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Pharmacopsychiatry 2019; 52(02): 84-91
DOI: 10.1055/s-0044-100523
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Prescription of Benzodiazepines and Related Drugs in Patients with Mild Cognitive Deficits and Alzheimer’s Disease

Philipp Hessmann
1   Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Germany
2   Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
,
Richard Dodel
3   Department of Neurology, Philipps-University Marburg, Germany
4   University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany
,
Erika Baum
5   Department of General Practice, Philipps-University Marburg, Germany
,
Matthias J. Müller
6   Oberberg Clinics Berlin, Germany, and Faculty of Medicine, Justus-Liebig-University Giessen, Germany
,
Greta Paschke
7   Practice for General Medicine, Wiesbaden, Germany
,
Bernhard Kis
1   Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Germany
,
Jan Zeidler
2   Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
,
Mike Klora
2   Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Germany
,
Jens-Peter Reese
8   Coordinating Center for Clinical Trials, Philipps-University Marburg, Germany
,
Monika Balzer-Geldsetzer
3   Department of Neurology, Philipps-University Marburg, Germany
4   University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany
› Author Affiliations
Further Information

Publication History

received 13 November 2017
revised  17 December 2017

accepted  03 January 2018

Publication Date:
31 January 2018 (online)

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Abstract

Introduction Benzodiazepines and related drugs (BZDR) should be avoided in patients with cognitive impairment. We evaluated the relationship between a BZDR treatment and the health status of patients with Alzheimer’s disease (AD).

Methods Cross-sectional study in 395 AD patients using bivariate and multiple logistic analyses to assess correlations between the prescription of BZDR and patients’ characteristics (cognitive and functional capacity, health-related quality of life (HrQoL), neuropsychiatric symptoms).

Results BZDR were used in 12.4% (n=49) of all participants. In bivariate analyses, the prescription was associated with a lower HrQoL, a higher need of care, and the presence of anxiety. Multivariate models revealed a higher risk of BZDR treatment in patients with depression (OR 3.85, 95% CI: 1.45 – 10.27). Community-dwelling participants and those treated by neurologists/psychiatrists had a lower risk of receiving BZDR (OR 0.33, 95% CI: 0.12 – 0.89 and OR 0.16, 95% CI: 0.07 – 0.36).

Discussion The inappropriate use of BZDR conflicts with national and international guidelines. We suggest evaluating indications and treatment duration and improving the knowledge of alternative therapies in healthcare institutions.

