(101) Concurrent Use of Central Nervous System-Acting Medications and Risk for Inpatient Psychiatric and Skilled Nursing Facility Admission Among Young-onset Alzheimer’s Patients
Graduate Research Associate The Ohio State University, United States
Background: Individuals who develop Alzheimer’s Disease before age of 65 years—Young-Onset Alzheimer’s Disease (YOAD) are highly comorbid with stroke, epilepsy, and mental health disorders, requiring central nervous system (CNS)-acting medications. Concurrent use of these CNS-acting medications may cause additional harm (e.g., injury and hospitalization) that may accelerate the chance of YOAD to costly medical institutionalization, such as inpatient psychiatric facility (IPF), skilled nursing facility (SNF), and assisted daily living (ADL) facilities. However, scarce studies have examined to what extent concurrent use of CNS-acting medication contributes to the risk of IPF and SNF.
Objectives: This retrospective cohort study aims to examine the association between the concurrent use of CNS-acting medications and risk for IPF and SNF or ADL admission among patients with YOAD.
Methods: We utilized 2012-2021 IBM® MarketScan® Commercial Database to identify patients aged 40-64 years with at least two Alzheimer’s disease and related dementia (ADRD) diagnosis codes in an inpatient or outpatient setting. After cohort entry, everyone was assigned an index date defined as the date of the first eligible ADRD diagnosis with continuous enrollment in medical and drug insurance for 1 year before the diagnosis (to measure baseline covariates) and 1 year after the diagnosis (to measure exposure). Exposure was concurrent use of ≥2 commonly prescribed CNS-acting medications (including antipsychotics, antidepressants, benzodiazepines, nonbenzodiazepines, anticonvulsants, CNS stimulants, and opioids) that overlapped for consecutive 30 days measured 6 months from the index date. Outcomes included the first admission to IPF and SNF or ADL, which were analyzed separately, during follow-up. Individuals were followed from the end of the 1-year exposure assessment period until the earliest date of an outcome event, insurance disenrollment, or study end (12 months after the end of the exposure assessment period). We used Cox proportional hazards modeling with inverse probability treatment weighting to compare the risk of IPF and SNF or ADL admission between concurrent and non-concurrent users of CNS medications.
Results: We identified 21,610 patients with YOAD with 32,289 eligible episodes. Concurrent use of CNS-acting medications was observed in 13% of patients in both cohorts. The incidence rate of IPF and SNF or ADL admissions during follow-up was 6.69 and 29.94 per 1000 patient-years. Compared to patients with YOAD who had non-concurrent use of ≥2 CNS-acting medications, those with concurrent use had 2.09 times (95% CI:1.70,2.56) higher risk for IPF admission and 1.89 times (95% CI:1.72,2.08) for SNF or ADL admission.
Conclusions: In these commercially insured YOAD patients, concurrent use of CNS-acting medications was associated with an increased risk of IPF and SNF or ADL admissions. Deprescribing CNS-acting medications may help reduce the risk of early institutionalization among YOAD.
