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Objectives To assess the effectiveness of medications used in the management of Alzheimer's disease and related dementias ( ADRD) on cognition and activity of daily living ( ADL) trajectories and to determine whether sex modifies these effects. Design Two-year (2007-2008) longitudinal study. Setting Medicare enrollment and claims data linked to the Minimum Dataset 2.0. Participants Older nursing home ( NH) residents with newly diagnosed ADRD (n = 18,950). Measurements Exposures included four medication classes: antidementia medications ( ADMs), antipsychotics, antidepressants, and mood stabilizers. Outcomes included ADLs and cognition (Cognitive Performance Scale ( CPS)). Marginal structural models were employed to account for time-dependent confounding. Results The mean age was 83.6, and 76% of the sample was female. Baseline use of ADMs was 15%, antidepressants was 40%, antipsychotics was 13%, and mood stabilizers was 3%. Mean baseline ADL and CPS scores were 16.6 and 2.1, respectively. ADM use was not associated with change in ADLs over time but was associated with a slower CPS decline (slope difference: −0.09 points/year, 99% confidence interval ( CI) = −0.14 to −0.03). Antidepressant use was associated with slower declines in ADL (slope difference: −0.36 points/year, 99% CI = −0.58 to −0.14) and CPS (slope difference: −0.12 points/year, 99% CI = −0.17 to −0.08). Sex modified the effect of both antipsychotic and mood stabilizer use on ADLs; female users declined most quickly. Antipsychotic use was associated with slower CPS decline (slope difference: −0.11 points/year, 99% CI = −0.17 to −0.06), whereas mood stabilizer use had no effect. Conclusion Despite the observed statistically significantly slower declines in cognition with ADMs, antidepressants, and antipsychotics and the slower ADL decline found with antidepressants, it is unlikely that these benefits are of clinical significance. [ABSTRACT FROM AUTHOR]

Objectives To describe population-based use of cognitive-enhancing and psychopharmacological medications across care settings in Medicare beneficiaries with dementia. Design One-year (2008) cross-sectional study. Setting Medicare administrative claims from a 5% random sample. Participants Medicare beneficiaries with dementia aged 65 and older with continuous Medicare Parts A, B, and D coverage and alive throughout 2008. To ascertain dementia, one or more medical claims with a dementia International Classification of Diseases, Ninth Revision, Clinical Modification code was required before 2008, and an additional claim was required in 2008 to confirm active disease. Measurements Use of medications commonly prescribed in managing dementia (cognitive enhancers, antidepressants, antipsychotics, and mood stabilizers) was assessed using three measures: annual prevalence of use, consistency of use, and count of psychopharmacological medication classes. Care setting was determined using the number of months of nursing home ( NH) residency: no NH (0 months), partial NH (1-11 months), and full NH (12 months). Results Community-dwellers represented 41.3% of the cohort, whereas 42.4% and 16.3% resided partially and fully in a NH, respectively. Annual prevalence of use was 57.1% for cognitive enhancers, 56.4% for antidepressants, 34.0% for antipsychotics, and 8.8% for mood stabilizers. Cognitive enhancer use was significantly lower in those with any NH stay (partial NH vs no NH, adjusted prevalence ratio ( APR) = 0.84, 99% confidence interval ( CI) = 0.83-0.86; full NH vs no NH, APR = 0.83, 99% CI = 0.81-0.85). In contrast, those with any NH residence had significantly higher use of all psychopharmacological medication classes than community-dwellers. More than half the cohort had consistent medication regimens during 2008 (64.8%). The number of psychopharmacological medication classes used increased with increasing NH stay duration. Conclusion This population-based study documents significant differences in medication use for managing dementia between care settings and substantial use of psychopharmacological medications in older adults with dementia. [ABSTRACT FROM AUTHOR]