Diagnoses and Treatment of Behavioral and Psychological Symptoms of Dementia Among Racially and Ethnically Diverse Persons Living with Dementia

Article type: Research Article

Authors: Thunell, Johanna A.^{a; b; *} | Joyce, Geoffrey F.^{a; c} | Ferido, Patricia M.^a | Chen, Yi^d | Guadamuz, Jenny S.^{a; c} | Qato, Dima M.^{a; c} | Zissimopoulos, Julie M.^{a; b}

Affiliations: [a] USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA | [b] USC Sol Price School of Public Policy, Los Angeles, CA, USA | [c] USC School of Pharmacy, Los Angeles, CA, USA | [d] Rush Alzheimer’s Disease Center, Chicago, IL, USA

Correspondence: [*] Correspondence to: Johanna A. Thunell, PhD, USC Schaeffer Center for Health Policy and Economics, 635 Downey Way, Verna and Peter Dauterive Hall, Los Angeles, CA 90089, USA. E-mail :jthunell@usc.edu.

Abstract: Background:Behavioral and psychological symptoms of dementia (BPSD) and prescribed central nervous system (CNS) active drugs to treat them are prevalent among persons living with Alzheimer’s disease and related dementias (PLWD) and lead to negative outcomes for PLWD and their caregivers. Yet, little is known about racial/ethnic disparities in diagnosis and use of drugs to treat BPSD. Objective:Quantify racial/ethnic disparities in BPSD diagnoses and CNS-active drug use among community-dwelling PLWD. Methods:We used a retrospective cohort of community-dwelling Medicare Fee-for-Service beneficiaries with dementia, continuously enrolled in Parts A, B and D, 2017–2019. Multivariate logistic models estimated rates of BPSD diagnosis and, conditional on diagnosis, CNS-active drug use. Results:Among PLWD, 67.1% had diagnoses of an affective, psychosis or hyperactivity symptom. White (68.3%) and Hispanic (63.9%) PLWD were most likely, Blacks (56.6%) and Asians (52.7%) least likely, to have diagnoses. Among PLWD with BPSD diagnoses, 78.6% took a CNS-active drug. Use was highest among whites (79.3%) and Hispanics (76.2%) and lowest among Blacks (70.8%) and Asians (69.3%). Racial/ethnic differences in affective disorders were pronounced, 56.8% of white PLWD diagnosed; Asians had the lowest rates (37.8%). Similar differences were found in use of antidepressants. Conclusions:BPSD diagnoses and CNS-active drug use were common in our study. Lower rates of BPSD diagnoses in non-white compared to white populations may indicate underdiagnosis in clinical settings of treatable conditions. Clinicians’ review of prescriptions in this population to reduce poor outcomes is important as is informing care partners on the risks/benefits of using CNS-active drugs.

Keywords: Alzheimer’s disease, antidepressants, antipsychotics, behavioral and psychological symptoms of dementia, dementia

DOI: 10.3233/JAD-231266

Journal: Journal of Alzheimer's Disease, vol. 99, no. 2, pp. 513-523, 2024