Drawing on clinical data from more than 450,000 patients, the research adds to growing evidence that incretin-based therapies have protective benefits for the brain.

The study examined GLP-1 receptor agonists, which include such medications as Ozempic, as well as DPP-4 inhibitors.

“These are very promising results,” said Dr. Christel Renoux, associate professor in McGill’s Department of Neurology and Neurosurgery and senior investigator at the Lady Davis Institute. “By measuring factors that were unaccounted for in earlier studies, our results provide more reliable evidence of the potential cognitive benefits.”

Type 2 diabetes increases the risk of dementia by about 60 per cent, and there are few known strategies for reducing the risk, she added. The number of Canadians living with dementia is projected to reach one million by 2030.

Stronger associations with longer use

For about three years, researchers followed patients age 50 or older who were starting the incretin-based therapies and those taking another common diabetes medication, sulfonylureas.

DPP-4 inhibitors were associated with a 23-per-cent lower dementia risk compared with sulfonylureas, which served as a comparison group and are not known to offer cognitive protection. The longer people used the DPP-4 inhibitors, and the higher the dose, the stronger the association became. GLP-1 receptor agonists showed a similar pattern, though with less certainty because fewer patients were using these newer medications.

“While there has been enormous attention on GLP-1 drugs, these findings suggest DPP-4 inhibitors also deserve a closer look,” said Renoux.

Study designed to reduce bias

Earlier studies have pointed to cognitive benefits of incretin-based therapies, but many lacked detailed information on patient health, including the severity of diabetes, a major predictor of dementia on its own. Using richer clinical data from the U.K.’s Clinical Practice Research Datalink, the authors were able to control for these and other factors, yielding a more reliable comparison.

“These results give us solid evidence for something scientists have suspected for some time,” said Renoux. “These drugs may have benefits far beyond blood-sugar control that we are only beginning to understand.”

She noted that longer-term studies will be needed to confirm the results, including in people now using GLP-1 drugs for weight loss.

About the study

“Incretin‑Based Drugs and the Risk of Dementia Among Patients with Type 2 Diabetes” by Yun‑Han Wang and Christel Renoux et al., was published in Drug Safety. The study was funded by a grant from the Canadian Institutes of Health Research.

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While prescriptions for these medications fell from 20% to 16% over the nine-year study period among all Medicare beneficiaries, they continue to be prescribed to individuals with cognitive impairment who are particularly susceptible to these ill effects.

“While this decline was encouraging, over two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021, the end of the study period, suggesting high levels of potentially inappropriate and harmful prescribing,” said senior author Dr. John N. Mafi, associate professor-in-residence of medicine, division of general internal medicine and health services research, at the David Geffen School of Medicine at UCLA. “Compared with patients with normal cognition, we also found higher levels of prescribing among older adults with cognitive impairment, who face a higher risk of adverse effects from these drugs. These results underscore substantial opportunities to improve the quality and safety of care for millions of older Americans.”

For this study, the researchers used survey data from the Health and Retirement Study linked to Medicare fee-for-services claims to trace central nervous system (CNS)-active prescribing patterns between January 1, 2013 through December 31, 2021 of possibly inappropriate CNS-active medications given to older adults with 1) normal cognition, 2) cognitive impairment without dementia, and 3) dementia.

The CNS-active medications studied included five drug classes: antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.

While CNS medications were prescribed for 17% of older adults with normal cognition, nearly 22% of those with cognitive impairment but without dementia were given the drugs. About 25% of the group with dementia were prescribed the CNS-active medications.

Among all Medicare fee-for-service beneficiaries, prescription trends by medication class were as follows:

• Benzodiazepines declined by 11.4% to 9.1%
• Nonbenzodiazepine hypnotics, or sleep drugs, fell from 7.4% to 2.9%

• Antipsychotic medication prescriptions rose from 2.6% to 3.6%
• Prescriptions for anticholinergic antidepressants remained at 2.6% through the study period
• Barbiturate prescriptions fell slightly from 0.4% to 0.3%

Furthermore, clinically justified prescriptions fell from 6% in 2013 to 5.5% in 2021, while likely inappropriately prescribed CNS-active medications saw a significant decline from 15.7% to 11.4%.

