This study evaluated the risk of cognitive decline associated with paroxetine use in elderly nursing home patients with depression.
Methods:
A retrospective cohort study was conducted using the 2007 to 2010 Medicare Part D claims and minimum data set (MDS) data involving new users of paroxetine and other selective serotonin reuptake inhibitors (SSRIs). The primary outcome was MDS Cognition Scale. The repeated-measures mixed model was used to examine the effect of paroxetine on cognition after controlling for other factors.
Results:
The baseline MDS Cognition Scale measures for paroxetine (n = 63) and other SSRI users (n =1018) were 2.02 (±1.85) and 2.50 (±2.39), respectively. The repeated-measures mixed model did not find statistically significant difference in cognition with the use of paroxetine (β = 0.02, 95% CI: −0.16 to 0.21]) when compared to other SSRIs.
Conclusions:
There was no differential effect of paroxetine on cognition when compared to other SSRIs.
American Geriatrics Society; American Association for Geriatric Psychiatry. Consensus statement on improving the quality of mental health care in US nursing homes: management of depression and behavioral symptoms associated with dementia. J Am Geriatr Soc. 2003;51(9):1287–1298.
2.
AlexopoulosGSBuckwalterKOlinJMartinezRWainscottCKrishnanKR. Comorbidity of late life depression: an opportunity for research on mechanisms and treatment. Biol Psychiatry. 2002;52(6):543–558.
3.
Act OBR. Public Law 100-203. Nursing Home Reform, Part C. 1987.
4.
WilkinsCHMathewsJShelineYI. Late life depression with cognitive impairment: evaluation and treatment. Clin Interv Aging. 2009;4:51–57.
5.
ChristensenHGriffithsKMackinnonAJacombP. A quantitative review of cognitive deficits in depression and Alzheimer-type dementia. J Int Neuropsychol Soc. 1997;3(6):631–651.
6.
PlassmanBLWilliamsJWJrBurkeJRHolsingerTBenjaminS. Systematic review: factors associated with risk for and possible prevention of cognitive decline in later life. Ann Intern Med. 2010;153(3):182–193.
CampbellNLBoustaniMALaneKA. Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology. 2010;75(2):152–159.
9.
CarriereIFourrier-ReglatADartiguesJF. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-city study. Arch Intern Med. 2009;169(14):1317–1324.
10.
CampbellNBoustaniMLimbilT. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225–233.
11.
American Medical Directors Association (AMDA). Depression in the Long-term Care Setting. Columbia, MD: 2011.
12.
GartlehnerGHansenRAMorganLC. Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Ann Intern Med. 2011;155(11):772–785.
13.
GartlehnerGThiedaPHansenRA. Comparative risk for harms of second-generation antidepressants: a systematic review and meta-analysis. Drug Saf. 2008;31(10):851–865.
OwensMJMorganWNPlottSJNemeroffCB. Neurotransmitter receptor and transporter binding profile of antidepressants and their metabolites. J Pharmacol Exp Ther. 1997;283(3):1305–1322.
16.
FujishiroJImanishiTOnozawaKTsushimaM. Comparison of the anticholinergic effects of the serotonergic antidepressants, paroxetine, fluvoxamine and clomipramine. Eur J Pharmacol. 2002;454(2-3):183–188.
17.
American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–2246.
18.
KerstenHMoldenEWillumsenTEngedalKBruun WyllerT. Higher anticholinergic drug scale (ADS) scores are associated with peripheral but not cognitive markers of cholinergic blockade. Cross sectional data from 21 Norwegian nursing homes. Br J Clin Pharmacol. 2013;75(3):842–849.
19.
KarkareSUBhattacharjeeSKamblePAparasuR. Prevalence and predictors of antidepressant prescribing in nursing home residents in the United States. Am J Geriatr Pharmacother. 2011;9(2):109–119.
20.
ChatterjeeSAparasuRRCarnahanRMJohnsonMLChenH. Prevalence of anticholinergic medication use among elderly nursing home residents with depressionValue Health. 2014;17(3):A211.
21.
BaliVAparasuRRJohnsonMLChenHCarnahanRM. Risk of dementia associated with the use of paroxetine among the elderly nursing home patients with depression. Value Health. 2014;17(3):A209.
22.
BiringerERongveALundA. A review of modern antidepressants effects on neurocognitive function. Curr Psychiatry Rev. 2009;5(3):164–174.
HanlonJTDonohueJ. Medicare Part D data: a valuable tool for pharmacoepidemiology and pharmacoeconomic research. Am J Geriatr Pharmacother. 2010;8(6):483–484.
25.
MorrisJNHawesCFriesBE. Designing the national resident assessment instrument for nursing homes. Gerontologist. 1990;30(3):293–307.
26.
MorrisJNMurphyKNonemakerS.Long Term Care Facility Resident Assessment Instrument (RAI) User’s Manual: For Use with Version 2.0 of the Health Care Financing Administration’s Minimum Data Set, Resident Assessment Protocols, and Utilization Guidelines. Health Care Financing Administration; 1995. Baltimore, Maryland.
27.
CantrellCREaddyMTShahMBReganTSSokolMC. Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes. Med Care. 2006;44(4):300–303.
28.
LiuXChenYFariesDE. Adherence and persistence with branded antidepressants and generic SSRIs among managed care patients with major depressive disorder. Clinicoecon Outcomes Res. 2011;3:63–72.
29.
HartmaierSLSloanePDGuessHAKochGG. The MDS Cognition Scale: a valid instrument for identifying and staging nursing home residents with dementia using the minimum data set. J Am Geriatr Soc. 1994;42(11):1173–1179.
30.
Cohen-MansfieldJTaylorLMcConnellDHortonD. Estimating the cognitive ability of nursing home residents from the minimum data set. Outcomes Manag Nurs Pract. 1999;3(1):43–46.
31.
Gruber-BaldiniALZimmermanSIMortimoreEMagazinerJ. The validity of the minimum data set in measuring the cognitive impairment of persons admitted to nursing homes. J Am Geriatr Soc. 2000;48(12):1601–1606.
32.
BurrowsABMorrisJNSimonSEHirdesJPPhillipsC. Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing. 2000;29(2):165–172.
33.
BuscemiJSteglitzJSpringB. Factors and predictors of cognitive impairment in the elderly: a synopsis and comment on “systematic review: factors associated with risk for and possible prevention of cognitive decline in later life.”Transl Behav Med. 2012;2(2):126–127.
34.
DaviglusMLPlassmanBLPirzadaA. Risk factors and preventive interventions for Alzheimer disease: state of the science. Arch Neurol. 2011;68(9):1185–1190.
35.
DaviglusMLBellCCBerrettiniW. NIH state-of-the-science conference statement: preventing Alzheimer’s disease and cognitive decline. NIH Consens State Sci Statements. 2010;27(4):1–30.
SingerJD. Using SAS PROC MIXED to fit multilevel models, hierarchical models, and individual growth models. J Educ Behav Stat. 1998;23(4):323–355.
38.
CassanoGBPucaFScapicchioPLTrabucchiM. Paroxetine and fluoxetine effects on mood and cognitive functions in depressed nondemented elderly patients. J Clin Psychiatry. 2002;63(5):396–402.
39.
BaliVChatterjeeSCarnahanRMChenHJohnsonMLAparasuRR. Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors. Psychiatr Serv. 2015;66(12):1333–1340.
40.
Proust-LimaCAmievaHDartiguesJFJacqmin-GaddaH. Sensitivity of four psychometric tests to measure cognitive changes in brain aging-population-based studies. Am J Epidemiol. 2007;165(3):344–350.
41.
TuneLE. Anticholinergic effects of medication in elderly patients. J Clin Psychiatry. 2001;62(suppl 21):11–14.
42.
FeinbergM. The problems of anticholinergic adverse effects in older patients. Drugs Aging. 1993;3(4):335–348.
43.
KemperRFSteinerVHicksBPierceLIwuagwuC. Anticholinergic medications: use among older adults with memory problems. J Gerontol Nurs. 2007;33(1):21–29; quiz 30-31.
44.
RemillardAJ. A pharmacoepidemiological evaluation of anticholinergic prescribing patterns in the elderly. Pharmacoepidemiol Drug Saf. 1996;5(3):155–164.
45.
MorV. A comprehensive clinical assessment tool to inform policy and practice: applications of the minimum data set. Med Care. 2004;42(4 suppl):III50–III59.
ButtersMABeckerJTNebesRD. Changes in cognitive functioning following treatment of late-life depression. Am J Psychiatry. 2000;157(12):1949–1954.
48.
PortellaMJMarcosTRamiLNavarroVGastoCSalameroM. Residual cognitive impairment in late-life depression after a 12-month period follow-up. Int J Geriatr Psychiatry. 2003;18(7):571–576.
49.
NebesRDPollockBGHouckPR. Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine. J Psychiatr Res. 2003;37(2):99–108.
