El-Jammal V, Gervais F, Richard G, Lepetit A, Mouchoux C, Novais T
BMC Geriatr . 2026 Jun 6.
PMID: 42249271
ABSTRACT
Background: Alzheimer's disease and related dementias (ADRD) are frequently associated with behavioral and psychological symptoms of dementia (BPSD), which complicate care, increase medication exposure and cognitive iatrogenic risk. The mobile team for ADRD (MTAD) provides therapeutic recommendations for acute cases following home interventions.
Objectives: This study evaluated the theoretical impact of MTAD medication recommendations on medication exposure in community-dwelling older patients with neurocognitive disorders (NCD) and BPSD.
Methods: This retrospective single-center study included older patients with NCDs visited by MTAD. Medication exposure was evaluated theoretically, assuming full implementation of MTAD medication recommendations, based on medication number, prevalence of potentially inappropriate medications (PIMs) identified using the EU(7)-PIM list, and sedative/anticholinergic burden quantified by the Drug Burden Index (DBI). MTAD medication recommendations were classified.
Results: Among 246 patients (mean age 83.9 years), MTAD recommendations would result in a significant reduction in PIMs per patient (0.91 versus 0.79, p < 0.001), with a significant increase in the overall and sedative DBI (0.55 versus 0.74, p < 0.001; 0.46 versus 0.65, p < 0.001, respectively), and number of prescribed medications (6.5 versus 6.9, p < 0.001), without change in the anticholinergic DBI (0.25 versus 0.26, p = 0.206). A total of 337 recommendations were issued, mainly additions (51%) and discontinuations (23%), primarily targeting psychotropics.
Conclusions: The theoretical implementation of MTAD recommendations for older patients with BPSD could reduce exposure to PIMs and may lead to an increased use of sedatives. However, further efforts are needed to optimize somatic treatments and minimize iatrogenic risks through comprehensive medication reviews.
