Key result
Diabetes is linked to ~4.3-fold higher odds of antiplatelet overuse in older adults with dementia.
Why the study?
The appropriateness of antiplatelet use across dementia subtypes in older adults and factors associated with inappropriate use were unclear.
What is the frequency of inappropriate antiplatelet prescribing across dementia subtypes in older adults, and what factors predict its overuse or underuse?
Observational (n=683)
No
What is the frequency of inappropriate antiplatelet prescribing across dementia subtypes in older adults, and what factors predict its overuse or underuse?
One-third of older adults with dementia receive inappropriate antiplatelet therapy compared to ESC guidelines, with overuse driven by diabetes in neurodegenerative subtypes and underuse predominantly seen in females and vascular dementia cases.
Clinicians should review antiplatelet appropriateness in dementia by sex and diabetes status; this cohort study leaves open effects on outcomes.
AIM: To evaluate the appropriateness of antiplatelet use across dementia subtypes in older adults and to identify factors associated with inappropriate antiplatelet use. METHODS: This population-based retrospective study enrolled adults aged ?65 years with dementia evaluated at a tertiary geriatric outpatient clinic at Gulhane Training and Research Hospital between 2016 and 2025. Antiplatelet (aspirin or clopidogrel) use was categorized as appropriate use, underuse, overuse, or appropriate non-use according to the 2021-2024 European Society of Cardiology guidelines. Multivariable logistic regression analyses were performed to identify the factors associated with inappropriate antiplatelet use. RESULTS: Among 683 older adults with dementia, 40.7% received antiplatelet therapy. Antiplatelet underuse and overuse were observed in 16.8% and 16.1% of the participants, respectively. Underuse was most prevalent in vascular dementia (38.9%), whereas overuse was most prevalent in Alzheimer disease (20.2%) and frontotemporal dementia (19.0%). In multivariable analyses, antiplatelet overuse was independently associated with diabetes mellitus (odds ratio [OR] 4.31; 95% confidence interval [CI] 1.66-11.16) and inversely associated with current smoking (OR 0.06; 95% CI 0.06-0.67). Antiplatelet underuse was independently associated with female sex (OR 4.44; 95% CI 1.52-12.92). CONCLUSIONS: Our findings highlight the gaps between guideline recommendations and real-world practice and support the need for individualized dementia-sensitive antiplatelet treatment strategies.
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Demirbas et al. (2026) conducted an observational in Dementia (n=683). Antiplatelet therapy vs. Appropriate use was evaluated on Antiplatelet overuse (association with diabetes mellitus) (OR 4.31, 95% CI 1.66-11.16, p=0.003). Among older adults with dementia, antiplatelet overuse was independently associated with diabetes mellitus (OR 4.31), whereas underuse was strongly associated with female sex (OR 4.44).
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