Impact of deprescribing AChEIs on aggressive behaviors and antipsychotic prescribing

Alzheimers Dement. 2020 Apr;16(4):630-640. doi: 10.1002/alz.12054. Epub 2020 Feb 13.

Abstract

Introduction: We evaluated the impact of deprescribing acetylcholinesterase inhibitors (AChEIs) on aggressive behaviors and incident antipsychotic use in nursing home (NH) residents with severe dementia.

Methods: We conducted a retrospective study of Medicare claims, Part D, Minimum Data Set for NH residents aged 65+ with severe dementia receiving AChEIs in 2016. Aggressive behaviors were measured using the aggressive behavior scale (ABS; n = 30,788). Incident antipsychotic prescriptions were evaluated among antipsychotic non-users (n = 25,188). Marginal structural models and inverse probability of treatment weights were used to evaluate associations of AChEI deprescribing and outcomes.

Results: The severity of aggressive behaviors was low at baseline (mean ABS = 0.5) and was not associated with deprescribing AChEIs (0.002 increase in ABS, P = .90). Incident antipsychotic prescribing occurred in 5.1% of residents and was less likely with AChEI deprescribing (adjusted odds ratio = 0.52 [0.40-0.68], P <.001]).

Discussion: Deprescribing AChEIs was not associated with a worsening of aggressive behaviors or incident antipsychotic prescriptions.

Keywords: Medicare; cholinesterase inhibitor; dementia; deprescribing; long term care; nursing home; pharmacoepidemiology.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aggression / drug effects*
  • Antipsychotic Agents / adverse effects*
  • Cholinesterase Inhibitors / adverse effects*
  • Dementia / complications
  • Dementia / drug therapy
  • Deprescriptions*
  • Female
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • Male
  • Medicare
  • Nursing Homes
  • Retrospective Studies
  • United States

Substances

  • Antipsychotic Agents
  • Cholinesterase Inhibitors