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CNS-Active Polypharmacy Examined in Seniors With Dementia

WEDNESDAY, March 10, 2021 -- A total of 13.9 percent of community-dwelling older adults with dementia meet the criterion for central nervous system (CNS)-active polypharmacy, according to a study published in the March 9 issue of the Journal of the American Medical Association.

Donovan T. Maust, M.D., from the University of Michigan in Ann Arbor, and colleagues examined the extent of CNS-active polypharmacy among 1,159,968 community-dwelling older adults with dementia in the United States. CNS-active polypharmacy was defined as exposure to three or more medications for longer than 30 days from the following drug classes: antidepressants, antipsychotics, antiepileptics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics, and opioids.

Of the participants, 13.9 percent met the criterion for CNS-active polypharmacy (32,139,610 polypharmacy-days of exposure). The researchers found that the median number of polypharmacy-days was 193 among those who met the criterion for CNS-active polypharmacy. Of those with CNS-active polypharmacy, 57.8 and 6.8 percent were exposed for longer than 180 days and for 365 days, respectively; 29.4 and 5.2 percent were exposed to five or more medications and five or more medication classes, respectively. Of the polypharmacy-days, 92.0, 47.1, and 40.7 percent included an antidepressant, antipsychotic, and benzodiazepine, respectively. The most common medication was gabapentin, which was associated with 33.0 percent of polypharmacy-days.

"It's important for family members and providers to communicate often about what symptoms are happening, and what might be done with nonmedication interventions such as physical therapy or sleep hygiene, as well as medications, to address them," Maust said in a statement.

One author disclosed financial ties to the pharmaceutical industry.

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