Key words

benzodiazepines - dementia - depression - neuropsychiatric specialists
 

  • References

  • 1 Prince M, Comas-Herrera A, Knapp M. et al. World Alzheimer Report 2016: Improving healthcare for people living with dementia. Alzheimer’s Disease International 2016; 6-20
    PubMedGoogle Scholar
  • 2 Ziegler U, Doblhammer G. Prevalence and incidence of dementia in Germany—a study based on data from the public sick funds in 2002. Gesundheitswesen 2009; 71: 281-290
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Prince M, Bryce R, Albanese E. et al. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 2013; 9: 63-75
    CrossrefPubMedGoogle Scholar
  • 4 Tampi R-R, Tampi D-J. Efficacy and tolerability of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia: a systematic review of randomized controlled trials. Am J Alzheimers Dis Other Demen 2014; 29: 565-574
    CrossrefPubMedGoogle Scholar
  • 5 Lapeyre-Mestre M. A review of adverse outcomes associated with psychoactive drug use in nursing home residents with dementia. Drugs Aging 2016; 33: 865-888
    CrossrefPubMedGoogle Scholar
  • 6 Maust DT, Kim HM, Seyfried LS. et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: Number needed to harm. JAMA Psychiatry 2015; 72: 438-445
    CrossrefPubMedGoogle Scholar
  • 7 Deuschl G, Maier W. 2016; S3-Leitlinie demenzen. In: Deutsche Gesellschaft für Neurologie (edt.) Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien , last updated January 24, 2016 (accessed on October 10, 2017)
    PubMed
  • 8 Gray SL, Dublin S, Yu O. et al Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. BMJ 2016; 352: i90
    PubMedGoogle Scholar
  • 9 Patel T, Slonim K, Lee L. Use of potentially inappropriate medications among ambulatory home-dwelling elderly patients with dementia: A review of the literature. Can Pharm J (Ott) 2017; 150: 169-183
    CrossrefPubMedGoogle Scholar
  • 10 Goeman D, Harvey K, Lee C-Y. et al. How Prolific is Psychotropic medicines use in people with dementia in australia within the community setting? A retrospective analysis. Drugs Real World Outcomes 2015; 2: 289-298
    PubMedGoogle Scholar
  • 11 Rhee Y, Csernansky J-G, Emanuel L-L. et al. Psychotropic medication burden and factors associated with antipsychotic use: an analysis of a population-based sample of community-dwelling older persons with dementia. J Am Geriatr Soc 2011; 59: 2100-2107
    CrossrefPubMedGoogle Scholar
  • 12 Tolppanen A-M, Voutilainen A, Taipale H. et al. Regional changes in psychotropic use among Finnish persons with newly diagnosed Alzheimer’s disease in 2005-2011. PloS One 2017; 12: e0173450
    CrossrefPubMedGoogle Scholar
  • 13 White N, Leurent B, Lord K. et al. The management of behavioural and psychological symptoms of dementia in the acute general medical hospital: a longitudinal cohort study. Int J Geriatr Psychiatry 2017; 32: 297-305
    CrossrefPubMedGoogle Scholar
  • 14 Wucherer D, Eichler T, Hertel J. et al. Potentially inappropriate medication in community-dwelling primary care patients who were screened positive for dementia. J Alzheimers Dis 2017; 55: 691-701
    Google Scholar
  • 15 Taipale H, Koponen M, Tanskanen A. et al. High prevalence of psychotropic drug use among persons with and without Alzheimer’s disease in Finnish nationwide cohort. Eur Neuropsychopharmacol 2014; 24: 1729-1737
    CrossrefPubMedGoogle Scholar
  • 16 Blacker D, Albert M-S, Bassett S-S. et al. Reliability and validity of NINCDS-ADRDA criteria for Alzheimer’s disease. The National Institute of Mental Health Genetics Initiative. Arch Neurol 1994; 51: 1198-1204
    CrossrefPubMedGoogle Scholar
  • 17 Reese J-P, Hessmann P, Seeberg G. et al. Cost and care of patients with Alzheimer’s disease: clinical predictors in German health care settings. J Alzheimers Dis 2011; 27: 723-736
    CrossrefPubMedGoogle Scholar
  • 18 Folstein M-F, Folstein S-E, McHugh P-R. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198
    CrossrefPubMedGoogle Scholar
  • 19 Galasko D, Bennett D, Sano M. et al. An inventory to assess activities of daily living for clinical trials in Alzheimer’s disease. The Alzheimer’s Disease Cooperative Study. Alzheimer Dis Assoc Disord 1997; 11: 33-39
    CrossrefPubMedGoogle Scholar
  • 20 Cummings J-L, Mega M, Gray K. et al. The neuropsychiatric inventory: Comprehensive assessment of psychopathology in dementia. Neurology 1994; 44: 2308-2314
    CrossrefPubMedGoogle Scholar
  • 21 Yesavage J-A, Brink T-L, Rose T-L. et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982; 17: 37-49
    CrossrefPubMedGoogle Scholar
  • 22 Logsdon R-G, Gibbons L-E, McCurry S-M. et al. Assessing quality of life in older adults with cognitive impairment. Psychosom Med 2002; 64: 510-519
    CrossrefPubMedGoogle Scholar
  • 23 Brooks R. EuroQol: the current state of play. Health Policy 1996; 37: 53-72
    CrossrefPubMedGoogle Scholar
  • 24 Montastruc F, Gardette V, Cantet C. et al. Potentially inappropriate medication use among patients with Alzheimer disease in the REAL.FR cohort: be aware of atropinic and benzodiazepine drugs!. Eur J Clin Pharmacol 2013; 69: 1589-1597
    CrossrefPubMedGoogle Scholar
  • 25 Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225-1230
    CrossrefPubMedGoogle Scholar
  • 26 Fiss T, Thyrian J-R, Fendrich K. et al. Cognitive impairment in primary ambulatory health care: pharmacotherapy and the use of potentially inappropriate medicine. Int J Geriatr Psychiatry 2013; 28: 173-181
    CrossrefPubMedGoogle Scholar
  • 27 Huber M, Kölzsch M, Rapp M-A. et al. Antipsychotic drugs predominate in pharmacotherapy of nursing home residents with dementia. Pharmacopsychiatry 2012; 45: 182-188
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Jacob L, Bohlken J, Kostev K. Prescription patterns and drug costs in German patients with dementia in nursing homes and home-care settings. Int J Clin Pharmacol Ther 2017; 55: 9-15
    CrossrefPubMedGoogle Scholar
  • 29 Vasudev A, Shariff S-Z, Liu K. et al. Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004-2013. Am J Geriatr Psychiatry 2015; 23: 1259-1269
    CrossrefPubMedGoogle Scholar
  • 30 Stevenson D-G, Decker S-L, Dwyer L-L. et al. Antipsychotic and benzodiazepine use among nursing home residents: findings from the 2004 National Nursing Home Survey. Am J Geriatr Psychiatry 2010; 18: 1078-1092
    CrossrefPubMedGoogle Scholar
  • 31 Maust D-T, Langa K-M, Blow F-C. et al. Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA. Int J Geriatr Psychiatry 2017; 32: 164-174
    CrossrefPubMedGoogle Scholar
  • 32 Wolter DK. Discontinuation of benzodiazepines in old age: When and if so, how?. Z Gerontol Geriatr 2017; 50: 115-122
    CrossrefPubMedGoogle Scholar
  • 33 Airagnes G, Pelissolo A, Lavallée M. et al. Benzodiazepine misuse in the elderly: Risk factors, consequences, and management. Curr Psychiatry Rep 2016; 18: 89
    CrossrefPubMedGoogle Scholar