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Potentially inappropriate medication use among patients with Alzheimer disease in the REAL.FR cohort: be aware of atropinic and benzodiazepine drugs!

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

Few studies have investigated potentially inappropriate medication (PIM) use in patients with Alzheimer’s disease (AD). The aim of our study was to assess the prevalence of PIM in community-dwelling patients diagnosed with mild-to-moderate AD and identify the clinical factors associated with PIM prescriptions.

Methods

REAL.FR is a 4-year, prospective, multicenter French cohort of AD patients recruited in centers of expertise. We analyzed patient baseline data at entry into the study. PIMs were assessed using the Laroche list. A multivariate logistic regression was conducted to assess factors associated with PIMs.

Results

A total of 684 AD patients were enrolled in the study [mean age 77.9 ± 6.8 years, 486 (71.0 %) females]. According to the Laroche list, 46.8 % [95 % confidence interval (CI) 43.0–50.5 %] of the patients had at least one PIM. “Cerebral vasodilators” were the most widely used class of PIM, accounting for 24.0 % (95 % CI 20.9–27.3 %) of all prescriptions, followed by atropinic drugs (17.0 %, 95 % CI 14.1–19.8 %) and long half-life benzodiazepines (8.5 %, 95 % CI 6.4–10.6 %). Atropinic drugs were associated with cholinesterase inhibitors in 16 % of patients. In the multivariate analysis, only two factors, namely, female gender [odds ratio (OR) 1.5, 95 % CI 1.1–2.2] and polypharmacy (≥5 drugs; OR 3.6, 95 % CI 2.6–4.5) were associated with prescriptions for PIMs.

Conclusions

These results reveal that approximately one out of two community-dwelling patients with mild-to-moderate AD treated by AD specialists use PIMs. They also indicate that the characteristics of the disease and the pharmacodynamic/pharmacokinetic profile of the drugs prescribed are not sufficiently taken into account by physicians when prescribing for AD patients.

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Acknowledgments

This work was supported by a grant from the Clinical Research Hospital Program from the French Ministry of Health (PHRC No. 98-47N/01-010-01).

REAL.FR Study group:

Principal investigator: Pr. B. Vellas (Toulouse). Associated investigators: Pr. M. Rainfray (Bordeaux), Pr. J.P. Emeriau (Bordeaux), Pr. A. Franco (Grenoble), Pr. F. Pasquier (Lille), Dr. B. Frigard (Lille), Dr. B. Michel (Marseille), Pr. C. Jeandel (Montpellier), Pr. J. Touchon (Montpellier), Pr. P.H. Robert (Nice), Pr. P. Brocker (Nice), Pr. B. Forette (Paris), Dr. L. Lechowski (Paris), Pr. J. Belmin (Paris), Pr. M. Verny (Paris), Pr. F. Forette, Pr. A.S. Rigaud (Paris), Pr. P. Jouanny (Rennes), Dr. S. Belliard (Rennes), Dr. O. Michel (Rennes), Pr. R. Gonthier (Saint Etienne). Study coordinators: S. Gillette-Guyonnet, Pr. F. Nourhashemi, Dr. P.J. Ousset (Toulouse). Epidemiologist: Pr. S. Andrieu (Toulouse). Data Management: C. Cantet (Toulouse).

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Authors and Affiliations

  1. Laboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université de Toulouse, 37 allées Jules-Guesde, 31000, Toulouse, France

    François Montastruc, Maryse Lapeyre-Mestre & Jean-Louis Montastruc

  2. Laboratoire de Santé Publique et d’Economie de la Santé, Faculté de Médecine, Université de Toulouse, Toulouse, France

    François Montastruc, Virginie Gardette & Sandrine Andrieu

  3. Département d’Epidémiologie, d’Economie de la Santé et de Santé Publique, Centre Hospitalier Universitaire (CHU) Toulouse, Toulouse, France

    François Montastruc, Virginie Gardette, Christelle Cantet & Sandrine Andrieu

  4. Service de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU Toulouse, Toulouse, France

    François Montastruc, Maryse Lapeyre-Mestre & Jean-Louis Montastruc

  5. INSERM UMR 1027, Toulouse, France

    Virginie Gardette, Christelle Cantet, Maryse Lapeyre-Mestre, Bruno Vellas, Jean-Louis Montastruc & Sandrine Andrieu

  6. Département de Médecine Interne et de Gériatrie, CHU Toulouse Purpan, Gérontopôle de Toulouse, Université de Toulouse, Toulouse, France

    Antoine Piau & Bruno Vellas

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  1. François Montastruc
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  2. Virginie Gardette
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  3. Christelle Cantet
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  4. Antoine Piau
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  6. Bruno Vellas
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  7. Jean-Louis Montastruc
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REAL.FR Group

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Correspondence to Jean-Louis Montastruc.

Additional information

François Montastruc and Virginie Gardette contributed equally to designing and writing the article, including the references.

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Montastruc, F., Gardette, V., Cantet, C. et al. Potentially inappropriate medication use among patients with Alzheimer disease in the REAL.FR cohort: be aware of atropinic and benzodiazepine drugs!. Eur J Clin Pharmacol 69, 1589–1597 (2013). https://doi.org/10.1007/s00228-013-1506-8

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  • DOI: https://doi.org/10.1007/s00228-013-1506-8

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