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Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease.

Abstract

OBJECTIVE

To examine whether the use of psychiatric medication and the presence of abnormal behaviors affects the progression of Alzheimer disease.

DESIGN

Cross-sectional with longitudinal follow-up and the likelihood of arriving at 4 end points: (1) Mini-Mental State Examination score of 9 or lower; (2) Blessed Dementia Rating Scale score of 15 or higher for activities of daily living; (3) nursing home admission; and (4) death, evaluated using a proportional hazard model with 9 variables: psychosis, insomnia, wandering, aggression, psychomotor agitation, depression, and use of antidepressants, antipsychotic agents, or sedatives/hypnotics.

SETTING

Multidisciplinary dementia research clinic.

PATIENTS

We examined baseline and follow-up behavioral symptoms and the use of psychiatric medication in 179 mildly to moderately impaired patients with probable Alzheimer disease participating in a longitudinal study of dementia. Patients were observed from 2.4 to 172 months (mean duration +/- SD, 49.5+/-27.4 months).

RESULTS

Nine patients (5%) were taking sedatives/ hypnotics; 16 (9%), antipsychotic agents; and 22 (12%), antidepressants at study entry. Patients taking antipsychotic agents had lower Mini-Mental State Examination scores and higher Blessed Dementia Rating Scale scores for activities of daily living than patients not taking any medication. Using proportional hazard analysis with time-dependent covariates for individual psychiatric symptoms and medications, we found that the development of psychosis was associated with functional decline (time to Blessed Dementia Rating Scale score of > or =15), institutionalization, aggression, and agitation with functional decline after adjusting for age at study entry, education, Mini-Mental State Examination scores, and Blessed Dementia Rating Scale scores. Use of antipsychotic medication was associated with functional decline, and sedatives/hypnotics with death. Neither the presence of psychiatric symptoms nor use of medication was associated with rate of cognitive decline (time to Mini-Mental State Examination score of < or =9).

CONCLUSIONS

These findings indicate that the use of antipsychotic agents and sedatives can affect the natural course of Alzheimer disease. Psychosis, agitation, and aggression are important predictors of outcome, even when the effects of medication to treat them is taken into account.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Alzheimer's Disease Research Center, Department of Neurology, University of Pittsburgh, PA, USA.

    , , ,

    Source

    Archives of neurology 56:10 1999 Oct pg 1266-72

    MeSH

    Aged
    Alzheimer Disease
    Antidepressive Agents
    Antipsychotic Agents
    Cross-Sectional Studies
    Depression
    Disease Progression
    Female
    Follow-Up Studies
    Humans
    Hypnotics and Sedatives
    Longitudinal Studies
    MMPI
    Male
    Middle Aged
    Predictive Value of Tests
    Proportional Hazards Models
    Psychomotor Agitation
    Psychotic Disorders
    Risk Factors
    Sleep Initiation and Maintenance Disorders
    Survival Analysis
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    10520944

    Citation

    Lopez, O L., et al. "Psychiatric Medication and Abnormal Behavior as Predictors of Progression in Probable Alzheimer Disease." Archives of Neurology, vol. 56, no. 10, 1999, pp. 1266-72.
    Lopez OL, Wisniewski SR, Becker JT, et al. Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease. Arch Neurol. 1999;56(10):1266-72.
    Lopez, O. L., Wisniewski, S. R., Becker, J. T., Boller, F., & DeKosky, S. T. (1999). Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease. Archives of Neurology, 56(10), pp. 1266-72.
    Lopez OL, et al. Psychiatric Medication and Abnormal Behavior as Predictors of Progression in Probable Alzheimer Disease. Arch Neurol. 1999;56(10):1266-72. PubMed PMID: 10520944.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Psychiatric medication and abnormal behavior as predictors of progression in probable Alzheimer disease. AU - Lopez,O L, AU - Wisniewski,S R, AU - Becker,J T, AU - Boller,F, AU - DeKosky,S T, PY - 1999/10/16/pubmed PY - 1999/10/16/medline PY - 1999/10/16/entrez SP - 1266 EP - 72 JF - Archives of neurology JO - Arch. Neurol. VL - 56 IS - 10 N2 - OBJECTIVE: To examine whether the use of psychiatric medication and the presence of abnormal behaviors affects the progression of Alzheimer disease. DESIGN: Cross-sectional with longitudinal follow-up and the likelihood of arriving at 4 end points: (1) Mini-Mental State Examination score of 9 or lower; (2) Blessed Dementia Rating Scale score of 15 or higher for activities of daily living; (3) nursing home admission; and (4) death, evaluated using a proportional hazard model with 9 variables: psychosis, insomnia, wandering, aggression, psychomotor agitation, depression, and use of antidepressants, antipsychotic agents, or sedatives/hypnotics. SETTING: Multidisciplinary dementia research clinic. PATIENTS: We examined baseline and follow-up behavioral symptoms and the use of psychiatric medication in 179 mildly to moderately impaired patients with probable Alzheimer disease participating in a longitudinal study of dementia. Patients were observed from 2.4 to 172 months (mean duration +/- SD, 49.5+/-27.4 months). RESULTS: Nine patients (5%) were taking sedatives/ hypnotics; 16 (9%), antipsychotic agents; and 22 (12%), antidepressants at study entry. Patients taking antipsychotic agents had lower Mini-Mental State Examination scores and higher Blessed Dementia Rating Scale scores for activities of daily living than patients not taking any medication. Using proportional hazard analysis with time-dependent covariates for individual psychiatric symptoms and medications, we found that the development of psychosis was associated with functional decline (time to Blessed Dementia Rating Scale score of > or =15), institutionalization, aggression, and agitation with functional decline after adjusting for age at study entry, education, Mini-Mental State Examination scores, and Blessed Dementia Rating Scale scores. Use of antipsychotic medication was associated with functional decline, and sedatives/hypnotics with death. Neither the presence of psychiatric symptoms nor use of medication was associated with rate of cognitive decline (time to Mini-Mental State Examination score of < or =9). CONCLUSIONS: These findings indicate that the use of antipsychotic agents and sedatives can affect the natural course of Alzheimer disease. Psychosis, agitation, and aggression are important predictors of outcome, even when the effects of medication to treat them is taken into account. SN - 0003-9942 UR - https://www.unboundmedicine.com/medline/citation/10520944/Psychiatric_medication_and_abnormal_behavior_as_predictors_of_progression_in_probable_Alzheimer_disease_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/vol/56/pg/1266 DB - PRIME DP - Unbound Medicine ER -