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Differences in Medication Use in the Alzheimer’s Disease Neuroimaging Initiative

Analysis of Baseline Characteristics

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Abstract

Introduction The ADNI (Alzheimer’s Disease Neuroimaging Initiative) is a large longitudinal study of patients with probable Alzheimer’s disease (AD), patients with mild cognitive impairment (MCI) and healthy elderly controls followed for at least 2–3 years. Many participants in the ADNI are being treated with medications, and these may have beneficial or deleterious effects.

Objective The goal of the study was to characterize baseline medication use in the ADNI.

Methods Diagnosis, demographics, medication status, psychometric data and MRI measures of hippocampal volume and entorhinal cortex thickness were obtained for 818 participants from the ADNI cohort. Total number of medications, Beers list (potentially dangerous) medications and AD treatments were also tabulated. ANOVA and logistic regression were used to assess associations between baseline pharmacotherapy and diagnosis, demographics, and selected clinical and MRI variables.

Results Of the 818 enrolled ADNI participants, 809 were available for analysis in the present study, including 184 patients with AD, 399 patients with MCI and 226 healthy elderly controls. Significant gender differences in recruitment were observed in the MCI group. The average number of medications per participant was 8 (SD 4) and 22% reported treatment with one or more Beers list medications. For symptomatic treatment of MCI or AD, donepezil and memantine were the most commonly reported drugs. As expected, MCI and AD patients with more severe impairment were more likely to be treated. Men received treatment more frequently than women. Older subjects and those with less education were less likely to receive treatment.

Conclusions AD and MCI participants from the ADNI cohort were being treated with polypharmacy and many were also taking one or more medications with the potential for adverse effects. Off-label use of cholinesterase inhibitors and/or memantine for MCI was common, with more severely affected patients most likely to receive treatment. Differences in the frequency of symptomatic treatment were also observed as a function of age, years of education, gender and disease severity.

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Acknowledgements

Data used in the preparation of this article were obtained from the ADNI database (www.loni.ucla.edu/ADNI). As such, the investigators within the ADNI contributed to the design and implementation of the ADNI and/or provided data but did not participate in the analysis or writing of this report. For a complete list of investigators involved in the ADNI see: http://www.loni.ucla.edu/ADNI/Data/ADNI_Authorship_List.pdf.

Data collection and sharing was funded by the ADNI (Principal Investigator: Michael Weiner; National Institutes of Health [NIH] grant U01 AG024904). The ADNI is funded by the NIA, the NIBIB and through generous contributions from the following: Pfizer, Wyeth, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Merck, AstraZeneca, Novartis, the Alzheimer’s Association, Eisai, Elan, Forest and the Institute for the Study of Aging, with participation by the FDA. Industry partnerships are coordinated through the Foundation for the National Institutes of Health. The grantee organization is the Northern California Institute for Research and Education, and the study is coordinated by the Alzheimer’s Disease Cooperative Study at the University of California, San Diego. ADNI data are disseminated by the Laboratory of Neuro Imaging at the UCLA. Data analysis was supported in part by the following grants from the NIH: NIA R01 AG19771, P30 AG10133, NIBIB R03 EB008674 and by the Indiana Economic Development Corporation (IEDC #87884).

Dr Farlow has received research funds from Bristol-Myers Squibb, Danone, Elan, Eli Lilly, Forest, Medivation, Novartis, OctaPharma, Pfizer and Sonexa; has acted as a consultant and/or speaker for and has received honoraria from Accera, Adamas, Adlyfe, Astellas, AstraZeneca, CoMentis, Cortex, DS-Pharma (Dainippon Sumitomo Pharma), Eli Lilly, Eisai, Forest, GlaxoSmithKline, Medivation, Merck, Novartis, Noven, OctaPharma, Pfizer, QR Pharma, Sanofi-Aventis, Schering-Plough, Suven Life Sciences and Toyama; has given expert testimony for Forest; has a spouse with Eli Lilly stock; and receives royalties from Elan for a genetically engineered mouse model. Dr Epstein, Dr Saykin, Dr Gao and Shannon Risacher have no conflicts of interest that are directly relevant to the content of this study.

All authors (Dr Epstein, Dr Saykin, Shannon Risacher, Dr Gao and Dr Farlow) contributed to this study. Dr Gao, who is a professor of biostatistics at Indiana University, completed the statistical analysis.

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Authors and Affiliations

  1. Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Noam U. Epstein

  2. Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 West Walnut St, R2 E124, Indianapolis, Indiana, 46202, USA

    Andrew J. Saykin & Shannon L. Risacher

  3. Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Andrew J. Saykin, Sujuan Gao & Martin R. Farlow

  4. Division of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Sujuan Gao

  5. Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Martin R. Farlow

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  1. Noam U. Epstein
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  2. Andrew J. Saykin
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  3. Shannon L. Risacher
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  5. Martin R. Farlow
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Correspondence to Andrew J. Saykin.

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Epstein, N.U., Saykin, A.J., Risacher, S.L. et al. Differences in Medication Use in the Alzheimer’s Disease Neuroimaging Initiative. Drugs Aging 27, 677–686 (2010). https://doi.org/10.2165/11538260-000000000-00000

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