The improvement was driven largely by reductions in prescriptions for benzodiazepines and sleep medications as well as in inappropriate prescriptions.

The findings are limited by unavailable Medicare Advantage data, possibly missing clinical information such as agitation, and a focus on prescribing prevalence rather than cumulative exposure.

“While CNS-active prescriptions may be appropriate in some cases, it is important for older patients or their caregivers to work closely with their physicians to ensure that these medications are appropriate to their cases. When inappropriate, patients and their care teams should consider alternative treatments and consider whether it might be safe to taper or stop the medication,” said Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University who led this study as a UCLA internal medicine resident.

Study co-authors are Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa of UCLA; Cheryl Damberg of RAND, and Dr. A. Mark Fendrick of University of Michigan. Ly and Sarkisian are also affiliated with VA Greater Los Angeles Healthcare System.

The National Institutes of Health/National Institute on Aging (R01AG070017-01) funded the study.

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As background, the authors noted, “Metformin, a first-line medication for Type 2 diabetes (T2D), has been suggested to reduce dementia risk. We investigated whether metformin use was associated with lower long-term incidence of dementia and all-cause mortality in obese patients.”

The investigators extracted and analyzed electronic health record data from the TriNetX network.

They categorized 452,777 subjects into four BMI (body mass index) groups (25–29.9, 30–34.9, 35–39.9 and over 40). For each BMI group, they compared data from subjects who had been prescribed metformin with matched controls who had not received the drug.

The endpoints of the study were incidence of dementia and all-cause mortality over a 10-year follow-up period.

They identified 35,784 cases of dementia and 76,048 deaths in the 10-year follow-up period.

They found significant benefits for subjects treated with metformin across all categories of overweight, obesity, and severe obesity, with 8–12% lower risks of dementia and 26–28% lower risks of death compared to untreated subjects.

The authors concluded, “In this large, multi-centre cohort study, metformin use was associated with reduced risks of dementia and all-cause mortality in obese patients. The protective effect was observed across all BMI groups, with variations noted by population. These findings support the potential of metformin in lowering dementia risk in patients with obesity. Further studies are needed to explore the underlying mechanisms.”

“Although our study results are promising for metformin’s effects on dementia and mortality, further research is required to explore the mechanisms involved,” added co-corresponding author Chiehfeng Chen, MD, PhD professor of medicine at Taipai Medical University in Taiwan.

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In research published in JAMA Neurology on April 7, UF researchers studied Medicare claims data of older adults with Type 2 diabetes to assess the association among glucagon-like peptide-1 receptor agonists, or GLP-1RAs, sodium-glucose cotransporter-2 inhibitors, or SGLT2is, and the risk of Alzheimer’s disease and related dementias.

The research is supported by funding from the National Institute on Aging and the National Institute of Diabetes and Digestive and Kidney Diseases, both part of the National Institutes of Health.

The data showed a statistically significant association between a lower risk of Alzheimer’s and the use of GLP-1RAs and SGLT2is compared with other glucose-lowering medications. According to the researchers, the findings indicated that the two drugs may have neuroprotective effects for people without diabetes and may help slow the rate of cognitive decline in Alzheimer’s patients.

Serena Jingchuan Guo, M.D., Ph.D., an assistant professor of pharmaceutical outcomes and policy and the study’s senior author, said these findings may point to new therapeutic uses for drugs commonly used to treat Type 2 diabetes and obesity.

“It’s exciting that these diabetes medications may offer additional benefits, such as protecting brain health,” Guo said. “Based on our research, there is promising potential for GLP-1RAs and SGLT2is to be considered for Alzheimer’s disease prevention in the future. As use of these drugs continues to expand, it becomes increasingly important to understand their real-world benefits and risks across populations.”

