Senile dementia and pharmacological drugs

Gorzoni, Milton Luiz; Fabbri, Renato Moraes Alves; Pires, Sueli Luciano

doi:10.1590/S1980-57642013DN70200007

ABSTRACT

Side effects and drug interactions are common in the elderly and highly relevant in the demented, being routinely confused with symptoms of cognitive impairment. Which drugs are most consumed by this patient group? Do prescription patterns differ between the demented and non-demented? Objective: To define drug consumption quantitatively and qualitatively in demented (D) and non-demented (ND) elderly. Methods: Patients were divided into men and women, by age group (<80 and ≥80 years), non-demented and demented status, and consumers of ≤3 or >3 drugs. As a criterion comparing groups, the Chi-square (Fisher's exact) test was employed. This study is part of Project No. 405/10 approved by the Ethics Committee of the institution. Results: The sample had a mean age of 81.5±8.8 years, 29 D (21 women and 8 men) and 21 ND (16 women and 5 men), 12 consumers of up to three drugs (7 D and 5 ND) and 38 consumers of 3 medications or more (22 D and 16 ND). The most used drugs among dementia patients were aspirin, angiotensin-converting enzyme inhibitors, statins, selective serotonin reuptake inhibitors, and vitamins. Drugs most consumed by non-demented included vitamins, aspirin, calcium carbonate, proton pump inhibitors, statins and alendronate sodium. There was no statistical significance on any of the comparisons, although the number of elderly consumers of vitamins in the ND had a p-value of 0.06 (Yates). Conclusion: The elderly in this series, regardless of dementia status, gender or age group, had similar drug consumption patterns and used multiple drugs simultaneously.

Key words:
elderly; senile dementia; alzheimer type; pharmaceutical preparations; iatrogenic disease

RESUMO

Iatrogenias, efeitos colaterais e interações medicamentosas são comuns em idosos e altamente relevantes em dementados, onde corriqueiramente as manifestações decorrentes são confundidas com disfunção cognitiva. Quais seriam os medicamentos mais consumidos por esses pacientes? O padrão de prescrição diferiria dos não-dementados? Objetivo: Definir os padrões de consumo medicamentoso, quantitativos e qualitativos em dementados (D) e não-dementados (ND). Métodos: Casuística dividida entre homens e mulheres, por idade (<80 e ≥80 anos), dementados e não-dementados, consumidores de ≤3 ou >3 medicamentos. Como critério comparativo entre grupos, utilizou-se qui-quadrado (teste exato de Fisher). Esse estudo faz parte do Projeto No. 405/10 aprovado pelo Comitê de Ética em Pesquisa da Irmandade da Santa Casa de Misericórdia de São Paulo. Resultados: A Idade média foi de 81,5±8,8 anos, 29 D (21 mulheres e 8 homens) e 21 ND (16 mulheres e 5 homens), 12 consumidores de até 3 medicamentos (7 D e 5 ND) e 38 consumidores de mais de 3 medicamentos (22 D e 16 ND). Os medicamentos mais consumidos entre os dementados foram: ácido acetil salicílico, inibidores da enzima conversora da angiotensina, estatinas, inibidores da recaptação da serotonina e vitaminas. Fármacos mais consumidos entre os não-dementados: vitaminas, ácido acetil salicílico, carbonato de cálcio, inibidores da bomba de prótons, estatinas e alendronato de sódio. Não houve significância estatística nas comparações entre os grupos D e ND, embora o número de idosos ND consumidores de vitaminas apresente p 0,06 (Yates). Conclusão: Na presente casuística, dementados ou não, independentemente do gênero ou da faixa de idade, apresentam padrão medicamentoso semelhante, merecendo ênfase a multiplicidade de fármacos em uso simultaneamente.

