People with dementia sometimes experience associated behavioural and psychological symptoms (BPSD). These are sometimes treated with antipsychotic drugs (APDs) and antidepressants (ADDs) although little is known about how long they are used for, and if treatment is discontinued whether they are reintroduced soon afterwards or alternative drugs are used. We also don't know if certain factors can predict if someone will be prescribed an APD or ADD, for example if they are male or female. It is important to know this to help us understand if these medications are used in an appropriate way. Some research has suggested that people with dementia who use APDs might have a higher risk of stroke, than people who do not use APDs. We are going to look at whether this is the case, and also look at the risk of death and other conditions including heart problems, infection, fractures, and acute kidney injury. We will determine how much this costs in relation to their hospital admissions and GP appointments which will give us an indication of how much could be saved if stroke was prevented.
Our aims are to explore the treatment patterns for medications prescribed for the Behavioural and Psychological Disorders (BPD) associated with dementia and to examine adverse outcomes associated with antipsychotic use (APD). We will delineate a prevalent cohort of patients with a diagnosis of dementia, and examine medication utilisation including APD dose, persistence and switching to alternative treatments, and antidepressant use (ADD). We will also determine factors which influence this use, using regression analysis. From the dementia cohort, we will use stratified cox-proportional hazards models to estimate hazard ratios (HR) for each of the specified outcomes including death, stroke, cardiovascular disease, venous thromboembolism, infection, fracture, and acute kidney injury; for APD use versus non-use. We will additionally use the findings to inform the parameters of an economic model, estimate the costs associated with this outcome in APD use and not use; and map primary and secondary health care utilisation with associated costs, related to this outcome.
Mortality
- Myocardial infarction
- Congestive heart failure
- Stroke or Transient Ischaemic Attack
- Pulmonary embolism or Venous thromboembolism
- Hip fracture
- Serious infection
- Secondary care utilisation
- Cardiac arrhythmia
- Primary care utilisation
Additional outcomes (Feb 2022): acute kidney injury (AKI); combined appendicitis, cholecystitis, and pancreatitis (as controlled outcomes). Please see the Appendix for code lists for these outcomes.
Darren Ashcroft - Chief Investigator - University of Manchester
Pearl Mok - Corresponding Applicant - University of Manchester
Bruce Guthrie - Collaborator - University of Edinburgh
Georgios Gkountouras - Collaborator - University of Manchester
Jill Stocks - Collaborator - University of Manchester
Matthew Carr - Collaborator - University of Manchester
Rachel Elliott - Collaborator - University of Manchester
Thomas Allen - Collaborator - University of Manchester
Tjeerd van Staa - Collaborator - University of Manchester
Tony Avery - Collaborator - University of Nottingham
Hayley Gorton - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation