Characterizing treatment initiation with central nervous system-active polypharmacy among adults with dementia

Central nervous system (CNS) -active polypharmacy, defined as concurrent use of antidepressants, antipsychotics, anti-seizure medications, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, opioids, or skeletal muscle relaxants for ≥ 31 consecutive days, poses significant risks patients with dementia.

Among community-dwelling patients in Medicare plans aged ≥ 65 with dementia and Medicare Part D coverage in 2021, we determined the rate of CNS-active polypharmacy initiation as well as medication and prescribing clinician characteristics.

Among beneficiaries with dementia (n = 1,214,928, mean age 81.6 years), 7.8% (n = 94,190) experienced incident polypharmacy. Antidepressants were the most frequent class (92.3%), and quetiapine (30.9%), gabapentin (29.0%), and trazodone (28.3%) the top individual medications. At the time of initiation, 43.8% of patients were prescribed all CNS-active medications by a single clinician; primary care clinicians accounted for most polypharmacy prescriptions.

Interventions to address polypharmacy should focus on development of guidelines targeting individual prescribers to help clarify appropriate use of CNS-active medications.