Cardiometabolic and anticholinergic medications fell slightly when people were diagnosed with dementia, while drugs affecting the central nervous system (CNS) increased, according to a new study.
Findings indicate that being diagnosed with dementia may be an “underused clinical opportunity” to reduce medications with high safety risk, unknown or limited benefit, and those that may further impact cognitive abilities. The study was published Aug. 21 in JAMA Internal Medicine.
Cardiometabolic medicines include those for diabetes, while anticholinergic drugs can stop involuntary muscle movements. CNS-active drugs include benzodiazepines, opioids, tricyclic antidepressants and some traditional antipsychotics.
Researchers looked at 266,675 Medicare Part D beneficiaries with incident dementia and compared them to 266,675 controls. All of the people were 67 and older. Those with dementia were diagnosed between 2012 and 2018.
When the study began, people with incident dementia were more likely to use CNS-active medications and anticholinergic medications compared to people without dementia. They were less likely to use most cardiometabolic medications. After being diagnosed, however, the people with dementia experienced an increase in the mean number of medications used.
In people diagnosed with dementia, the use of CNS-active medications rose by 2.65% due to increased use of antipsychotics, antidepressants and antiepileptics. Meanwhile, they had a slightly greater decline in using anticholinergic medications and most cardiometabolic medications. One year after diagnosis, 75.2% of the cohort with dementia were using five or more medications, a 2.8% increase, and 30.8% of the people with dementia were on 10 or more drugs, a 1.3% increase.
People were more likely to start CNS-active medications and slightly more likely to stop cardiometabolic and anticholinergic medications compared to people without dementia.
“These findings suggest missed opportunities to reduce burdensome polypharmacy by deprescribing long-term medications with high safety risks or limited likelihood of benefit or that may be associated with impaired cognition,” the authors said.
