Baseline Predictors of Antipsychotic Treatment Continuation and Response at Week 8 in Patients with Alzheimer’s Disease with Psychosis or Aggressive Symptoms: An Analysis of the CATIE-AD Study

Article type: Research Article

Authors: Nagata, Tomoyuki^{a; *} | Nakajima, Shinichiro^{b; c; d; e} | Shinagawa, Shunichiro^a | Plitman, Eric^{c; f} | Nakayama, Kazuhiko^a | Graff-Guerrero, Ariel^{c; f} | Mimura, Masaru^b

Affiliations: [a] Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan | [b] Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan | [c] Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Canada | [d] Geriatric Mental Health Division, Centre for Addiction and Mental Health, Toronto, Canada | [e] Department of Psychiatry, University of Toronto, Toronto, Canada | [f] Institute of Medical Science, University of Toronto, Toronto, Canada

Correspondence: [*] Correspondence to: Tomoyuki Nagata, MD, PhD, Department of Psychiatry, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105–8471, Japan. Tel.: +81 3 3433 1111; Fax: +81 3 3435 1922; E-mail: t.nagata@jikei.ac.jp.

Abstract: Background/Objective:The aim of the present study was to investigate predictors of atypical antipsychotic (AAP) treatment continuation and response by week 8 in patients with Alzheimer’s disease (AD) who have psychotic/aggressive symptoms using the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer’s Disease (CATIE-AD) dataset. Methods:Clinical data was utilized from 421 AD outpatients with psychotic/aggressive symptoms who needed interventional treatment. Logistic regression analyses were performed to examine which baseline sociodemographic and clinical characteristics contributed to treatment ‘continuation’ and ‘response’, the latter of which was evaluated by the Clinical Global Impression of Change (CGI-C), Neuropsychiatric Inventory (NPI), and Brief Psychiatric Scale (BPRS). Results:The treatment continuation rate was 48.7%, and CGI-C, NPI, and BPRS response rate by the last observation carried forward method were 42.7%, 48.6%, and 37.5%, respectively. No significant predictor was identified for treatment continuation in the Caucasian patients (n = 331), while better treatment response was predicted by a lower Mini-Mental State Examination score, treatment with risperidone (versus olanzapine and quetiapine), history of diabetes mellitus, healthier physical status, and more severe initial psychotic symptoms. Conclusions:Comparatively high intolerability from AAPs in the short term was confirmed. We found that baseline clinical predictors to treatment response in Caucasian AD patients with psychotic/aggressive symptoms include treatment with risperidone (versus quetiapine and olanzapine), diabetes mellitus, global physical status, cognitive impairment, and psychotic symptoms. Going forward, these findings may help to determine treatment strategies or care plans.

Keywords: Aggression, Alzheimer’s disease, atypical antipsychotic, neuropsychiatric symptom, psychosis

DOI: 10.3233/JAD-170412

Journal: Journal of Alzheimer's Disease, vol. 60, no. 1, pp. 263-272, 2017