Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026
Characterizing treatment initiation with central nervous system-active polypharmacy among adults with dementia.
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Maust Donovan T, Davis Rachel C, Strominger Julie, Marcus Steven C, Kim Hyungjin Myra, Caverly Tanner, Blow Frederic C, Wallner Lauren P, Krein Sarah, Vordenberg Sarah E
Аннотация
INTRODUCTION: Central nervous system (CNS) -active polypharmacy, defined as concurrent use of antidepressants, antipsychotics, anti-seizure medications, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, opioids, or skeletal muscle relaxants for ≥ 31 consecutive days, poses significant risks patients with dementia.
METHODS: Among community-dwelling patients in Medicare plans aged ≥ 65 with dementia and Medicare Part D coverage in 2021, we determined the rate of CNS-active polypharmacy initiation as well as medication and prescribing clinician characteristics.
RESULTS: Among beneficiaries with dementia (n = 1,214,928, mean age 81.6 years), 7.8% (n = 94,190) experienced incident polypharmacy. Antidepressants were the most frequent class (92.3%), and quetiapine (30.9%), gabapentin (29.0%), and trazodone (28.3%) the top individual medications. At the time of initiation, 43.8% of patients were prescribed all CNS-active medications by a single clinician; primary care clinicians accounted for most polypharmacy prescriptions.
DISCUSSION: Interventions to address polypharmacy should focus on development of guidelines targeting individual prescribers to help clarify appropriate use of CNS-active medications.
METHODS: Among community-dwelling patients in Medicare plans aged ≥ 65 with dementia and Medicare Part D coverage in 2021, we determined the rate of CNS-active polypharmacy initiation as well as medication and prescribing clinician characteristics.
RESULTS: Among beneficiaries with dementia (n = 1,214,928, mean age 81.6 years), 7.8% (n = 94,190) experienced incident polypharmacy. Antidepressants were the most frequent class (92.3%), and quetiapine (30.9%), gabapentin (29.0%), and trazodone (28.3%) the top individual medications. At the time of initiation, 43.8% of patients were prescribed all CNS-active medications by a single clinician; primary care clinicians accounted for most polypharmacy prescriptions.
DISCUSSION: Interventions to address polypharmacy should focus on development of guidelines targeting individual prescribers to help clarify appropriate use of CNS-active medications.