Forns J, Danysh H, McQuay L, Turner ME, Dempsey C, Anthony M, Layton B. Natural history of dementia-related psychosis and antipsychotic treatment patterns in older adults in the United States. Presented at the International Conference on Alzheimer's and Parkinson's Diseases 2022; March 18, 2022. Barcelona, Spain.

AIMS: To describe the natural history and antipsychotic treatment patterns of adults with dementia-related psychosis (DRP).

METHODS: A cohort of patients with newly-diagnosed DRP was identified in United States Medicare claims data during 2013-2018. Baseline demographic and clinical characteristics were described. We estimated the incidence rates (IR) and 95% confidence intervals (CIs) for falls/fractures, infections, healthcare utilization, and death. Antipsychotic initiation and treatment patterns were evaluated.

RESULTS: We identified 484,520 patients with newly-diagnosed DRP. At the index date, patients had a mean age of 84 years, and 66% were female. Among those with a specified dementia type (44%), the majority had Alzheimer’s disease (70%), followed by vascular dementia (28%). The most prevalent psychosis symptom was unspecific (70%), followed by hallucinations (23%) and delusions (7%). Most patients had “severe” scores in the Charlson Comorbidity Index (71%) and in the frailty index (61%). Patients with DRP had high IRs (95% CI) per 100 person-years: emergency department visits (186.04 [185.75-186.33]), oral anti-infectives use (148.27 [148.01-148.53]), and urinary tract infections (121.06 [120.82-121.31]). The mortality rate was 29.64 per 100 person-years [29.53-29.76]. A total of 132,380 (27%) patients with DRP initiated treatment with antipsychotics during follow-up. The mean time to start treatment after DRP diagnosis was 34 weeks. At 6 months of antipsychotic initiation, 32% of patients discontinued treatment.

CONCLUSIONS: DRP is a complex disorder involving neurological and psychiatric symptoms. Patients with DRP additionally experience a substantial burden of non-neuropsychiatric events after diagnosis, with high rates of emergency department visits, hospital admissions, infections, and death.

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