Abstract
ObjectivesTo describe and compare temporal changes in prevalence and incidence of psychotropic use (antipsychotics, antidepressants and benzodiazepines and related drugs; BZDRs) in persons with newly diagnosed Alzheimer’s disease (AD) between university hospital districts of Finland during 2005–2011.MethodsThe MEDALZ study includes all community-dwellers of Finland who received a clinically verified AD diagnosis in 2005–2011 (N = 70,718). Prevalent and incident use of psychotropics among those who had received AD diagnosis less than one year ago were compared in 2005–2011.ResultsRegional differences in psychotropic use between university hospital districts were more evident in 2005 than 2011 for prevalent use of any psychotropic, antipsychotic and BZDRs and incident use of any psychotropic and antipsychotics. Regional differences in prevalent antidepressant use and incident BZDR use remained similar during the follow-up, while differences in incident antidepressant use increased during the follow-up. The prevalence of any psychotropic use in 2005 varied between 44.7–50.7% and between 45.0–47.9% in 2011. Incidence of any psychotropic use in 2005 was between 8.6–12.1% and 6.2–8.2% in 2011. In 2005, the distribution of incident psychotropic use followed a large scale spatial variation that, however, did not correspond to university hospital districts. During the study period from 2005 to 2011 the cyclic spatial variation disappeared. No sign of adjacent hospital districts being more or less closely related to each other compared to hospital districts in general was detected.ConclusionsExcept for antidepressants, regional differences in psychotropic use have mainly diminished between 2005 and 2011. Our findings highlight the importance of acknowledging regional differences in a country with relatively homogeneous healthcare system and conducting future studies assessing the reasons behind these differences.
Highlights
Antidementia medications are recommended as the first-line treatments for behavioural and psychological symptoms of dementia, [1] psychotropic drugs are frequently used among persons with dementia or Alzheimer’s disease (AD; the most common form of dementia)
Regional differences in prevalent antidepressant use and incident benzodiazepine and related drug (BZDR) use remained similar during the follow-up, while differences in incident antidepressant use increased during the follow-up
Our findings highlight the importance of acknowledging regional differences in a country with relatively homogeneous healthcare system and conducting future studies assessing the reasons behind these differences
Summary
Antidementia medications (acetylcholinesterase inhibitors and memantine) are recommended as the first-line treatments for behavioural and psychological symptoms of dementia, [1] psychotropic drugs (antidepressants, antipsychotics and benzodiazepines and related drugs; BZDRs) are frequently used among persons with dementia or Alzheimer’s disease (AD; the most common form of dementia). Studies on psychotropic use among persons with incident dementia/AD have reported an annual prevalence of 13–31% for antipsychotic use, 22– 54% for antidepressants and 5–29% for BZDRs (depending on the definition of BZDRs).[2,3,4,5,6,7] These numbers are considerably higher than in age- and sex-matched population without AD/ dementia [3,4,6,7] and have remained high despite the safety warnings.[2,3,4,5,7]
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