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Background Antipsychotics have been associated with aspiration pneumonia in older people. However, epidemiologic evidence of the association between antipsychotic drug use and pneumonia is limited. Purpose To investigate the association between antipsychotic exposure and aspiration pneumonia during hospitalisation in a large older population. Material and methods Retrospective cross-sectional study. We included all hospitalisations between January 2013 and December 2017 of patients aged from 65 to 85 years. Aspiration pneumonia was defined according to the discharge diagnosis codes of the International Classification of Diseases 9 and 10 and antipsychotic use as any pharmacy charge for an antipsychotic medication. Results Our cohort included 1 06 552 hospitalisations of patients from 65 to 85 years (medium age 74.86±10.61 years; 58% female). Aspiration pneumonia occurred in 1291 (1.2%) hospitalisations. Antipsychotics were used in 4484 (4.2%) hospitalisations. The incidence of aspiration pneumonia was 0.6% (612 patients) in patients not taking antipsychotics and 0.9% (41 patients) in those taking antipsychotics (OR=1.5, 95% CI 1.0 to 2.1). The magnitude of the association was only a little bit higher for typical (OR=1.6, 95% CI: 0.94 to 2.2) rather than atypical (OR=1.4, 95% CI: 1.0 to 2.0) antipsychotics. Conclusion The use of either typical or atypical antipsychotics in older people is modestly associated with increased risk for aspiration pneumonia. Clinicians who prescribe antipsychotics should closely monitor patients for pneumonia, should consider the lowest possible dose of the antipsychotic for the shortest possible time and it should be stopped when the patient stabilises or symptoms cease. References and/or acknowledgements No conflict of interest.

Background Nowadays, 12 different therapies are available as immune-mediated therapies (IMT) for multiple sclerosis (MS) drugs. Guidelines classify these treatments as first- and second-line. This variety allows treatment discontinuations (TD) under situations different from those initially planned. Apart from high disease activity or poor drug tolerance, patient comfort or lack of adherence are becoming important reasons for TD. Treatment changing reasons in the usual practice can help better understand this reality and in future decision making. Purpose Assessing reasons for TD in relapsing-remitting MS for IMT. Assessing TD causes for each kind of IMT. Material and methods In this retrospective, observational study, TD for any cause with IMT for MS from August 2014 to August 2017 was studied in our centre. Treatments with no available discontinuation conditions were excluded. To achieve the objectives, IMT was divided according to: interferon-like, glatiramer acetate, teriflunomide, dimethyl-fumarate, fingolimod and natalizumab. Reasons for TD were listed according to: high disease activity, isolated radiological disease activity, complete interruption of IMT, administration patient preferences (oral drugs or pegylated interferon),drug hypersensitivity reactions, injection-site reactions, lymphopenias, JC virus detection, and other adverse reactions (specified) or situations. Results During the study period, 65 TD were performed: 60 (92.3%) due to treatment switch, three (4.61%) led to IMT complete interruption and two (3.97%) were not correctly evaluated due to patient transfer. Conclusion Probably, the 27 cases reported as patient preferences are related to the most prominent INF adverse effects (injection-site reactions and flu-like symptoms) although it has not been documented. During the study period, IMT extension variety had permitted individualised treatment adjustment according to disease clinical form, each subject progression, and patient preferences and tolerance. No conflict of interest

Background Antipsychotics (APs) are commonly used to manage neuropsychiatric symptoms (NPS) in the elderly with dementia (approximately 48% of the elderly with dementia are treated with APs), even though several large studies have demonstrated an association between AP treatment and increased morbidity and mortality in people with dementia. Purpose The aim of this study was to review the scientific literature of the use of AP in the elderly with dementia and to propose an algorithm to assist in decision-making regarding the withdrawal of APs. Material and methods A computerised literature search (MEDLINE: 1966 to July 2017, EMBASE: 1982 to July 2017) was used to locate relevant literature. The following terms were used in the MESH database and EMTREE thesaurus: aged, antipsychotic agents, behavioural symptoms and dementia. The information and recommendations of full references were extracted to perform an algorithm represented on paper in a flow-chart form. In the algorithm we define non-pharmacological interventions, NPS and signs and symptoms of AP withdrawal. We use the Neuropsychiatric Inventory Questionnaire (NPI-Q) to score the severity of the NPS. Results Earlier studies of APs used in the elderly with dementia suggest that, in most elderly demented patients, APs can be withdrawn with no effect on behaviour. These patients are likely to benefit from the algorithm we propose to assist clinicians with in the withdrawal of APs (Algorithm 1). Although prolonged treatment in specific circumstances may be advisable in clinical practice, the general advice is to discontinue APs after 12 weeks in cases of agitation or psychosis associated with dementia based on weak and conflicting evidence regarding long-term efficacy. A gradual tapering strategy is to reduce dosage by 25% to 50% every 2 weeks and to end treatment 2 weeks after administering the lowest dose. Conclusion Information gathered in this review raises the need to establish safe and effective pharmacological approaches to AP prescription for the demented elderly with NPS. We have described an algorithm consisting of three main steps presented in the form of a flowchart that draws on AP withdrawal approaches recommended in both dementia and care guidelines, and which can assist clinicians in the withdrawal of APs. No conflict of interest

BACKGROUND: The prevalence of dysphagia in patients with dementia ranges from 13% to 84%. The high prevalence is likely the result of the presence of age-related lesions in the diffuse area of the brain in addition to those produced by the neuropathology. Moreover, antipsychotics (APs), which are extensively used to treat dementia patients, have also been associated with impaired swallow. PURPOSE: The objective of this study is to characterise the patophysiology of oropharyngeal dysphagia (OD) using videofluoroscopy (VFS) in patients with dementia and those with dementia and taking APs. MATERIAL AND METHODS: An observational cross-sectional study was performed on dementia patients (DP) discharged from the hospital with a diagnosis of dementia and a VFS study. Demographical, clinical factors and swallowing parameters measured by VFS were compared between no dementia patients (NDP). NDP were elderly patients with dysphagia but without a diagnosis of dementia or other neurological or cerebrovascular diseases. Moreover, DP taking APs (DPA) were also compared with DP not taking APs (DPWA). Receiver operating characteristic (ROC) curves were drawn for laryngeal vestibule closure (LVC) time for DPA, DPWA and NDP, which predicts unsafe swallow. RESULTS: We included 129 consecutive DP (82.2±7.8 years, 56.3% females) studied by VFS. 85.2% presented impaired efficacy and 66.4% impaired safety of swallow, penetration aspiration scale (PAS)=3.81±1.94. Time to glossopalatal junction opening (GPJO) and upper esophagal sphincter opening (UESO) was significally delayed in DP in comparison with NDP (p