Use of Anti-Dementia Drugs in Relation to Change in Cognition, Behavior, and Functioning in Alzheimer’s Disease over a Three-Year Period: Kuopio ALSOVA Study

Article type: Research Article

Authors: Törmälehto, Soili M.^{a; b; 1} | Martikainen, Janne A.^{a; 1} | Väätäinen, Saku T.^a | Hallikainen, Ilona T.^{b; c} | Hallikainen, Merja^b | Bell, J. Simon^{d; e; 2} | Koivisto, Anne M.^{b; f; 2; *} | and on the behalf of the ALSOVA study group

Affiliations: [a] Pharmacoeconomics and Outcomes Research Unit (PHORU), School of Pharmacy, University of Eastern Finland, Kuopio, Finland | [b] Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland | [c] School of Educational Sciences and Psychology, University of Eastern Finland, Kuopio, Finland | [d] Kuopio Research Centre of Geriatric Care, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland | [e] Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia | [f] Neurology of NeuroCentre, Kuopio University Hospital, Kuopio, Finland

Correspondence: [*] Correspondence to: Anne Koivisto, University of EasternFinland, Faculty of Health Sciences, School of Medicine,Neurology, Box 1627, FI-70211 Kuopio, Finland. Tel.: +358 44 7175629; Fax: +358 17 172305; E-mail: [email protected]

Note: [1] These authors contributed equally to this work.

Note: [2] These authors share the last authorship.

Abstract: Background: Alzheimer’s disease (AD) is characterized by deterioration in cognition, decline in physical function, and increase in behavioral disturbances. These symptoms are associated with dependence. Objective: We investigated the use of anti-dementia drugs in relation to change in cognition, function, and behavior over a 3-year period. Methods: Data were collected as part of the prospective follow-up ALSOVA study. All study participants (n = 236) had very mild or mild AD at baseline. All participants and their informal caregivers underwent annual clinical and medication assessments. Repeated measures logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with anti-dementia drug use and disease progression measures over time. Results: The overall prevalence of anti-dementia drug use remained stable (from 89% to 92%) during the follow-up period. The use of memantine and cholinesterase inhibitor-memantine combination treatment increased with disease severity. After adjustment for confounding, a one-point increase in the disease severity scale (CDR-SOB) was associated with 15.6% increased odds of memantine use. A one-point decrease in CERAD Neuropsychological battery (CERAD-NB) total score was associated with 2.4% increased odds of memantine use. The overall unadjusted rate of switching between anti-dementia drugs was 9.17 (95% CI 7.10 to 11.88) changes per 100 person-years. Conclusion: Nearly 90% of newly diagnosed persons with AD were prescribed anti-dementia drugs. Use of memantine was found to be associated with disease progression. Switching and use of anti-dementia drugs was consistent with Finnish and European clinical practice guidelines for AD.

Keywords: ALSOVA, Alzheimer’s disease, cholinesterase inhibitor, dementia, drug utilization, memantine

DOI: 10.3233/JAD-150092

Journal: Journal of Alzheimer's Disease, vol. 48, no. 4, pp. 1033-1041, 2015