Clinical outcomes and treatment patterns of older adults with dementia-related psychosis by dementia type in the United States.

Autor: Forns J; Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain. jforns@rti.org., Danysh HE; Pharmacoepidemiology and Risk Management, RTI Health Solutions, Waltham, MA, USA., McQuay LJ; Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA., Turner ME; Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA., Dempsey C; Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, Princeton, NJ, USA., Anthony MS; Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA., Demos G; Drug Safety and Pharmacovigilance, ACADIA Pharmaceuticals Inc, San Diego, CA, USA., Layton JB; Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC, USA.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2022 Oct 06; Vol. 22 (1), pp. 784. Date of Electronic Publication: 2022 Oct 06.
DOI: 10.1186/s12877-022-03489-3
Abstrakt: Background: Little is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis. Given that dementia-related psychosis comprises various dementia types, this study describes the incidence of clinical events and treatment patterns by dementia type after patients with dementia are diagnosed with psychosis.
Methods: Adults aged ≥ 65 years with dementia and newly diagnosed with psychosis were identified in US Medicare claims during 2013-2018. Baseline characteristics were evaluated at the time of the psychosis diagnosis. After the initial psychosis diagnosis, incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described for each dementia type (Alzheimer's disease [AD], Parkinson's disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and unspecified dementia). Daily mean cumulative counts were estimated to describe the incidence of recurrent events over time. Mortality was described using Kaplan-Meier survival curves.
Results: We identified 484,520 patients with dementia-related psychosis: mean age, 84 years (standard deviation, 7.8); female, 66%. At the time of psychosis diagnosis, the most prevalent type of dementia was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%), and most patients had scores indicating severe illness on the Charlson Comorbidity Index (71%) and frailty index (62%). Across all dementia types, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections after the initial psychosis diagnosis. Patients with DLB had the highest incidence of most clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all dementia types, and after 5 years, was about 80% among patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia.
Conclusions: Patients with dementia-related psychosis had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest.
(© 2022. The Author(s).)
Databáze: MEDLINE
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