항정신병 약물 사용 및 치매의 심리행동 증상과 알츠하이머 환자의 인지능력 저하와의 연관성
Association of Antipsychotics and Behavioral and Psychological Symptoms of Dementia With Cognitive Decline in Subjects With Alzheimer’s Disease
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: Neuropsychiatric symptoms are common among patients with major neurocognitive disorder. Antipsychotic medications have been widely used to manage behavioral and psychological symptoms of dementia (BPSD), however efficacy and safety of these agents are conflicting. In this study, we tried to overview the association of antipsychotic medication use and neuropsychiatric symptoms with cognitive decline in patients with Alzheimer’s disease. Methods: We reviewed the medical charts of patients who were diagnosed as major neurocognitive disorder due to Alzheimer’s disease from November 2014 to October 2015. We reviewed whether the subjects had used antipsychotics, and whether patients had neuropsychiatric symptoms. We used linear mixed models to examine the statistical difference between each group. Results: Total of 106 subjects were included in the study. There was no statistically significant difference in cognitive function decline (Korean Version of Mini-Mental State Examination score change) between subjects with or without BPSD (p=0.62), and between subjects with or without antipsychotic medication (p=0.09). Conclusion: There was no evidence that antipsychotic medication and BPSD are associated with more cognitive decline. Findings imply that neuropsychiatric symptoms and cognitive impairment come from different etiologic causes, which highlights the heterogeneity of the disorder. Clinician should decide whether to use antipsychotic medication while carefully considering the effect and side effects of antipsychotic medication throughout the treatment period.
Abstract
Objective: Neuropsychiatric symptoms are common among patients with major neurocognitive disorder. Antipsychotic medications have been widely used to manage behavioral and psychological symptoms of dementia (BPSD), however efficacy and safety of these agents are conflicting. In this study, we tried to overview the association of antipsychotic medication use and neuropsychiatric symptoms with cognitive decline in patients with Alzheimer’s disease. Methods: We reviewed the medical charts of patients who were diagnosed as major neurocognitive disorder due to Alzheimer’s disease from November 2014 to October 2015. We reviewed whether the subjects had used antipsychotics, and whether patients had neuropsychiatric symptoms. We used linear mixed models to examine the statistical difference between each group. Results: Total of 106 subjects were included in the study. There was no statistically significant difference in cognitive function decline (Korean Version of Mini-Mental State Examination score change) between subjects with or without BPSD (p=0.62), and between subjects with or without antipsychotic medication (p=0.09). Conclusion: There was no evidence that antipsychotic medication and BPSD are associated with more cognitive decline. Findings imply that neuropsychiatric symptoms and cognitive impairment come from different etiologic causes, which highlights the heterogeneity of the disorder. Clinician should decide whether to use antipsychotic medication while carefully considering the effect and side effects of antipsychotic medication throughout the treatment period.
참고문헌 (25)
- Porsteinsson AP, "Neuropsychiatric symptoms in dementia: a cause or consequence?", Am J Psychiatry, 172, pp.410~411 (2015)
- Connors MH, "Psychosis and clinical outcomes in Alzheimer disease : a longitudinal study", Am J Geriatr Psychiatry, 26, pp.304~313 (2018)
- Smeets CH, "Efficacy of antipsychotics in dementia depended on the definition of patients and outcomes : a meta-epidemiological study", J Clin Epidemiol, 101, pp.17~27 (2018)
- Masopust J, "Treatment of behavioral and psychological symptoms of dementias with psychopharmaceuticals : a review", Neuropsychiatric Dis Treat, 14, pp.1211~1220 (2018)
- Maust DT, "Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm", JAMA psychiatry, 72, pp.438~445 (2015)
- Taipale H, "20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20)", World Psychiatry, 19, pp.61~68 (2020)
- Vigen CL, "Cognitive effects of atypical antipsychotic medications in patients with Alzheimer’s disease : outcomes from CATIE-AD", Am J Psychiatry, 168, pp.831~839 (2011)
- Wilson RS, "Hallucinations, delusions, and cognitive decline in Alzheimer’s disease", J Neurol Neurosurg Psychiatry, 69, pp.172~177 (2000)
- Wolf A, "Do antipsychotics lead to cognitive impairment in dementia? A meta-analysis of randomised placebocontrolled trials", Eur Arch Psychiatry Clin Neurosci, 267, pp.187~198 (2017)
- Folstein MF, ""Mini-mental state" : a practical method for grading the cognitive state of patients for the clinician", J Psychiatr Res, 12, pp.189~198 (1975)
- Kwon YC, "Korean Version of Mini-Mental State Examination(MMSE-K)part I : developement of the test for the elderly", J Korean Neuropsychiatr Assoc, 28, pp.125~135 (1989)
- Hughes CP, "A new clinical scale for the staging of dementia", Br J Psychiatry, 140, pp.566~572 (1982)
- Lopez OL, "Predicting cognitive decline in Alzheimer’s disease : an integrated analysis", Alzheimers Dement, 6, pp.431~439 (2010)
- Ehrenberg AJ, "Neuropathologic correlates of psychiatric symptoms in Alzheimer’s disease", J Alzheimers Dis, 66, pp.115~126 (2018)
- Peters ME, "Neuropsychiatric symptoms as predictors of progression to severe Alzheimer’s dementia and death : the Cache County Dementia Progression Study", Am J Psychiatry, 172, pp.460~465 (2015)
- Garre-Olmo J, "Grouping and trajectories of neuropsychiatric symptoms in patients with Alzheimer’s disease. Part II: two-year patient trajectories", J Alzheimers Dis, 22, pp.1169~1180 (2010)
- Gottesman RT, "Behavioral and psychiatric symptoms of dementia and rate of decline in Alzheimer’s disease", Front Pharmacol, 10, pp.1062~ (2019)
- Geda YE, "Neuropsychiatric symptoms in Alzheimer’s disease : past progress and anticipation of the future", Alzheimers Dement, 9, pp.602~608 (2013)
- Keefe RS, "The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia : a review and meta-analysis", Schizophr Bull, 25, pp.201~222 (1999)
- Maher AR, "Efficacy and comparative effectiveness of atypical antipsychotic medications for off-label uses in adults : a systematic review and meta-analysis", JAMA, 306, pp.1359~1369 (2011)
- Koponen M, "Long-term use of antipsychotics among community-dwelling persons with Alzheimer’s disease : a nationwide register-based study", Eur Neuropsychopharmacol, 25, pp.1706~1713 (2015)
- Yunusa I, "Assessment of reported comparative effectiveness and safety of atypical antipsychotics in the treatment of behavioral and psychological symptoms of dementia : a network meta-analysis", JAMA Netw Open, 2, pp.e190828~ (2019)
- Brodaty H, "Antipsychotic deprescription for older adults in long-term care : the HALT study", J Am Med Dir Assoc, 19, pp.592~600.e7 (2018)
- Gareri P, "Use and safety of antipsychotics in behavioral disorders in elderly people with dementia", J Clin Psychopharmacol, 34, pp.109~123 (2014)
- Declercq T, "Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia", Cochrane Database Syst Rev, (3), pp.CD007726~ (2013)