Palavras-chave:
idosos; demência senil; medicamentos; iatrogenia

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REFERENCES

The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60:616-623.
Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: The PRISCUS List. Dtsch Arztebl Int 2010;107:543-51.
Gallagher P, O'Mahony D. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria. Age Aging 2008;37:673-679.
Laroche AM, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: A French consensus list. Eur J Clin Pharmacol 2007; 63:725-731.
Fick DM, Cooper JW, Wade WE, Waller JL, MacLean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003;163:2716-2724.
Gouraud-Tanguy A, Berlioz-Thibal M, Brisseau JM, et al. Analyse du risque iatrogène lié à des effets anticholinergiques en utilisant deux échelles en unité d'hospitalisation aiguë gériatrique. Geriatr Psychol Neuropsychiatr Vieil 2012;10:27-32.
Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: The Medical Research Council Cognitive Function and Ageing Study. J Am Geriatr Soc2011;59:1477-1483.
Vanier A, Paille C, Abbey H, Berrut G, Lombrail P, Moret L. Évaluation de la prescription inappropriée chez le sujet âgé pendant l'hospitalisation de soins aigus. Geriatr Psychol Neuropsychiatr Vieil2011;9:51-57.
Bhattacharya R, Chatterjee S, Carnahan RM, Aparasu RR. Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. Am J Geriatr Pharmacother 2011;9:434-441.
American Psychiatric Association - Diagnostic and statistical manual of mental disorders. 4th. ed. Washington (DC): American Psychiatric Association. 1994.
Associação Americana de Psiquiatria - DSM-IV - Manual diagnóstico e estatístico de transtornos mentais. 4ª. ed. Porto Alegra: Artes Médicas; 1995.
Gorzoni ML, Fabbri RMA, Pires SL. Critérios de Beers-Fick e medicamentos genéricos no Brasil. Rev Assoc Med Bras 2008;54:353-356.
Bleich GW, Bleich A, Chiamulera P, Sanches ACC, Schneider DSLG, Teixeira JJV. Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil. São Paulo Med J 2009;127:206-210.
Acursio FA, Silva AL, Ribeiro AQ, Rocha NP, Silveira MR. Complexidade do regime terapêutico prescrito para idosos. Rev Assoc Med Bras2009;55:468-474.
Passarelli MCG, Jacob Filho W. Reações adversas a medicamentos em idosos: como preveni-las? Einstein 2007;5:246-251.
Medeiros-Souza P, Santos-Neto LLS, Kusano LTE, Pereira MG. Diagnosis and control of polypharmacy in the elderly. Rev Saúde Pública 2007;41:1049-1053.
Osborn GG, Saunders AV. Current treatment for patients with Alzheimer disease. J Am Osteopath Assoc 2010;110(9 Suppl 8):S16-S26.
Di Lulio F, Palmer K, Blundo C, et al. Occurrence of neuropsychiatric symptoms and psychiatric disorders in mild Alzheimer's disease and mild cognitive impairment subtypes. Int Psychogeriatr 2010;22:629-640.
Borja B, Borja CS, Gade S. Psychiatric emergencies in the geriatric population. Clin Geriatr Med 2007;23:391-400.
Rock CL. Multivitamin-multimineral supplements: who uses them? Am J Clin Nutr. 2007;85(suppl):277S-279S.
Benedetti TRB, Borges LJ, Petroski EL, Gonçalves LHT. Atividade física e estado de saúde mental de idosos. Rev Saúde Pública2008;42:302-307.
Petroianu A, Capanema HXM, Silva MMQ. Atividade física e mental no risco de demência em idosos. J Bras Psiquiatr 2010;59(4):302-307.
Paula JJ, Schlottfeldt CG, Moreira L, et al. Propriedades psicométricas de um protocolo neuropsicológico breve para uso em populações geriátricas. Rev Psiq Clín 2010;37:246-250.
Huang HY, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med 2006;145:372-385.
Prentice RL. Clinical trials and observational studies to assess the chronic disease benefits and risks of multivitamin-multimineral supplements. Am J Clin Nutr2007;85(suppl):308S-313S.
Yetley EA. Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. Am J Clin Nutr2007;85(suppl):269S-276S.
Gorzoni ML, Fabbri RMA, Pires SL. Medicamentos em uso à primeira consulta geriátrica. Diag Tratamento 2006;11:138-142.
Locatelli J, Lira AR, Torraga LK, Paes AT. Inappropriate medications using the Beers criteria in Brazilian hospitalized elderly patients. Consult Pharm 2010;25:36-40.

Publication Dates

Publication in this collection
Apr-Jun 2013

History

Received
18 Dec 2012
Accepted
15 Mar 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60:616-623.

[2] Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: The PRISCUS List. Dtsch Arztebl Int 2010;107:543-51.

[3] Gallagher P, O'Mahony D. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria. Age Aging 2008;37:673-679.

[4] Laroche AM, Charmes JP, Merle L. Potentially inappropriate medications in the elderly: A French consensus list. Eur J Clin Pharmacol 2007; 63:725-731.

[5] Fick DM, Cooper JW, Wade WE, Waller JL, MacLean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003;163:2716-2724.