Guo conducted this research in collaboration with William Donahoo, M.D., clinical professor and chief of the UF Health Division of Endocrinology, Diabetes and Metabolism, and Steven T DeKosky, M.D., deputy director of the McKnight Brain Institute and professor of Alzheimer’s research, neurology and neuroscience in the UF Department of Neurology. As the study only included patients with Type 2 diabetes, Guo said next steps include evaluating the effects of the two drugs in broader populations by using recent, real-world data that captures their growing use in clinical settings.

“Future research should focus on identifying heterogeneous treatment effects — specifically, determining which patients are most likely to benefit and who may be at greater risk for safety concerns,” Guo said.

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The researchers found that engaging in as little as 35 minutes of moderate to vigorous physical activity per week, compared to zero minutes per week, was associated with a 41% lower risk of developing dementia over an average four-year follow-up period. Even for frail older adults—those at elevated risk of adverse health outcomes—greater activity was associated with lower dementia risks.

The researchers found dementia risk decreased with higher amounts of physical activity. Dementia risks were 60% lower in participants in the 35 to 69.9 minutes of physical activity/week category; 63% lower in the 70 to 139.9 minutes/week category; and 69% lower in the 140 and over minutes/week category.

For their analysis, the researchers analyzed a dataset covering nearly 90,000 adults living in the U.K. who wore smart-watch-type activity trackers.

The study was published online January 15 in the Journal of the American Medical Directors Association.

“Our findings suggest that increasing physical activity, even as little as five minutes per day, can reduce dementia risk in older adults,” says study lead author Amal Wanigatunga, PhD, MPH, assistant professor in the Bloomberg School’s Department of Epidemiology. Wanigatunga is also a core faculty member at the Johns Hopkins Center on Aging and Health and has a joint appointment at the Johns Hopkins University School of Medicine. “This adds to a growing body of evidence that some exercise is better than nothing, especially with regard to an aging-related disorder that affects the brain that currently has no cure.”

Dementia, usually from Alzheimer’s disease, is one of the most common conditions of old age. It is estimated to affect about seven million people in the U.S., including about a third of those who are 85 years or older. Although the risk of dementia rises with age, studies in recent years have suggested that dementia is somewhat preventable, within a normal lifespan, by lifestyle changes that include better control of cholesterol, blood pressure and blood sugar, and being more active.

The minimum amount of activity needed to reduce dementia risk meaningfully isn’t yet clear. For many older individuals, especially frail ones, the high amounts of exercise recommended in official guidelines are unattainable and may discourage any exercise at all. Both the U.S. Department of Health and Human Services and the U.K. National Health System recommend that adults get at least 150 minutes of moderate intensity exercise per week, an average of 20 minutes per day.

For their study, Wanigatunga analyzed data on British adults generated as part of the UK Biobank project, a long-running, ongoing study of approximately 500,000 individuals. The dataset for the new study covered 89,667 adults, mostly in their 50s and older, who used wrist-worn accelerometers to track their physical activity for a week during the period from February 2013 to December 2015. Follow-up of their health status extended for an average of 4.4 years, through November 2021, during which 735 of the participants were diagnosed with dementia.

The analysis compared individuals whose trackers showed some weekly moderate to vigorous physical activity to those whose trackers showed none and accounted for age and other medical conditions. The associations between higher activity and lower dementia risk were striking. Participants in the lowest activity category, ranging from one to 34.9 minutes per week, had an apparent risk reduction of about 41%.

When the researchers took into account participants who met their definitions of frailty or “pre-frailty,” they found that the association between more activity and less dementia was essentially unchanged.

“This suggests that even frail or nearly frail older adults might be able to reduce their dementia risk through low-dose exercise,” Wanigatunga says.

