Use of Antiepileptic Drugs Among Community-Dwelling Persons with Alzheimer's Disease in Finland

Article type: Research Article

Authors: Bell, J Simon^{a; b; c; *} | Lönnroos, Eija^{a; b; d} | Koivisto, Anne M^{e; f} | Lavikainen, Piia^a | Laitinen, Marja-Liisa^{a; b; d} | Soininen, Hilkka^{e; f} | Hartikainen, Sirpa^{a; b; g}

Affiliations: [a] Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland | [b] Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland | [c] Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia | [d] Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland | [e] Department of Neurology, Kuopio University Hospital, Kuopio, Finland | [f] Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, Kuopio, Finland | [g] Leppävirta Health Centre, Leppävirta, Finland

Correspondence: [*] Correspondence to: J Simon Bell, PhD, Kuopio Research Centre of Geriatric Care, PO Box 1627, University of Eastern Finland, Kuopio 70211, Finland. Fax: +35 81716 2424; E-mail: simon.bell@uef.fi.

Abstract: Persons with Alzheimer's disease (AD) may be particularly susceptible to the adverse drug reactions associated with anti-epileptic drugs (AEDs). The objective of this study was to investigate the national pattern of AED use among community-dwelling persons with and without AD in Finland. All persons (n = 28,093) with a diagnosis of AD in 2005 were identified by the Social Insurance Institution of Finland (SII). The SII also identified comparison persons without AD individually matched in terms of age (±one year), gender, and region. Records of all reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for reimbursed AED use. Persons with and without AD were aged 42 to 101 (mean 80.0) years, with men comprising 32.2% (n = 9,048) of persons. Epilepsy was diagnosed for 2.1% of persons with AD compared to 1.3% of persons without AD (OR 1.66; 95% CI, 1.45 to 1.89). AEDs were used by 5.0% (n = 1417) of persons with AD compared to 3.4% (n = 955) persons without AD (adjusted OR 1.33; 95% CI, 1.21 to 1.46). The annual prevalence of phenytoin, clonazepam, valproic acid, and oxcarbazepine use was higher among persons with AD. In contrast, pregabalin use was lower among persons with AD (adjusted OR 0.83; 95% CI, 0.70 to 0.99). Use of older AEDs is more prevalent among persons with AD, despite persons with AD being particularly vulnerable to adverse drug reactions associated with many older AEDs.

Keywords: Aged, anticonvulsants, drug utilization, epilepsy, neurology

DOI: 10.3233/JAD-2011-110200

Journal: Journal of Alzheimer's Disease, vol. 26, no. 2, pp. 231-237, 2011