Baseline Prevalence of Polypharmacy in Older Hypertensive Study Subjects with Elevated Dementia Risk: Findings from the Risk Reduction for Alzheimer’s Disease Study (rrAD)

Article type: Research Article

Authors: Vidoni, Eric D.^{a; b} | Kamat, Ashwini^a | Gahan, William P.^c | Ourso, Victoria^c | Woodard, Kaylee^c | Kerwin, Diana R.^d | Binder, Ellen F.^e | Burns, Jeffrey M.^{a; b} | Cullum, Munro^{d; g} | Hynan, Linda S.^{d; f} | Vongpatanasin, Wanpen^h | Zhu, David C.ⁱ | Zhang, Rong^{d; h} | Keller, Jeffrey N.^{c; *}

Affiliations: [a] KU Alzheimer’s Disease Center, Fairway KS, USA | [b] Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA | [c] Pennington Biomedical Research Center, Baton Rouge, LA, USA | [d] Department of Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA | [e] Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA | [f] Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA | [g] Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA | [h] Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA | [i] Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, USA

Correspondence: [*] Correspondence to: Dr. Jeffrey N. Keller, Pennington Biomedical Research Center, Baton Rouge, LA, USA. Tel.: +1 225 763 3190; E-mail: jeffrey.keller@pbrc.edu.

Abstract: Background:Little is known about the prevalence of polypharmacy, the taking of five or more medications a day, in older adults with specific dementia risk factors. Objective:To examine the prevalence of polypharmacy in participants at baseline in a vascular risk reduction focused Alzheimer’s disease (rrAD) trial targeting older patients with hypertension and elevated dementia risk. Methods:We conducted a detailed review of medications in a cross-sectional study of community-dwelling older adults with hypertension and elevated dementia risk. Medications were identified in a structured interview process with an onsite pharmacist or qualified designee. Polypharmacy was defined as use of five or more medications on a regular basis. Descriptive analyses were conducted on the sample as well as direct comparisons of subgroups of individuals with hypertension, diabetes, and hyperlipidemia. Results:The 514 rrAD participants, mean age 68.8 (standard deviation [sd] 6), reported taking different combinations of 472 unique medications at their baseline visit. The median number of medications taken by participants was eight [Range 0–21], with 79.2% exhibiting polypharmacy (n = 407). Sites differed in their prevalence of polypharmacy, χ2(3) = 56.0, p < 0.001. A nearly identical percentage of the 2,077 prescribed (51.8%) and over the counter (48.2%) medications were present in the overall medication profile. The presence of diabetes (87.5%), hyperlipidemia (88.2%), or both (97.7%) was associated with a higher prevalence of polypharmacy than participants who exhibited hypertension in the absence of either of these conditions (63.2%), χ2(3) = 35.8, p < 0.001. Conclusion:Participants in a dementia risk study had high levels of polypharmacy, with the co-existence of diabetes or hyperlipidemia associated with a greater prevalence of polypharmacy as compared to having hypertension alone.

Keywords: Alzheimer’s disease, dementia, hypertension, inappropriate medication, polypharmacy, risk factor

DOI: 10.3233/JAD-200122

Journal: Journal of Alzheimer's Disease, vol. 77, no. 1, pp. 175-182, 2020