A study of medication use patterns in older adults living with dementia found increased overall drug use in the year after dementia diagnosis, pointing to potential gaps in clinical practice on deprescribing guidelines.
A large cohort study published in JAMA Internal Medicine analyzed medication use patterns for 266,675 adults living with dementia and a similar-sized control group. What researchers found were missed opportunities to reduce the simultaneous use of multiple medications that may further affect cognition.
The researchers, led by Beth Israel Deaconess Medical Center in Boston, found that people living with dementia tended to use more anti-dementia medication, as expected. But they also noticed an unexpected increase in the use of central nervous system-active medications, which is contrary to professional guidelines and likely reflects off-label use for behavioral and psychological symptoms of dementia.
The findings, according to the authors, raise concerns because those drugs can worsen cognitive function and increase an individual’s fall risk, and they typically are not recommended for people living with dementia.
The study noted that the use of certain cardiometabolic drugs — including antihypertensives and insulins — immediately increased following a dementia diagnosis. And although anticholinergic medication use dropped slightly, it still was being prescribed. Those drugs have the potential for adverse cognitive side effects.
The implications are important, the investigators said, because a majority of older adults living with dementia also have other chronic conditions, and further cognitive decline may alter the risk-benefit balance of medications taken for those conditions.
The researchers said that their findings indicate that deprescribing guidelines and efforts are not effectively implemented at the expected levels, suggesting a potential gap in clinical practice.
Clinical practice guidelines, according to the authors, recommend tailoring treatments based on comorbidities, potential benefits and patient-specific goals. A new dementia diagnosis can substantially alter chronic disease management goals due to shortened life expectancy and an increased potential risk associated with some medications.
“A new dementia diagnosis should prompt a conversation about the consequences this diagnosis has for the benefits and harms of current medications for all patients, with the goal of aligning medication use with patient priorities and goals,” the authors stated. “In many cases, the consequences of dementia for life expectancy and function are likely to reduce the benefit profile of long-term medications and warrant deprescribing, particularly in the case of patients facing burdensome polypharmacy or using medications associated with impaired cognition.”
