Antiepileptic Drugs and Accumulation of Hospital Days Among Persons With Alzheimer's Disease

Piia Lavikainen; Heidi Taipale; Antti Tanskanen; Marjaana Koponen; Jari Tiihonen; Sirpa Hartikainen; Anna-Maija Tolppanen

doi:10.1016/j.jamda.2018.11.012

Antiepileptic Drugs and Accumulation of Hospital Days Among Persons With Alzheimer's Disease

J Am Med Dir Assoc. 2019 Jun;20(6):751-758. doi: 10.1016/j.jamda.2018.11.012. Epub 2019 Jan 7.

Authors

Piia Lavikainen¹, Heidi Taipale², Antti Tanskanen³, Marjaana Koponen⁴, Jari Tiihonen³, Sirpa Hartikainen⁴, Anna-Maija Tolppanen⁵

Affiliations

¹ School of Pharmacy, University of Eastern Finland, Kuopio, Finland. Electronic address: piia.lavikainen@uef.fi.
² School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
³ Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden; Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
⁴ School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
⁵ School of Pharmacy, University of Eastern Finland, Kuopio, Finland.

PMID: 30630728
DOI: 10.1016/j.jamda.2018.11.012

Abstract

Objectives: To compare the accumulation of hospital days between initiators and noninitiators of antiepileptic drugs (AEDs) among persons with Alzheimer's disease (AD).

Design: Exposure-matched cohort study.

Setting and participants: Persons newly diagnosed with AD in 2005-2011 (n = 70,718) and initiating AED use identified from Finnish health care registers. For each AED initiator, 1 noninitiator matched on age, sex, and time since AD diagnosis was selected. Persons with epilepsy were excluded from the study.

Methods: Association between AED initiation or use of individual AEDs and accumulation of hospital days during a 2-year follow-up was assessed using negative binomial model.

Results: AED initiators (n = 4432) were hospitalized on average for 43.7 (SD: 88.3) days and matched noninitiators for 32.2 (SD: 71.3) days during the 2-year follow-up. Altogether, 27.3% of the AED initiators and 35.6% of the noninitiators had no hospital days during the study period. Number of accumulated hospital days during the follow-up was 31% higher [adjusted incidence rate ratio (aIRR): 1.31, 95% confidence interval (CI): 1.19-1.43] among AED initiators than the noninitiators. Hospital days due to diseases of the nervous system excluding dementia (aIRR: 2.72, 95% CI: 1.72-4.31), musculoskeletal system (aIRR: 2.49, 95% CI: 1.73-3.58), respiratory system (aIRR: 1.89, 95% CI: 1.47-2.43), and mental and behavioral disorders excluding dementia (aIRR: 1.96, 95% CI: 1.02-3.79) were more common among the AED initiators than noninitiators. Among pregabalin (aIRR: 0.65, 95% CI: 0.56-0.77), gabapentin (aIRR: 0.66, 95% CI: 0.49-0.88), and clonazepam (aIRR: 0.73, 95% CI: 0.55-0.96) initiators, the number of accumulated hospital days was 27% to 35% lower than the days accumulated among the initiators of valproic acid.

Conclusions and implications: AED initiators had more hospital days than noninitiators. Pregabalin and gabapentin were associated with a lower number of hospital days than valproic acid. Further research is needed on the reasons for these findings.

Keywords: Alzheimer's disease; antiepileptic drugs; hospital days.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Alzheimer Disease*
Anticonvulsants / administration & dosage*
Cohort Studies
Epilepsy / drug therapy*
Female
Finland
Hospitalization / trends*
Humans
Male
Middle Aged

Substances

Anticonvulsants