Initiation of Psychotropic Drugs in Spouses of Patients With Early-Onset Alzheimer's Disease: A Matched Cohort Study

IF 3.6 3区医学 Q2 GERIATRICS & GERONTOLOGY

International Journal of Geriatric Psychiatry Pub Date : 2025-01-03 DOI:10.1002/gps.70041

Toshiki Fukasawa, Kota Matsumoto, Kotaro Sasaki, Yukako Nakagami, Yuta Goto, Yusuke Sakamoto, Yukihiko Washimi, Sachiko Tanaka-Mizuno, Satomi Yoshida, Kayoko Mizuno, Yuta Kamada, Mika Ishii, Koji Kawakami

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引用次数: 0

Abstract

Objectives

The diagnosis of early-onset Alzheimer's disease (EOAD) can cause emotional stress not only to the patients themselves but also to their spouses. This study aimed to evaluate the risk of psychiatric disorders in spouses of EOAD patients, using psychotropic drug initiation as a surrogate indicator.

Methods

A cohort study was conducted using a Japanese claims database, with spouses of EOAD patients (exposed spouses) matched with spouses of non-EOAD individuals (reference spouses) up to a 1:10 ratio. Primary outcome was the initiation of mood disorder drugs, and secondary outcomes were the initiation of drugs for anxiety disorders, sleep disorders, and schizophrenia spectrum disorders. Four study cohorts were created according to each outcome analysis. Multivariable Cox regression models were used to estimate adjusted hazard ratios (aHRs) and their 95% confidence intervals (CIs) for study outcomes.

Results

The analysis of mood disorder drugs included 395 exposed spouses and 3711 reference spouses. The proportion of patients excluded from the analysis due to prescription of mood disorder drugs during the baseline period was 4.3% higher among exposed spouses than reference spouses. There was no major difference between groups with respect to mood disorder drug initiation after 1 year (aHR, 2.08 [95% CI, 0.61 to 7.13]). In subgroup analysis of females and dependents, exposed spouses showed a higher rate of initiation (females: aHR, 6.39 [95% CI, 1.24 to 32.80]; dependents: aHR, 6.47 [95% CI, 1.25 to 33.55]). No substantial differences in secondary outcomes were observed in any comparison.

Conclusions

This study does not conclusively demonstrate an increase in mood disorder drug initiation among spouses of EOAD patients overall; however, initiation rates may be higher among female or dependent spouses. Our findings also suggest that exposed spouses experience significant psychological stress prior to their partners' EOAD diagnoses.

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早发性阿尔茨海默病患者配偶开始使用精神药物：一项匹配队列研究

目的：早发性阿尔茨海默病（EOAD）的诊断不仅会给患者本身带来情绪压力，也会给其配偶带来情绪压力。本研究旨在评估EOAD患者配偶的精神障碍风险，以精神药物起始作为替代指标。方法：使用日本索赔数据库进行队列研究，将EOAD患者的配偶（暴露配偶）与非EOAD个体的配偶（参考配偶）匹配，比例为1:10。主要结局是开始使用情绪障碍药物，次要结局是开始使用治疗焦虑症、睡眠障碍和精神分裂症谱系障碍的药物。根据每个结果分析创建了四个研究队列。采用多变量Cox回归模型估计研究结果的校正风险比（aHRs）及其95%置信区间（CIs）。结果：情绪障碍药物分析对象为暴露配偶395人，参照配偶3711人。暴露配偶中因基线期服用情绪障碍药物而被排除在分析之外的患者比例比参考配偶高4.3%。1年后，两组间在情绪障碍药物使用方面无显著差异（aHR, 2.08 [95% CI, 0.61 ~ 7.13]）。在女性及其家属的亚组分析中，暴露的配偶显示出更高的启动率(女性：aHR， 6.39 [95% CI， 1.24至32.80]；依赖性：aHR， 6.47 [95% CI, 1.25 ~ 33.55])。在任何比较中，次要结果均未观察到实质性差异。结论：本研究并没有结论性地证明EOAD患者的配偶中情绪障碍药物初始化的总体增加；然而，女性或受抚养配偶的开始率可能更高。我们的研究结果还表明，在伴侣的EOAD诊断之前，暴露的配偶会经历显著的心理压力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

6.10

自引率

2.50%

发文量

168

审稿时长

4-8 weeks

期刊介绍： The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers. The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.