Initiation of Anti-dementia Medication in Older Adults Undergoing Pharmaceutical Management for Existing Chronic Conditions by the Assessment of Insurance Claims
Abstract BACKGROUND The influences of co-prescribed medications for chronic co-morbid conditions in very older adults on clinical dementia onset are uncertain.OBJECTIVE To evaluate the influences of co-prescribed medications on clinical dementia onset, which was indicated by the initiation of a new prescription of anti-dementia medication (NPADM).METHODS This retrospective cohort study consisted of 42024 adults aged ≥77 years residing in a suburban city of Tokyo Metropolitan Area who did not take any anti-dementia medication on April 1, 2012. The primary outcome was NPADM during followed-up period until March 31, 2015 (35 months). Subjects were categorized into four age groups: Group I (77-81 years), Group II (82-86 years), Group III (87-91 years), and Group IV (≥92 years). Covariates were fourteen groups of medications prescribed between April 1, 2012 and June 31, 2012. RESULTS In a follow-up period of 1345457 patient-months (mean=32.0±7.5 months), NPADM occurred in 2365 subjects. NPADM incidence at 12 months was 1.9±0.1% (Group I: 0.9±0.1%, Group II: 2.1±0.1%, Group III: 3.2±0.2% and Group IV: 3.6±0.3%; P<0.0001). In addition to older age and female sex, the use of the following medications was associated with NPADM: statins (hazard ratio: 0.82, 95% confidence interval: 0.73-0.92; P=0.001), antihypertensives (0.80, 0.71-0.85; P<0.0001), non-steroidal bronchodilators (0.72, 0.58-0.88; P=0.002), antidepressants (1.79, 1.47-2.18; P<0.0001), post-stroke medications (1.45, 1.16-1.82; P=0.002), insulin (1.34, 1.01-1.78; P=0.046) and antineoplastics (1.12, 1.01-1.24; P=0.035)CONCLUSIONS These findings provide a benchmark for the management of dementia in the real-world setting, and contribute to evidence-based healthcare policymaking. (Clinical Trial Registration: UMIN-CTR UMIN000039040)