The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease

P. B. Rosenberg, M. M. Mielke, D. Han, J. S. Leoutsakos, C. G. Lyketsos, P. V. Rabins, P. P. Zandi, J. C.S. Breitner, M. C. Norton, K. A. Welsh-Bohmer, I. H. Zuckerman, G. B. Rattinger, R. C. Green, C. Corcoran, J. T. Tschanz

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

Objective The use of psychotropic medications in Alzheimer's disease (AD) has been associated with both deleterious and potentially beneficial outcomes. We examined the longitudinal association of psychotropic medication use with cognitive, functional, and neuropsychiatric symptom (NPS) trajectories among community-ascertained incident AD cases from the Cache County Dementia Progression Study. Methods A total of 230 participants were followed for a mean of 3.7 years. Persistency index (PI) was calculated for all antidepressants, selective serotonin reuptake inhibitors (SSRIs), antipsychotics (atypical and typical), and benzodiazepines as the proportion of observed time of medication exposure. Mixed-effects models were used to examine the association between PI for each medication class and Mini-Mental State Exam (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-Sum), and Neuropsychiatric Inventory - Total (NPI-Total) trajectories, controlling for appropriate demographic and clinical covariates. Results At baseline, psychotropic medication use was associated with greater severity of dementia and poorer medical status. Higher PI for all medication classes was associated with a more rapid decline in MMSE. For antidepressant, SSRI, benzodiazepine, and typical antipsychotic use, a higher PI was associated with a more rapid increase in CDR-Sum. For SSRIs, antipsychotics, and typical antipsychotics, a higher PI was associated with more rapid increase in NPI-Total. Conclusions Psychotropic medication use was associated with more rapid cognitive and functional decline in AD, and not with improved NPS. Clinicians may tend to prescribe psychotropic medications to AD patients at risk of poorer outcomes, but one cannot rule out the possibility of poorer outcomes being caused by psychotropic medications.

Original languageEnglish (US)
Pages (from-to)1248-1257
Number of pages10
JournalInternational Journal of Geriatric Psychiatry
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2012

Keywords

  • Alzheimer's disease
  • SSRI
  • antidepressants
  • antipsychotics
  • cognition
  • epidemiology
  • neuropsychiatric symptoms
  • pharmacoepidemiology
  • psychosocial function

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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    Rosenberg, P. B., Mielke, M. M., Han, D., Leoutsakos, J. S., Lyketsos, C. G., Rabins, P. V., Zandi, P. P., Breitner, J. C. S., Norton, M. C., Welsh-Bohmer, K. A., Zuckerman, I. H., Rattinger, G. B., Green, R. C., Corcoran, C., & Tschanz, J. T. (2012). The association of psychotropic medication use with the cognitive, functional, and neuropsychiatric trajectory of Alzheimer's disease. International Journal of Geriatric Psychiatry, 27(12), 1248-1257. https://doi.org/10.1002/gps.3769