[6] Gouraud-Tanguy A, Berlioz-Thibal M, Brisseau JM, et al. Analyse du risque iatrogène lié à des effets anticholinergiques en utilisant deux échelles en unité d'hospitalisation aiguë gériatrique. Geriatr Psychol Neuropsychiatr Vieil 2012;10:27-32.

[7] Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: The Medical Research Council Cognitive Function and Ageing Study. J Am Geriatr Soc2011;59:1477-1483.

[8] Vanier A, Paille C, Abbey H, Berrut G, Lombrail P, Moret L. Évaluation de la prescription inappropriée chez le sujet âgé pendant l'hospitalisation de soins aigus. Geriatr Psychol Neuropsychiatr Vieil2011;9:51-57.

[9] Bhattacharya R, Chatterjee S, Carnahan RM, Aparasu RR. Prevalence and predictors of anticholinergic agents in elderly outpatients with dementia. Am J Geriatr Pharmacother 2011;9:434-441.

[10] American Psychiatric Association - Diagnostic and statistical manual of mental disorders. 4th. ed. Washington (DC): American Psychiatric Association. 1994.

[11] Associação Americana de Psiquiatria - DSM-IV - Manual diagnóstico e estatístico de transtornos mentais. 4ª. ed. Porto Alegra: Artes Médicas; 1995.

[12] Gorzoni ML, Fabbri RMA, Pires SL. Critérios de Beers-Fick e medicamentos genéricos no Brasil. Rev Assoc Med Bras 2008;54:353-356.

[13] Bleich GW, Bleich A, Chiamulera P, Sanches ACC, Schneider DSLG, Teixeira JJV. Frequency of potential interactions between drugs in medical prescriptions in a city in southern Brazil. São Paulo Med J 2009;127:206-210.

[14] Acursio FA, Silva AL, Ribeiro AQ, Rocha NP, Silveira MR. Complexidade do regime terapêutico prescrito para idosos. Rev Assoc Med Bras2009;55:468-474.

[15] Passarelli MCG, Jacob Filho W. Reações adversas a medicamentos em idosos: como preveni-las? Einstein 2007;5:246-251.

[16] Medeiros-Souza P, Santos-Neto LLS, Kusano LTE, Pereira MG. Diagnosis and control of polypharmacy in the elderly. Rev Saúde Pública 2007;41:1049-1053.

[17] Osborn GG, Saunders AV. Current treatment for patients with Alzheimer disease. J Am Osteopath Assoc 2010;110(9 Suppl 8):S16-S26.

[18] Di Lulio F, Palmer K, Blundo C, et al. Occurrence of neuropsychiatric symptoms and psychiatric disorders in mild Alzheimer's disease and mild cognitive impairment subtypes. Int Psychogeriatr 2010;22:629-640.

[19] Borja B, Borja CS, Gade S. Psychiatric emergencies in the geriatric population. Clin Geriatr Med 2007;23:391-400.

[20] Rock CL. Multivitamin-multimineral supplements: who uses them? Am J Clin Nutr. 2007;85(suppl):277S-279S.

[21] Benedetti TRB, Borges LJ, Petroski EL, Gonçalves LHT. Atividade física e estado de saúde mental de idosos. Rev Saúde Pública2008;42:302-307.

[22] Petroianu A, Capanema HXM, Silva MMQ. Atividade física e mental no risco de demência em idosos. J Bras Psiquiatr 2010;59(4):302-307.

[23] Paula JJ, Schlottfeldt CG, Moreira L, et al. Propriedades psicométricas de um protocolo neuropsicológico breve para uso em populações geriátricas. Rev Psiq Clín 2010;37:246-250.

[24] Huang HY, Caballero B, Chang S, et al. The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference. Ann Intern Med 2006;145:372-385.

[25] Prentice RL. Clinical trials and observational studies to assess the chronic disease benefits and risks of multivitamin-multimineral supplements. Am J Clin Nutr2007;85(suppl):308S-313S.

[26] Yetley EA. Multivitamin and multimineral dietary supplements: definitions, characterization, bioavailability, and drug interactions. Am J Clin Nutr2007;85(suppl):269S-276S.

[27] Gorzoni ML, Fabbri RMA, Pires SL. Medicamentos em uso à primeira consulta geriátrica. Diag Tratamento 2006;11:138-142.

[28] Locatelli J, Lira AR, Torraga LK, Paes AT. Inappropriate medications using the Beers criteria in Brazilian hospitalized elderly patients. Consult Pharm 2010;25:36-40.

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