Alzheimer’s Patients Often Given Too Many Meds

By Dennis Thompson
HealthDay reporter

WEDNESDAY, March 10, 2021 (HealthDay News) – Many older people with dementia are prescribed dangerous combinations of drugs that increase their risk of overdose, falls and further mental deterioration, according to a new study.

About 1 in 7 people with dementia living outside nursing homes take three or more drugs that work on their brain and nervous system, the researchers reported.

The most troubling combinations involved opioids, noted lead researcher Dr. Donovan Maust, associate professor of psychiatry at Michigan Medicine, the University Medical Center at the University of Michigan.

Opioids are prescribed for pain, but they carry a black box required by the U.S. Food and Drug Administration for overdose and death if taken with benzodiazepines, antipsychotics, and anti-seizure drugs, Maust said.

“About half of the top 20 combinations included an opioid plus other CNS drugs[centralnervoussystemdepressantdrugs”hesaid[centraldepressantmedicationssystem”hesaid[médicamentsdépresseursdusystèmenerveuxcentral»a-t-ildéclaré[centralnervoussystemdepressantmedications”hesaid

For this study, Maust and colleagues analyzed 2018 Medicare prescription data on more than 1.2 million people with dementia, focusing specifically on drugs that act on the central nervous system.

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People over 65 should not be prescribed three or more CNS active drugs at the same time, as drug interactions can be potentially dangerous, the researchers said in briefing notes.

Still, nearly 14% of dementia patients were taking at least three CNS active drugs at the same time for at least a month, according to the results.

Of that group, about 58% took three or more overlapping medications for more than six months and 7% for the whole year, Maust said.

The most common combination included at least one antidepressant, antiepileptic, and antipsychotic, Maust said.

Very often, these drugs are prescribed for purposes other than their function, the researchers said.

For example, the most commonly prescribed drug overall was gabapentin, an often off-label anti-seizure drug to treat pain, Maust said. It accounted for a third of the daily prescription supply patients received in 2018.

And at least 47% who were taking three or more medications were taking at least one antipsychotic drug, which is often prescribed to patients with dementia for restlessness and insomnia.

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More than 9 out of 10 patients taking three or more drugs were on antidepressants and almost two-thirds were on anti-seizure medication.

The problem is, these drugs present more risks than benefits for patients when taken in combination, Maust said.

“For most of these drugs, the evidence that they help is pretty slim,” Maust said. “On the other hand, there is a lot of evidence that there are risks associated with it.”

Drugs that act on the brain and nervous system increase the risk of bad falls, for example.

“Almost all of these medications are associated with an increase in falls and fall-related injuries, which for the elderly can be a catastrophic outcome,” continued Maust.

There is also some evidence that antidepressants and antipsychotics may actually contribute to memory and reasoning loss in patients with dementia.

“Obviously, it is of great concern to patients with dementia that you are giving them drugs that actually seem to cause further deterioration in their cognition,” said Maust.

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Maust, a geriatric psychiatrist, said that “one of my favorite things to do is try to stop the drugs that people take, because people can end up with a lot of different drugs.”

His team published the results on March 9 in the Journal of the American Medical Association.

Dr Howard Fillit, founding executive director and scientific director of the Alzheimer’s Drug Discovery Foundation, said physicians treating the elderly should regularly conduct drug reviews. It was not part of the new research.

“Whenever I see a new patient, I always ask them to empty their medicine cabinet, put it in a bag, bring it to my office. We’re going to put it on my table and we’re going to go through every one of them, ”said Fillit, clinical professor of geriatric medicine at the Icahn School of Medicine at Mount Sinai in New York City.

“It can be very complicated,” Fillit continued. “Sometimes people were put on drugs five or 10 years ago, not even knowing why. Sometimes people get the same medicine from two different doctors, and the doctors don’t know that the patient is on duplicate medicine. “

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Maust said a drug review can ensure dementia patients receive drugs essential to their well-being while reducing their risk of harm.

“It’s important to note that there are certainly concerns about undertreated pain in the elderly,” said Maust. “For someone with dementia who exhibits worrying behaviors, they may experience pain that they cannot articulate. It is really important that his pain is treated. So my question would be, what is the reason for this other drug. are you on? “

More information

The US National Institute on Aging has more on medication management for patients with Alzheimer’s disease.

SOURCES: Donovan Maust, MD, associate professor, psychiatry, Michigan Medicine; Howard Fillit, MD, founding executive director and scientific director, Alzheimer’s Drug Discovery Foundation, and clinical professor, geriatric medicine and palliative care, Icahn School of Medicine in Mount Sinai, New York City; Journal of the American Medical Association, March 9, 2021

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