Psychotropic Polypharmacy in Dementia: A Retrospective Analysis for People with Neuropsychiatric Symptoms Referred to an Australian Dementia Support Service.

Background And Objectives: Despite their limited benefits and serious adverse effects, psychotropics remain frequently prescribed for neuropsychiatric symptoms (NPS) of dementia. Psychotropic polypharmacy, the use of two or more concomitant psychotropic medications, is therefore not recommended for people with dementia. The objectives of this study were to investigate the prevalence of psychotropic polypharmacy in Australians living with dementia whose caregivers sought external NPS support from Dementia Support Australia (DSA; the national provider of NPS support) and the association of psychotropic polypharmacy with their demographics and NPS characteristics.

Methods: A retrospective cross-sectional study of a subset of DSA referrals at baseline (i.e., yet to receive psychosocial intervention(s)) between 2016 and 2020 was conducted. Referrals with and without psychotropic polypharmacy were compared on the basis of demographic characteristics (e.g., sex, dementia subtype), NPS type (e.g., agitation), NPS severity and associated caregiver distress as measured by the Neuropsychiatric Inventory (NPI), using Pearson's chi-square test and Welch's t-test for categorical and continuous data, respectively. Logistic regression models were used to examine the relationship between individual NPI domains and exposure to psychotropic polypharmacy.

Results: A total of 421 referrals (mean age 81.5 (standard deviation 8.5) years, 52.3% males, 46.8% Alzheimer's disease) were analysed. Of those, over 90% (n = 383) were prescribed at least one psychotropic, with 214 referrals (50.8%) prescribed psychotropic polypharmacy. The medication types most associated with psychotropic polypharmacy were antipsychotics (n = 162, 75.7%), opioids (n = 104, 48.6%), anxiolytics (n = 93, 43.5%), sedative/hypnotics (n = 52, 24.3%) and antidepressants (n = 47, 22.0%). No relationship between psychotropic polypharmacy and any variable tested was identified, including age, sex, dementia subtype and NPI severity.

Conclusions: Psychotropic polypharmacy is highly prevalent in Australians living with dementia referred to external dementia-specific behaviour support programs, but no factors were associated with its presence in this cohort.