Alzheimer’s disease patients often show psychotropic polypharmacy

Up to half of patients with Alzheimer’s disease (AD) use a psychotropic drug, that alters their perception, mood, consciousness, cognition, or behaviour, while one-in-five uses two or more such drugs at the same time, reveals a new study at the University of Eastern Finland.

The use of antipsychotic drugs was almost eight times more common among patients with Alzheimer’s disease than other groups. It was also noted that psychotropic drug use was more common among people with Alzheimer’s disease five years before their diagnosis. Four years after the diagnosis, psychotropic drug use was three times more common in Alzheimer’s disease suffers than other comparable groups. No differences were noted in the use of benzodiazepines and related drugs.

Using at least two psychotropics at the same time was three times more common among people with Alzheimer’s disease four years after their diagnosis. The most common combination included an antidepressant plus either an antipsychotic or a benzodiazepine.

First-line anti-dementia drugs

The use of first-line anti-dementia drugs, such as acetylcholinesterase inhibitors, was linked to a lower risk of psychotropic polypharmacy (or taking two or more psychotropic drugs at the same time). However, the use of memantine was associated with an increased risk.

Professor Sirpa Hartikainen, from the University of Eastern Finland, said the results of the study gave cause for concern. "Concomitant use of psychotropics is concerning, as previous studies have shown that there is a link between several adverse events and psychotropic drug use among older persons and persons with dementia," said Prof Hartikainen.

Many countries recommend prescribing an acetylcholinesterase inhibitor to people with Alzheimer’s disease – provided there is no contraindication for use

An acetylcholinesterase inhibitor

The research was part of the nationwide register-based MEDALZ study conducted at the University of Eastern Finland. The study included all 70,718 persons diagnosed with Alzheimer’s disease in Finland during 2005-2011. Researchers from Utrecht University also contributed to this study.

Meanwhile, Alzheimer’s disease is most common in people over the age of 65, according to the National Health Service. The risk of Alzheimer’s disease and other types of dementia increases with age. Currently it affects an estimated one in 14 people over the age of 65 and one in every six people over the age of 80. About one in every 20 cases of Alzheimer’s disease affects people aged 40 to 65 and is known as early- or young-onset Alzheimer’s disease.

While there’s currently no cure for Alzheimer’s disease, medicines can help relieve some of the symptoms.

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