Trial lecture over a chosen topic - time and place
27.10.2022, 15.00, Auditorium 1, Helga Eng
Falls in people with dementia; Risk factors and prevention strategies with special focus on drug use
Trial lecture over a given topic - time and place
28.10.2022, 10.15, Auditorium 2, Helga Eng
How anticholinergic properties of drugs are measured. The use of anticholinergic burden scales and of serum anticholinergic activity
Conferral summary
Anne Sverdrup Efjestad har i sin avhandling vist at personer med Alzheimers demens får forskrevet legemidler mot depresjon og psykose før de får en demensdiagnose og behandling med antikolinesterase. Det kan tyde på at psykiatriske symptomer ved Alzheimers sykdom er et tidlig tegn. Uhensiktsmessig komedisinering med slike nervemedisiner førte til tidlig avbrekk i behandling med antikolinesterase og økt risiko for bivirkninger og interaksjoner.
Main research findings
Comedication with psychotropics and analgesics in patients treated with acetylcholinesterase inhibitors (AChEIs) was studied prior to- and after start of AChEIs which was a surrogate measure of the dementia diagnosis due to Alzheimer’s disease. Data from the Norwegian Prescription Database was used. Co-prescribing with potentially unfavourable medications like anticholinergic agents that may counteract or limit the clinical effect of the AChEI was common. Patients being prescribed antipsychotics were more likely to stop AChEI treatment early. The use of antidepressants and antipsychotics increased before and after initiation of AChEIs, indicating that behavioural and psychological symptoms of dementia occur in an early- or preclinical phase of Alzheimer´s disease. A low use of opioids may indicate an undertreatment of pain. Women were prescribed more psychotropics and analgesics than men, except for antipsychotics, and were more often subjected to polypharmacy. A large proportion of the patients were prescribed drugs that have the potential to increase heart related adverse effects of the AChEIs, like bradycardia. Inappropriate drugs should be avoided in patients in a predementia or dementia stage, especially in the oldest age groups. Pain should be detected and treated as early as possible. Co-prescribing of drugs which could increase heart related adverse effects of the AChEI should be monitored closely.