Wanigatunga notes that the study was not a clinical trial that established causation indicating that exercise reduces dementia risk, but its findings are consistent with that hypothesis. To check the possibility that their findings reflected undiagnosed dementia leading to lower physical activity, the researchers repeated their analysis but excluded dementia diagnoses in the first two years of follow-up. The association between more activity and lower dementia risk remained robust.

Wanigatunga and his colleagues recommend that future clinical trial-type studies investigate low-dose exercise as an important initial step towards increasing physical activity as a dementia-preventing strategy.

“Moderate-to-Vigorous Physical Activity at Any Dose Reduces All-Cause Dementia Risk Regardless of Frailty Status” was co-authored by Amal Wanigatunga, Yiwen Dong, Mu Jin, Andrew Leroux, Erjia Cui, Xinkai Zhou, Angela Zhao, Jennifer Schrack, Karen Bandeen-Roche, Jeremy Walston, Qian-Li Xue, Martin Lindquist and Ciprian Crainiceanu.

Funding for the study was provided by the National Institute on Aging (K01 AG076967, R01 AG075883).

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“Antibiotics have been found in previous research to disrupt the gut microbiome, which is the community of tiny organisms that live in our intestines and support digestion,” said  author Andrew T. Chan, MD, MPH, Professor of Medicine at Harvard Medical School, Chief of the Clinical and Translational Epidemiology Unit, and the Program Director for gastroenterology training at Massachusetts General Hospital in Boston, Massachusetts. “Because the gut microbiome has been found to be important for maintaining overall health, and possibly cognitive function, there was concern that antibiotics may have a harmful long-term effect on the brain. Given that older adults are more frequently prescribed antibiotics and are also at higher risk for cognitive decline, these findings offer reassurance about using these medications.”

The investigators enrolled 13,571 healthy subjects over 70 (mean age 75 years, 54.3% female).

Subjects had no cognitive impairment and dementia during the first two years of the study.

The investigators used prescription records to ascertain use of antibiotics. They found that a total of 63% of the subjects were treated with an antibiotics at least once during that two-year period.

They divided the entire study group into two sub-groups, antibiotic users during the two-year period and antibiotic never-users during the same period.

The subjects were also divided into sub-groups according to the number of antibiotic prescriptions they had received in the two years, from 0 to over 5.

The investigators tracked the subjects for an average of 4.7 additional years. During this period, 461 subjects developed dementia and 2,576 people developed cognitive impairment.

At baseline, subjects took cognitive tests. They did so again after one year. The testing was repeated every two years thereafter. The testing showed changes in cognition and memory skills like attention, executive function and language.

Upon comparing the data from antibiotic users and non-users, the investigators concluded, “Compared with nonuse, antibiotic use was not associated with increased risks for dementia.”

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Researchers from Drexel University’s College of Nursing and Health Professions recently published a study in Biological Research For Nursing examining symptoms, health outcomes and physical function over time in older adults with and without Alzheimer’s disease and related dementias and polypharmacy.

Led by Martha Coates, PhD, a postdoctoral research fellow in the College, the research team found that individuals who experiencing polypharmacy and have Alzheimer’s disease and related dementias experience more symptoms, falls, hospitalizations, mortality and had lower physical function – indicating that polypharmacy can also negatively impact quality of life for older adults with Alzheimer’s disease and related dementias.

“The cut-off of point of five or more medications daily has been associated with adverse health outcomes in previous research, and as the number of medications increase the risk of adverse drug events and harm increases,” said Coates.

The research team used a publicly available dataset from the National Health and Aging Trends Study – a nationally representative sample of Medicare beneficiaries in the United States from Johns Hopkins University. Since 2011, data is collected yearly to examine social, physical, technological and functional domains that are important in aging.

For this study, the research team used data from 2016 through 2019 to compare changes in symptoms, health outcomes and physical function among four groups: 1) those with Alzheimer’s disease and related dementias and polypharmacy; 2) those with Alzheimer’s disease and related dementias only; 3) those with polypharmacy only; and 4) those without either Alzheimer’s disease and related dementias or polypharmacy.

Coates explained that the researchers used analytic weights to analyze the data, which generates national estimates, making the sample of 2,052 individuals representative of 12 million Medicare beneficiaries in the U.S., increasing the generalizability of the findings.

“We found that older adults with Alzheimer’s disease and related dementias and polypharmacy experienced more unpleasant symptoms, increased odds of falling, being hospitalized and mortality compared to those without Alzheimer’s disease and related dementias and polypharmacy,” said Coates. “They also experienced more functional decline, required more assistance with activities of daily living like eating, bathing and dressing, and were more likely to need an assistive device like a cane or walker.”

Coates noted that there are tools available to help health care providers review and manage medication regimens for older adults experiencing polypharmacy and possibly taking medications that are potentially inappropriate or no longer provide benefit. However, currently there are no specific tools like that for older adults with Alzheimer’s disease and related dementias.

The findings from this research shed light on the negative impact polypharmacy can have on older adults with Alzheimer’s disease and related dementias. But Coates added that further research is needed to develop strategies to reduce the occurrence of polypharmacy in people with Alzheimer’s disease and related dementias.

“The older adult population is growing in the U.S., with an estimated 80 million individuals over the age of 65 by 2040,” said Coates. “This means that the number of older adults diagnosed with Alzheimer’s disease and related dementias will also increase, and currently there is no cure. Avoiding adverse outcomes related to polypharmacy can improve quality of life and prevent excess disability for older adults with Alzheimer’s disease and related dementias.”

The research team anticipates this study will help guide future analysis of the impact of specific medications on health outcomes in individuals with Alzheimer’s disease and related dementias and that it provides a foundation to support intervention development for medication optimization in older adults with Alzheimer’s disease and related dementias and polypharmacy.

Read the full study here: https://journals.sagepub.com/doi/10.1177/10998004241289942.

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The findings were published on Oct. 24, 2024 in Alzheimer’s and Dementia.

“This new study provides real-world evidence for its impact on Alzheimer’s disease, even though preclinical research has suggested that semaglutide may protect against neurodegeneration and neuroinflammation,” said Rong Xu, PhD, Professor of Biomedical Informatics and Director of the Center for AI in Drug Discovery at Case Western Reserve University School of Medicine in Cleveland, Ohio.

As background, the investigators noted that semaglutide, a glucagon-like peptide receptor (GLP-1R) molecule is also the active component in the diabetes and weight-loss drugs Wegovy and Ozempic.

The investigators conducted emulation target trials, a statistical approach that mimics a randomized clinical trial. They used data from a nationwide database of electronic health records of 116 million US patients.

Comparing semaglutide with seven other antidiabetic medications, they emulated seven target trials with a total of 1,094,761 eligible subjects who had been diagnosed with type 2 diabetes and who had no prior Alzheimer’s disease diagnosis.

They reported that semaglutide was associated with significantly reduced risk for first-time Alzheimer’s disease diagnosis when compared to insulin and with other GLP-1Ras.

“Our results indicate that further research into semaglutide’s use will need to be further investigated through randomized clinical trials so alternative drugs can be tested as potential treatment for this debilitating illness,” Xu said.

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Tanja Wehran and colleagues from the University of Heidelberg, Germany describe the development and pilot testing of an algorithm‑based approach to anticholinergic deprescribing in older patients.

Key elements of the study were:

• Compilation of a list of 85 drugs with anticholinergic effects and 21 algorithms for reduction of anticholinergic load
• Algorithms that proposed alternative drugs with fewer or no anticholinergic side effects
• The inclusion of a test to measure changes in cognitive function after deprescribing – the Neuropsychological Assessment Battery
• A personalised letter to the treating clinician prepared in a standardized way by a clinical pharmacist and a clinical pharmacologist
• Deprescribing recommendations that were implementable without the need for referral to a specialist.

