Symptomatic and preventive medication use in communitydwelling older people with and without Alzheimer's disease.

Abstract

Introduction: Priorities of care among people with Alzheimer's disease (AD) may transition from prevention of chronic diseases to focus on symptomatic care for better quality of life. This study aimed to investigate longitudinal changes in symptomatic and preventive medication use among community-dwelling people with and without AD five years pre-and post-diagnosis. Method(s): Retrospective matched cohort study comprising 58,496 people with AD and 58,496 people without AD in Finland from 2005-2010. Prevalence of symptomatic and preventive medication use were evaluated every six months from five years pre-to postdiagnosis and further stratified by age and sex. Result(s): Among people with AD, the prevalence of both symptomatic and preventive medications increased from five years before until the time of diagnosis. This increase was most pronounced in the oldest age group (>= 85 years) in comparison to younger age groups. After diagnosis, symptomatic medication use plateaued over the next five years, while preventive medication use gradually declined. While most symptomatic medication classes became less prevalent after AD diagnosis, use of paracetamol, antipsychotics, proton pump inhibitors, and opioids increased continuously post-diagnosis. Prevalence of preventive medication classes including antidepressants, calcium supplements, beta-blockers, and statins decreased following AD diagnosis. In contrast, people without AD had a continuous increase for both medication categories throughout the 10-year period. Conclusion(s): AD diagnosis is the key timepoint for change in symptomatic and preventive medication use. The time of AD diagnosis prompts for regular medication reviews to re-evaluate the appropriateness of each nominated treatment and better align regimens to individual priorities of care.