Effect of Discontinuing Cholinesterase Inhibitor Therapy on Behavioral and Mood Symptoms in Nursing Home Patients With Dementia
Effect of Discontinuing Cholinesterase Inhibitor Therapy on Behavioral and Mood Symptoms in Nursing Home Patients With Dementia
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DOI：
10.1016/j.amjopharm.2009.04.002
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发表时间：
2009-04-01
期刊：
影响因子：
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通讯作者：
Dore, David D.
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文献类型：
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作者：
Daiello, Lori A.;Ott, Brian R.;Dore, David D.
背景：胆碱酯酶抑制剂（CHEIs）可改善阿尔茨海默病患者的某些类型的行为症状。然而，之前很少有关于停止这些药物的相关结果的研究。 目的：本研究的主要目的是评估一组诊断为痴呆的疗养院居民与接受长期 CHEI 治疗的居民相比，停止 CHEI 治疗对行为和情绪症状的影响程度。 方法：这是一项使用罗德岛州医疗补助处方索赔和最小数据集 (MDS) 的回顾性队列研究。参与者是罗德岛州疗养院居民，年龄 60 岁，诊断为阿尔茨海默病或非阿尔茨海默病，接受 CHEI 单一疗法治疗，并在 2004 年 1 月 1 日至 2005 年 12 月 31 日期间参加医疗补助计划。停药队列 (CHEI-DC) 是通过确定接受 3 至 9 个月不间断 CHEI 治疗的居民来选择的。继续队列 (CHEI-CONT) 接受连续 CHEI 治疗超过 9 个月。将 CHEI-DC 居民的攻击性行为量表 (ABS) 和抑郁评定量表 (DRS) 的分数变化与 CHEI-CONT 居民的分数变化进行比较。次要结果包括个体行为症状随时间的变化以及 MDS 上编码的认知和功能状态指标。结果：最终匹配样本 (N = 178) 包括 62 个 CHEI-DC 病例和 116 个 CHEI-CONT 对照。超过一半的队列年龄>= 85 岁，样本主要是女性。 40.3% 的 CHEI-DC 患者和 46.5% 的 CHEI-CONT 患者被诊断为阿尔茨海默病。行为恶化，表现为 ABS 评分估计平均每月分数变化的增加，发生在 CHEI-DC 组（0.08；95% CI，0.01 至 0.16），但在 CHEI-CONT 组中没有出现（-0.01；95% CI，-0.06 至 0.04），组间差异显着（0.09；95% CI，0.01 至 0.04）。 0.18）。 DRS 上情绪症状的平均每月点变化没有显着的组间差异（0.04；95% CI，-0.03 至 0.12）。对于次要结局，重复言语行为频率的平均每月 MDS 点变化表明，与 CHEI-CONT 居民相比，CHEI-DC 患者表现出明显更多的重复询问事件（0.17；95% CI，0.05 至 0.29）和重复健康投诉（0.16；95% CI，0.04 至 0.27）。在研究期间，持续使用 CHEI 与花在休闲相关活动上的时间增多相关（-0.26；95% CI，-0.50 至 -0.02），而 CHEI-DC 组花在活动上的时间更少（0.11；95% CI，0 至 0.23）；组间差异也显着（0.37；95% CI，0.10 至 0.65）。 结论：这项回顾性分析的结果表明，与较长时间的 CHEI 治疗相比，这些患有痴呆症的疗养院居民中止 CHEI 与声音不良行为变化和从事休闲相关活动的时间减少有关。 (Am J Geriatr Pharmacotber. 2009;7:74-83) (C) 2009 Excerpta Medica Inc.
Background: Cholinesterase inhibitors (CHEIs) ameliorate some types of behavioral symptoms in patients with Alzheimer's disease. However, there has been little previous study of the outcomes associated with discontinuing these medications.Objective: The primary aim of this study was to evaluate the extent to which discontinuing CHEI therapy affected behavioral and mood symptoms in a cohort of nursing home residents with a diagnosis of dementia compared with residents receiving longer-term CHEI therapy.Methods: This was a retrospective cohort study using Rhode Island Medicaid prescription claims and the Minimum Data Set (MDS). Participants were Rhode Island nursing home residents aged :60 years with a diagnosis of Alzheimer's disease or non-Alzheimer's dementia, treated with CHEI monotherapy, and enrolled in the Medicaid program between January 1, 2004, and December 31, 2005. The discontinuation cohort (CHEI-DC) was selected by identifying residents who received 3 to 9 months of uninterrupted CHEI therapy. The continuation cohort (CHEI-CONT) was prescribed continuous CHEI therapy for >9 months. Changes in scores on the Aggressive Behavior Scale (ABS) and the Depression Rating Scale (DRS) for CHEI-DC residents were compared with changes in scores for CHEI-CONT residents. Secondary Outcomes included change over time for individual behavioral symptoms and indicators of cognitive and functional status coded on the MDS.Results: The final matched sample (N = 178) included 62 CHEI-DC cases and 116 CHEI-CONT controls. More than half of the cohort was aged >= 85 years, and the sample was predominantly female. A diagnosis of Alzheimer's disease was documented in 40.3% of the CHEI-DC patients and in 46.5% of the CHEI-CONT patients. Behavioral worsening, indicated by an increase in the estimated mean monthly point change in ABS score, occurred in the CHEI-DC group (0.08; 95% CI, 0.01 to 0.16) but not in the CHEI-CONT group (-0.01; 95% CI, -0.06 to 0.04), and the between-group difference was significant (0.09; 95% CI, 0.01 to 0.18). There were no significant between-group differences in the mean monthly point change in mood symptoms on the DRS (0.04; 95% CI, -0.03 to 0.12). For the secondary outcomes, the mean monthly MDS point change for frequency of repetitive verbal behaviors indicated that CHEI-DC patients exhibited significantly more episodes of repetitive questioning (0.17; 95% CI, 0.05 to 0.29) and repetitive health complaints (0.16; 95% CI, 0.04 to 0.27) compared with CHEI-CONT residents. Continued use of CHEIs was associated with more time spent in leisure-related activities over the Study period (-0.26; 95% CI, -0.50 to -0.02), with the CHEI-DC group spending less time in activities (0.11; 95% CI, 0 to 0.23); the between-group difference was also significant (0.37; 95% CI, 0.10 to 0.65).Conclusion: Results of this retrospective analysis Suggest that, compared with longer duration of CHEI therapy, discontiuation of CHEIs in these nursing home residents with dementia was associated with sonic adverse behavioral changes and decreased time spent engaging in leisure-related activities. (Am J Geriatr Pharmacotber. 2009;7:74-83) (C) 2009 Excerpta Medica Inc.