Reducing antipsychotic use in people with dementia living in nursing homes

Analysis of research article by Clarissa Giebel for the Mental Elf

Article: Ballard C, et al. (2015) Impact of Antipsychotic Review and Nonpharmacological Intervention on Antipsychotic Use, Neuropsychiatric Symptoms, and Mortality in People With Dementia Living in Nursing Homes: A Factorial Cluster. American Journal of Psychiatry 2015

Image source: NHS PhotoLibrary

‘This is a really substantial randomised controlled trial, that takes into account a complex set of interventions. It is great to see that the trial integrated evidence-based interventions, which were based on existing manuals, such as the Seattle protocol for the exercise intervention. This increases the trial credibility and methodological strength.

As the authors point out, there needs to be a shift away from solely prescribing antipsychotics to using nonpharmacological interventions also, or, in some cases, as an alternative. Hence, it’s recommended that practice guidelines are changed. Indeed, a shift towards nonpharmacological interventions isn’t specific to antipsychotic prescription only. There are many areas in which nonpharmacological interventions can be effective, such as cognition or everyday functioning (Giebel & Challis, 2015). Plus, with the majority of people with dementia being 65 years or older, and most likely already taking several medications, we should be trying to avoid offering more medication wherever possible. Looking at the interventions offered here also, increasing social activities and physical functioning will have additional benefits to the residents’ well-being and cardiovascular functioning.’

Read the full analysis via the Mental Elf


Observational cohort study: deprivation and access to anti-dementia drugs in the UK

Cooper, C. et al. Age Ageing (2015). 

Background: UK National Dementia Strategies prioritise fair access to dementia treatments for the whole population. We investigated for the first time inequalities in NHS national dementia prescribing and how they have varied between UK countries and over time.

Method: we investigated the association between Townsend deprivation score and anti-dementia drug prescribing in 77,045 dementia patients from UK primary care records from 2002 to 2013.

Results: we included 77,045 patients with recorded dementia diagnosis or anti-dementia drug prescription. Least deprived patients were 25% more likely to be initiated on anti-dementia drugs than the most deprived (adjusted incidence rate ratio 1.25, 95% confidence interval 1.19–1.31). This was driven by data from English practices where prescribing rates were consistently lower in more deprived patients compared with Scotland, Northern Ireland and Wales, where prescribing was not related to deprivation quintile. Compared with English practices, anti-dementia medication was prescribed more often in Northern Irish (1.81, 1.41–2.34) and less in Welsh practices (0.68, 0.55–0.82), with a trend towards more prescribing in Scottish practices (1.14, 0.98–1.32). Drug initiation rates were also higher in younger people and men.

Conclusion: four years after the English National Dementia Strategy, there is no evidence that the Strategy’s key objective of reducing treatment inequalities is being achieved. Higher overall anti-dementia drug prescribing in Scottish and Northern Irish practices, and differing clinical guidelines in Scotland from other UK countries might explain greater equality in prescribing in these countries. Strategies to offer treatment to more deprived people with dementia in England are needed.

Dementia Drug Effective in Helping Avoid Transitions into Care Homes

Analysis of data from the DOMINO-AD Trial indicates that the drug Donepezil may be effective in avoiding care home admissions in more advanced cases of Alzheimer’s Disease. Discontinuation of donepezil appears to be associated with an increased risk of nursing home admissions in community-living patients with moderate-to-severe Alzheimer’s Disease during the first 12 months following drug cessation.

Full reference: Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer’s Disease (DOMINO-AD) trial: secondary and post-hoc analyses. The Lancet Neurology. [Epub ahead of print].

Related: Dementia drug ‘keeps patients out of nursing homes’ BBC News

Trial begins to investigate diabetes drug’s potential for Alzheimer’s disease | Alzheimer’s Research UK

Trial begins to investigate diabetes drug’s potential for Alzheimer’s disease

It has been reported today that a drug commonly used to treat type 2 diabetes is to be tested in a clinical trial for Alzheimer’s disease. The drug, liraglutide, is to be evaluated in a phase 2 trial of people in the early stages of Alzheimer’s at centres across the UK.

via Trial begins to investigate diabetes drug’s potential for Alzheimer’s disease | Alzheimer’s Research UK.