Antidementia Drugs Delay Nursing Home Admission

Fran Lowry

October 11, 2011

October 11, 2011 — The use of antidementia drugs may give patients an extra year at home and delay admission to nursing homes, new research confirms.

The finding itself is not new, lead author Emad Salib, MD, honorary senior lecturer at Liverpool University, United Kingdom, and a consultant in old age psychiatry who is currently in private practice, told Medscape Medical News.

"This has been shown previously in the United States mainly, and perhaps in one study from Australia, but these studies were supported by drug companies. This British study is the first one which is not related to any drug company," Dr. Salib said.

The article appears in the October issue of The Psychiatrist.

Longer Survival

Dr. Salib and coauthor Jessica Thompson, MD, from Peasley Cross Hospital, St. Helens, United Kingdom, compared 127 patients who were prescribed cholinesterase inhibitors in 2006 with 212 patients who were not to see whether they had been placed in care or had remained in their own home during a 4-year period.

All patients were seen at a clinic that provided psychiatric services for the elderly. Participants' mean age was 82 years; 219 (65%) were women, and 120 (35%) were men.

The most commonly prescribed cholinesterase inhibitor was donepezil, which was given to 74% of patients, followed by galantamine in 14%, and rivastigmine in 8%. Four percent of patients received memantine in combination with a cholinesterase inhibitor.

A diagnosis of probable Alzheimer's disease was made in 56% of the patients, 34% had a diagnosis of dementia possibly combined with Alzheimer's disease, and the remaining 10% had a diagnosis of Parkinson's disease-related dementia, Lewy body dementia, or other dementias.

In addition, patients who were not prescribed cholinesterase inhibitors had diagnoses that included senile dementia of Alzheimer's type, early-onset dementia, and dementia of combined etiology.

The mean survival from the time patients were first seen at the clinic was 33 months, and the mean survival time in a care home was 18 months.

The authors found that during the first 30 months of follow-up there was a delay in care home placement by a median of 12 months in those patients who took cholinesterase inhibitors compared with those who did not.

They also found that of the patients who remained at home throughout the study period, significantly more individuals who took cholinesterase inhibitors were alive at the end of the study period compared with those who did not (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 - 3.4; P < .01).

"Immense Implications"

A similar association was seen in those who entered a nursing home during the study period, but it did not reach statistical significance (OR, 1.5; 95% CI, 0.3 - 11; P = .07).

By 40 months, the probability of being placed in a nursing home was similar for both groups.

Treating patients who exhibit early signs of dementia with cholinesterase inhibitors has immense implications, Dr. Salib said.

"Treatment daily with drugs like Aricept would cost £2 a day, so in a year it will cost about £700. A year in a nursing home will cost £25,000, so if I delay admission to a nursing home by using drugs, this means enormous savings, not just in money but in emotions and stress," he said.

Dr. Salib also pointed out that his study was observational and needs to be replicated using a larger sample of patients.

"The major deficiency here is the controls were not matched. Every case should be matched with controls, but if you select controls this way you will deprive people of treatment. So the matching wasn't perfect, but it was the best I could do," he said.

Support for Early and Consistent Use

Commenting on this study for Medscape Medical News, Anton P. Porsteinsson, MD, William B. and Sheila Konar professor of psychiatry and director, Alzheimer's Disease Care, Research and Education Program at University of Rochester School of Medicine and Dentistry, New York, called it a strong study, despite its limitations.

"A cautious interpretation of this study is that in an observational sample it appears that consistent use of cholinesterase inhibitors is associated with temporary delay in admission to a nursing home, and as published previously, more patients on the drugs were alive at the end of the 4-year observation period," Dr. Porsteinsson said.

"While there might be subtle differences between the groups that could explain the findings, they nevertheless support early and consistent use of these medications and suggest that there may be benefits beyond the short term," he said. "The fact that this is a community based observational study, independent of pharmaceutical company support, is a strength."

Dr. Salib and Dr. Porsteinsson have reported no relevant financial relationships.

Psychiatrist. 2011;35,384-388. Abstract

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