The scheme was tested in a pilot study in patients aged 65 years and older who were taking at least one drug with strong anticholinergic activity.  Strong anticholinergic drugs used by the patients included amitriptyline, biperiden, clozapine, dimenhydrinate, doxepin, fesoterodine, and solifenacin. Patients with diagnosed dementia were excluded as this was unlikely to be reversible. A control group of patients with no anticholinergic load was also included.

Findings

A total of 20 patients included – 11 in the intervention group.  Recommendation letters were issued for nine and the anticholinergic burden was successfully reduced in seven.

The authors report that “there was a significant improvement on the Neuropsychological Assessment Battery memory test between baseline and follow-up assessment in patients with reduced anticholinergic load compared with patients with unchanged medication (6 ± 3 vs. − 1 ± 6 points). In addition, the Neuropsychological Assessment Battery memory score correlated significantly with changes in measured serum anticholinergic activity (SAA)  (difference between baseline and follow-up assessment based on all participants; Pearson r ²  = 0.36, p = 0.03)”

Treating physicians found the approach helpful. The authors note that the team approach and personalisation of letters were important to success of study.

Recommendations

Whilst acknowledging the limitations of such a small pilot study the authors made the following recommendations for future work:

“Future proof-of-principle studies should

(1) enrol patients with cognitive impairment that is likely to be at least partly reversible;

(2) suggest individualized therapy changes that are easy to follow;

(3) communicate the recommendations to the treating physician in a format that makes them easy to understand and implement;

(4) monitor the effect of the intervention with feasible and sensitive instruments; and

(5) use study designs that avoid excessive dropout rates”

Reference

Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA. 2015;175:401–7.

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“Although we’re making progress with the new treatments for Alzheimer’s disease that work to clear amyloid plaques in the brain for people with early stages of the disease, we desperately need treatments that can prevent or delay the development of Alzheimer’s disease,” said author Ruth Brauer, PhD, of the University College in London, UK. “These results are encouraging and warrant further research.”

The authors analyzed retrospectively health records from IQVIA Medical Research Data UK (formerly known as the THIN database). They identified men aged 40 and older who received a new diagnosis of erectile dysfunction between 2000 and 2017.

They excluded men with a prior diagnosis of dementia, cognitive impairment, confusion or prescriptions for treatment of dementia symptoms.

The study included 269,725 subjects. There were 1,119 newly diagnosed subjects with Alzheimer’s disease during a median follow-up of 5.1 years.

Among the subjects treated with erectile dysfunction drugs, 749 developed Alzheimer’s disease, which is a rate of 8.1 cases per 10,000 person-years.

Among those who did not take Alzheimer’s disease drugs, 370 developed Alzheimer’s disease, which is a rate of 9.7 cases per 10,000 person-years.

When the investigators adjusted the findings for other factors that could affect the rate of Alzheimer’s disease onset (age, smoking and alcohol consumption), they noted that users of erectile dysfunction drugs were 18% less likely to develop Alzheimer’s than non-users.

Also, the reduction in Alzheimer’s risk was greatest among subjects issued the most prescriptions for erectile dysfunction drugs during of the study.

“More research is needed to confirm these findings, learn more about the potential benefits and mechanisms of these drugs and look into the optimal dosage,” Brauer said. “A randomized, controlled trial with both male and female participants is warranted to determine whether these findings would apply to women as well.”

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Previous studies, based on data up to 2010, showed that dementia incidence had declined in high-income countries. However, the new research, published in The Lancet Public Health, indicates that dementia incidence started to increase in England and Wales after 2008.

Based on this estimated upward incidence trend, researchers project that the number of people with dementia in England and Wales may be significantly higher than expected in the future.

According to previous research* in England and Wales, the number of people living with dementia was previously predicted to increase by 57% from 0.77 million in 2016 to 1.2 million in 2040.

However, the new research, funded by the UK Economic and Social Research Council, suggests that this figure could be as high as 1.7 million.

Researchers examined nine waves of data from people over the age of 50 and living in private households in England between 2002 and 2019, from the English Longitudinal Study of Ageing (ELSA).

