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Utilization of Antihypertensives, Antidepressants, Antipsychotics, and Hormones in Alzheimer Disease

Zhu, Carolyn W. PhD*,†; Livote, Elayne E. MPH, MS*,†; Kahle-Wrobleski, Kristin PhD; Scarmeas, Nikolaos MD, MSc§,∥; Albert, Marilyn PhD; Brandt, Jason PhD; Blacker, Deborah MD, ScD; Sano, Mary PhD*,†,**; Stern, Yaakov PhD§,∥

Alzheimer Disease & Associated Disorders: April-June 2011 - Volume 25 - Issue 2 - p 144–148
doi: 10.1097/WAD.0b013e3181fcba68
Original Articles
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This study explores the longitudinal relationship between patient characteristics and use of 4 drug classes (antihypertensives, antidepressants, antipsychotics, and hormones) that showed significant changes in use rates over time in patients with Alzheimer disease. Patient/caregiver-reported prescription medication usage was categorized by drug class for 201 patients from the Predictors Study. Patient characteristics included use of cholinesterase inhibitors and/or memantine, function, cognition, living situation, baseline age, and sex. Assessment interval, year of study entry, and site were controlled for. Before adjusting for covariates, useage increased for antihypertensives (47.8% to 62.2%), antipsychotics (3.5% to 27.0%), and antidepressants (32.3% to 40.5%); use of hormones decreased (19.4% to 5.4%). After controlling for patient characteristics, effects of time on the use of antidepressants were no longer significant. Antihypertensive use was associated with poorer functioning, concurrent use of memantine, and older age. Antipsychotic use was associated with poorer functioning and poorer cognition. Antidepressant use was associated with younger age, poorer functioning, and concurrent use of cholinesterase inhibitors and memantine. Hormone use was associated with being female and younger age. Findings suggest accurate modeling of the Alzheimer disease treatment paradigm for certain subgroups of patients should include antihypertensives and antipsychotics in addition to cholinesterase inhibitors and memantine.

*Geriatric Research, Education, and Clinical Center (GRECC) and Health Services Research and Development (HSR&D) Center for the Study of Health Care across Systems and Sites of Care, James J. Peters VA Medical Center, Bronx

Brookdale Department of Geriatrics

**Department of Psychiatry, Mount Sinai School of Medicine, New York, NY

Gertrude H. Sergievsky Center and the Department of Neurology, Columbia University Medical Center, New York, NY

Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN

§Cognitive Neuroscience Division of the Taub Institute for Research in Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD

Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Funding Sources: The Predictors Study is supported by Federal grants AG07370, RR00645, and U01AG010483. Funding for this analysis was also partially provided by Eli Lilly and Company. Drs Zhu and Sano and Ms Livote are also supported by the US Department of Veterans Affairs, Veterans Health Administration. The views expressed in this article are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs.

All authors certify that they have no conflict of interest to report in this manuscript.

Reprints: Carolyn W. Zhu, PhD, Geriatric Research, Education, and Clinical Center (GRECC), James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468 (e-mail: carolyn.zhu@mssm.edu).

Received June 4, 2010

Accepted August 10, 2010

© 2011 Lippincott Williams & Wilkins, Inc.