Key result
Pre-MCI cardio-metabolic and mixed drug profiles are linked to ~72% lower risk of dementia conversion.
Why the study?
Polypharmacy is linked to cognitive decline, yet treating modifiable risk factors targeted by common drugs could reduce dementia; whether baseline drug regimens before mild cognitive impairment (MCI) associate with progression remained unclear.
Are specific baseline drug prescription profiles associated with progression to dementia in patients with mild cognitive impairment?
Cohort (n=342)
Are specific baseline drug prescription profiles associated with progression to dementia in patients with mild cognitive impairment?
Higher drug prescription profiles, including cardio-metabolic and mixed regimens, were associated with a lower risk of conversion from mild cognitive impairment to dementia compared to a low prescription profile.
Higher prescription profiles associated with lower MCI-to-dementia conversion; leaves open causal effects and needs prospective validation.
Polypharmacy has been linked to cognitive decline. However, interventions targeting modifiable risk factors, some of which are targets of the most commonly used drugs, could reduce the prevalence of dementia. Our aim was to determine the drug prescription regimen at baseline, prior to the diagnosis of mild cognitive impairment (MCI), and its possible association with progression to dementia. Data were collected from the electronic medical records of 342 MCI outpatients diagnosed during 2006–2017 at their first neurology consultation. We followed the classical three-step method of statistical analysis, starting with a Latent Class Analysis (LCA) to discover subgroups of drug prescription probability. Half of the patients were under polypharmacy (≥5 drugs), 17.5% had no recorded medication, 33.3% progressed to dementia (94.7% in ≤5 years), and 84.1% of them to Alzheimer’s disease (AD). According to the LCA and based on 20 therapeutic indicators obtained from 240 substances and regrouped according the Anatomical Therapeutic Chemical Classification, we identified a four-profile model: (1) low (35.7% of patients); (2) mixed (28.7%); (3) cardio-metabolic (19.3%); and (4) psychotropic (16.4%). The binomial regression logistic model showed that profiles 2 and 3 (and 4 for AD), with a higher drug prescription conditioned probability against classic risk factors, were protective than profile 1 (OR = 0.421, p = 0.004; OR = 0.278, p = 0.000; OR = 0.457, p = 0.040, respectively), despite polypharmacy being significant in profiles 2 and 3 (mean > 7 drugs) vs. profile 1 (1.4 ± 1.6) (p = 0.000). Patients in the latter group were not significantly older, although being aged 65–79 years old quadrupled (OR = 4.217, p = 000) and being >79 tripled (OR = 2.945, p = 0.010) the conversion risk compared to patients <65 years old. According to the proposed analytical model, profiling the heterogeneous association of risk factors, which were taken prior to diagnosis, could be explored as an indicator of prior care and a predictor of conversion to dementia.
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Gómez et al. (2023) conducted a cohort in Mild Cognitive Impairment (MCI) (n=342). Drug prescription profiles (mixed, cardio-metabolic, psychotropic) vs. Low drug prescription profile was evaluated on Conversion to dementia (OR 0.421 (mixed); OR 0.278 (cardio-metabolic), p=0.004 (mixed); 0.000 (cardio-metabolic)). Mixed and cardio-metabolic drug profiles prior to MCI diagnosis were protective against conversion to dementia compared to a low prescription profile (OR 0.421, p=0.004 and OR 0.278, p=0.000).
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