Thyroid function tests before prescribing anti-dementia drugs: a retrospective observational study

Area of Science:

• Geriatric Medicine
• Neurology
• Endocrinology

Background:

• Cognitive dysfunction can stem from treatable conditions like hypothyroidism.
• Clinical guidelines recommend thyroid function tests (TFTs) for cognitive dysfunction screening.
• Assessing TFT implementation before dementia medication initiation is crucial.

Purpose of the Study:

• To determine the national rate of TFTs within 365 days before initiating anti-dementia drugs in Japan.
• To identify factors influencing TFT implementation in dementia patients.

Main Methods:

• Retrospective observational study using Japan's nationwide claims database.
• Included patients aged 65+ newly prescribed anti-dementia drugs (April 2015-March 2016).
• Analyzed demographic data, comorbidities, care setting, and provider type as covariates.

Main Results:

• 262,279 patients were identified; only 32.6% received pre-treatment TFTs.
• Patients in dementia care centers had higher TFT rates (57%) compared to clinics (26%).
• Adjusted risk ratio for TFTs in dementia centers was 2.17 (95% CI: 2.01-2.33).

Conclusions:

• A significant gap exists in TFT screening for dementia patients in Japan prior to anti-dementia drug prescription.
• Implementation rates are notably lower in primary care settings.
• Current practices warrant auditing to ensure treatable causes of cognitive dysfunction are adequately screened.