitive decline and dementia. Moreover, anticholinergic drugs have also been shown to work against dementia medications (cholinesterase inhibitors). Researchers and regulatory bodies have now warned against prescribing anticholinergic medications to dementia patients and have urged clinicians to offer alternative treatments when possible. However, little is known about the prescription rate of anticholinergic drugs in Northern Ireland. This is a retrospective analysis using data from national datasets. Data from the Honest Broker Service in Northern Ireland, which has information on approximately 13,000 people with dementia will be analysed to assess the rate of anticholinergic drug prescriptions. By conducting a retrospective analysis on nationaldatasetswe aim to identify several demographic characteristics which influence mortality rates in dementia. Understanding anticholonergic drug prescription rates has the potential to help put policies in place for clinicians to reduce the use of these drugs when possible.

P26.6. The Electronic Person Specific Outcome Measures (ePSOM) Project for Prodromal Alzheimer’s Dementia

SAUNDERS Stina, WATSON Julie, MUNIZ-TERRERA Graciela, CLARKE Charlotte, RITCHIE Craig, LUZ Saturnino

University of Edinburgh, Edinburgh, United Kingdom

Introduction: Whilst the importance of using outcome measures that offer clinically meaningful benefits to patients in clinical trials for novel interventions in Alzheimer’s disease is widely recognised, there is a dearth of knowledge about the patient reported outcome measures and preferences for treatment outcomes balancing risk and benefit.

Methods and materials: As a first step in a research programme developing an Electronic Person Specific Outcome Measure (ePSOM), we conducted a literature review on patient reported outcome measures and patient preferences in the Alzheimer’s disease and MCI population. This informed a qualitative study involving focus groups with people living with memory problems and healthy volunteers, and interviews with health care professionals, on what matters when developing new treatments for Alzheimer’s disease.41 individuals took part in a focus group or were interviewed.

Results: An overlapping theme across participants is that the ordinary things that matter to people in everyday life are what matters in developing new treatments, including tolerable risks. A primary concern was the loss of memory for words/names resulting in loss of confidence which cascades into other losses e.g. the ability to stay connected with friends and family and do enjoyable activities such as play golf or participate in a book group. This gradual loss of connections is compounded by the loss of technical abilities e.g. driving, using a computer, managing money, and self-care, ultimately leading to the loss of identity e.g. the role in the family. What mattered in treatment was retention/restoration of these abilities, with nuances depending on age.  

Conclusions: The themes identified in focus groups and interviews are being used to develop an accessible survey, suitable for people with dementia, to identify the most important issues for new treatments for Alzheimer’s disease to target.

 

 
 

Last Updated: Wednesday 14 November 2018

 

 
  • Acknowledgements

    The 28th AE Conference in Barcelona received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe, CEAFA and Fundación Alzheimer España gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche
 
 

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