They found that the dementia incidence rate (a measure that considers what percentage of the population in each age group has dementia) decreased by 28.8% between 2002 and 2008. However, it increased again by 25.2% between 2008 and 2016.

A similar non-linear pattern was observed across subgroups according to age, sex, and educational attainment.

Most notably, researchers found that disparities in the rate of dementia incidence was increasing between education groups, as there was both a slower decline in 2002-2008 and a faster increase after 2008 in participants with lower educational attainment.

If the incidence rate increases as fast as what was observed between 2008 to 2016 (a 2.8% increase per year) researchers predict that the number of people with dementia in England and Wales is set to increase to 1.7 million by 2040 – approximately twice the number in 2023. This compares to an estimate of one million people if dementia rates had continued to decline as previously reported.

Lead author, Dr Yuntao Chen (UCL Institute of Epidemiology & Health Care), said: “It is shocking to think that the number of people living with dementia by 2040 may be up to 70% higher than if dementia incidence had continued to decline.

“Not only will this have a devastating effect on the lives of those involved but it will also put a considerably larger burden on health and social care than current forecasts predict.

“Continued monitoring of the incidence trend will be crucial in shaping social care policy.”

Although an increase in dementia cases has often been attributed to an ageing population, the researchers also found that the rate of dementia onset within older age groups is also increasing.

Principal investigator, Professor Eric Brunner (UCL Institute of Epidemiology & Health Care), said: “Our research has exposed that dementia is likely to be a more urgent policy problem than previously recognised – even if the current trend continues for just a few years.

“We have found that not only is the ageing population a major driver of the trend in England and Wales but also the number of people developing dementia within older age groups is increasing.

“We don’t know how long this pattern will continue but the UK needs to be prepared so we can ensure that everyone affected, whatever their financial circumstances, is able to access the help and support that they need.”

James White, Alzheimer’s Society’s Head of National Influencing, commented: “Dementia is the biggest health and social care issue of our time. Statistics from this Lancet Public Health study are a stark reminder that, without action, the individual and economic devastation caused by dementia shows no sign of stopping.

“We know that one in three people born in the UK today will develop this terminal condition in their lifetime. With prevalence on the rise, improving diagnosis has never been more important. Everyone living with dementia must have access to a timely, accurate and specific diagnosis, and who you are or where you live should have no bearing on this. The figures also make it clear that pressure on our already struggling social care system is only going to increase. Quality social care can make a huge difference to people’s lives, but we know that people with dementia – who are the biggest users of social care – are struggling with a care system that’s costly, difficult to access, and too often not tailored to their needs.”

* https://www.bmj.com/content/358/bmj.j2856

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Antipsychotic drugs are not approved for the treatment of dementia—they are mostly used off-label to manage the symptoms that many people with ADRD experience, such as agitation, aggression, and psychosis that are called “behavioral and psychological symptoms of dementia.” In addition, antipsychotics carry considerable risks of serious drug-related adverse events, especially stroke and sudden cardiac death among older adults with ADRD.

When investigators examined information on 6,684 adults aged 65 years and older who were receiving care from a home health care agency in New York in 2019, they found that patients with ADRD were more than twice as likely to use antipsychotics than patients without ADRD (17.2% versus 6.6%). The most commonly used antipsychotic was quetiapine, a drug approved to help manage conditions including schizophrenia, bipolar disorder, and major depressive disorder.

Among patients living with ADRD, predictors of antipsychotic use included having greater limitations in activities of daily living, taking more medications, having behavioral and psychological symptoms, and living alone. Among patients living with ADRD, antipsychotic use was linked with having less improvement in activities of daily living when discharged from home health care.

“Antipsychotic use in persons with dementia is a serious patient safety issue, and it should be regularly reviewed for opportunities of deprescribing—such as dose reduction until discontinuation—whenever possible,” said corresponding author Jinjiao Wang, PhD, RN, of the University of Rochester.

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1111/jgs.18555

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