Kim Orsel's research while affiliated with University of Eastern Finland and other places

Psychotropic drugs are frequently used for the treatment of behavioural and psychological symptoms of dementia in persons with Alzheimer's disease (AD). Evidence for benefits are limited and concerns have been raised about the safety, especially for the concomitant use of multiple psychotropic drugs. The objective of this study was to investigate prevalence of psychotropic drug and psychotropic polypharmacy (PPP) use and associations with PPP among persons with and without AD, from five years before until four years after AD diagnosis at time points every six months. Data is a part of the nationwide MEDALZ cohort, including all community-dwelling persons who received a clinically verified diagnosis of AD between 2005 and 2011 in Finland (n = 70,719). Register-based data included purchased prescription drugs, comorbidities, and hospital discharge diagnoses. Prevalence and factors associated with PPP were studied with logistic regression. The prevalence of psychotropic drug use, especially use of antipsychotics and antidepressants, increased during the course of AD. The use of ≥ 2 psychotropic drugs increased from 5.9% five years before to 18.3% four years after AD diagnosis. The most frequently used combination was antipsychotics and antidepressants. Predictors for PPP were younger age (< 75 years), female sex and history of psychiatric disease. The use of acetylcholinesterase inhibitors was inversely associated with PPP. The high prevalence of PPP is concerning because of possible higher risks for adverse effects and events.

Background: Antipsychotics (APs) are known to exacerbate symptoms of benign prostate hyperplasia (BPH) and may even cause urinary retention. The anticholinergic effects of APs and their dopamine D2- and α-receptor blockade may lead to voiding dysfunction of BPH patients. The objective of our study was to investigate whether the use of APs is associated with an increased risk of initiating medication for BPH in men with Alzheimer disease (AD). Methods: Data from the nationwide MEDALZ (MEDication use and ALZheimer's disease) cohort, including all community-dwelling persons diagnosed with AD in Finland, were utilized. Register-based data included medication dispensing, comorbidities, and hospital discharge diagnoses. Men who initiated APs (n = 4579) were 1:1 matched with men who did not initiate APs (n = 4579), according to time since AD diagnoses and age. The risk of starting BPH medication was investigated with Cox regression. Results: Among AP users, BPH medication was initiated to 345 persons (7.5%). Antipsychotic use was not associated with risk of initiating BPH medication (comorbidity-adjusted hazard ratio, 0.92; 95% confidence interval, 0.74-1.15) compared with no use of APs. In addition, no risk was found when AP drug substances were analyzed separately. Conclusions: Use of APs did not increase the risk of initiating medication for BPH in men with AD.