Drug utilization among patients with mild cognitive impairment and Alzheimer’s disease in diverse populations: A large nationwide electronic health record cohort study

Abstract

AbstractBackgroundCholinesterase inhibitors (ChE‐Is), such as donepezil, rivastigmine, and galantamine, and N‐methyl‐d‐aspartate receptor antagonists, such as memantine, are prescribed to decrease symptoms associated with cognitive impairment. Few studies have examined the initiation and utilization of these medications among diverse populations. This study’s objective was to characterize drug utilization among patients with mild cognitive impairment (MCI) and/or Alzheimer’s disease (AD) in the United States and stratify by gender, age and race/ethnicity.MethodThis retrospective cohort study was conducted using the Optum® Market Clarity database, which contains electronic health records and insurance claims. Cases of MCI and AD were identified utilizing the International Classification of Diseases, Ninth and Tenth Revisions diagnosis codes. Drug prescriptions were determined to occur before, on, or after the date of first diagnosis. All cases were required to have ≥12 months of enrollment in the database prior to first diagnosis. The study period was from January 2017 through September 2021. Descriptive statistics were calculated stratified by demographic groups.ResultA large number of cases were identified (197,346 MCI and 144,321 AD cases). Approximately 6% of individuals with MCI had prescriptions for ChE‐Is prior to diagnosis and 14% after diagnosis. For memantine, the proportions with prescriptions before and after MCI diagnosis were 2% and 5%, respectively. Among individuals with AD, prescriptions for ChE‐Is occurred in 22% prior to diagnosis and 32% after diagnosis. Memantine prescriptions increased from 10% prior to AD diagnosis to 18% after. The results did not differ by gender. The highest proportions with ChE‐Is and memantine prescriptions were older age groups <85 years. When examining race/ethnic groups, the proportion of MCI and AD cases with these prescriptions was generally lowest among African Americans.ConclusionAs expected, prescriptions for ChE‐Is and memantine increased after diagnosis. The proportion of MCI and/or AD cases with prescriptions were similar across genders. The proportion with prescriptions was generally lowest among African Americans. Future research into the discrepancy in the occurrence of prescriptions by race/ethnicity as well as the timing of certain prescriptions will be valuable in further understanding the patient population and their access to appropriate medications.