Associate Professor The Ohio State University Columbus, United States
Background: Individuals who develop Alzheimer’s disease and related dementia (ADRD) early before age of 65 years are highly comorbid with neuropsychiatric symptoms (e.g., depression, anxiety, and sleep disorder) and conditions (e.g., traumatic brain injury) that contribute to pain, predisposing them to concurrent use of multiple central nervous system (CNS)-active medications. Despite well-established evidence of harms associated with concurrent CNS medication use, little is known about the trends in relevant prescribing patterns among young-onset ADRD.
Objectives: To determine prevalence, trend, and determinants of concurrent use of CNS-active medications among US young adults with ADRD
Methods: We conducted a multi-year, cross-sectional study using 2012-2021 IBM MarketScan Commercial Database. We included patients aged 40 to 64 years with ADRD diagnosis codes in an inpatient or outpatient setting. For each patient, we randomly selected one ADRD diagnosis and required continuous enrollment in healthcare insurance for 12 months before (to measure covariates) and 12 months after the ADRD diagnosis (to measure CNS medication use). The key outcome was the prevalence of use of concurrent use of 2 or more commonly prescribed CNS-active medications (including antipsychotics, antidepressants, benzodiazepines, nonbenzodiazepines, anticonvulsants, CNS stimulants, and opioids) that overlapped for consecutive 30 days. We used multivariable modified Poisson regression models to assess time trends in prevalence and determinants of concurrent CNS-active medication use. All analyses were performed using SAS 9.4 (SAS Institute), using 2-sided tests (α = .05).
Results: Of 42,821 young adults with ADRD, 20.0% were aged less than 50 years, 55.7% were females, and 16.5% were rural residents. Overall, 11.5% of patients had concurrent use of ≥ 2 CNS-active medications in the 12 months after ADRD diagnosis, with the proportion significantly increasing between 2013 and 2020 (adjusted prevalence relative ratio, 4.04; 95% CI, 3.53-4.62). Concomitant use of 2 or more antidepressants was most common, followed by the drug combination of antidepressants and opioids. Characteristics associated with concurrent CNS medication use included being female, rural residents, living in Southern US, and having mental disorders, chronic pain, seizure, substance use disorder, and hypertension.
Conclusions: In this US commercially insured young adults aged 40-64 with ADRD, concurrent use of CNS medications was common and increased by 4 folds between 2013 to 2020. Further research is needed to understand how concurrent CNS medication use in early adulthood among patients with young-onset ADRD may impact health outcomes later in their older adulthood.
