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Study: Parkinson Disease Psychosis in Nursing Home Setting
Few studies have assessed Parkinson disease psychosis (PDP) in the nursing home (NH) setting, including uses of off-label antipsychotics (AP) and AP treatment plans.
Presenters at the 2018 AGS conference conducted a comparative retrospective analysis of disease burden, antipsychotic utilization, and antipsychotic treatment patterns in NH residents with PDP.
PherMerica diagnosis and claims data was used, with ICD-9 and 10 codes used to identify PDP residents from January 1, 2013 to June 30, 2016. Residents were evaluated +/- 1 year to ensure residents had up to 12-month follow-up.
Two cohorts, with or without AP usage, with age, gender, comorbid conditions, and concomitant medications identified. The first AP identified with MDD for each AP and treatment patterns for each were classified as Continued, Discontinued, Switched, or Augmented. Descriptive statistics assessed differences between groups using a two-sided t test for continuous variables, and tests of proportions for categorical variables. A priori P < .05 was considered statistically significant. (Recently approved pimavanserin was not part of the analysis).
Researchers identified 864 residents with PDP; 408 (47%) received AP therapy. The PDP-AP group was younger (76 years) vs the PDP-no AP group (78 years). Along with age, prevalence rates of anxiety, UTI, dementia, depression, diabetes, hypertension, renal disease, and stroke were higher (P < .05) in this group as well. The most common APs used were quetiapine (52%, MDD 75±65mg), risperidone (17%, MDD 9±3mg), olanzapine (11%, MDD 10±5mg), aripiprazole (9%, MDD 10±9mg), and haloperidol (6%, MDD 14±10mg). Treatment patterns of AP use showed that 335 (82%) continued, 13 (3%) discontinued, 11 (3%) switched, and 49 (12%) augmented.
In this assessment of how residents with PDP are managed in the NH setting, presenters found that these residents appear to receive non-optimal AP therapies. Due to the higher rate of comorbidities and concomitant drug use, alone with the lack of sufficient evidence of efficacy with off-label APs, points to inappropriate AP use in this population.
Presenters concluded that there is an unmet need for optimal treatment of PDP in NH residents.
—Amanda Del Signore
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