Effect of comprehensive, individualized, person-centered management (CI-PCM) on psychotropic medication usage in advanced Alzheimer's persons in a 28-week randomized controlled trial.

BACKGROUND: Behavioral and Psychological Symptoms of Dementia (BPSD) are burdensome and disturbing for caregivers and persons living with Alzheimer's disease (AD). They are also a primary cause of institutionalization of Alzheimer's persons. Physicians use psychotropic medications to treat the BPSD of AD. Many of these medications have deleterious consequences as evidenced in part by their black box warnings. We published results of a 28-week, clinician-blind, randomized, controlled trial of our CI-PCM program in moderate-to-severe, community-residing, Alzheimer's persons receiving memantine (Reisberg…Kenowsky, Dement Geriatr Cogn Disord, 2017). The BPSD were examined using the Behavioral Pathology in Alzheimer's Disease-Frequency Weighted severity scale, which showed significant benefit in the CI-PCM subject group at week 28 (p<0.05).

METHODS: We examined the magnitude of usage of psychotropic medications used to treat BSPD in subjects from our 2017 study who were randomized to receive Usual Community Care (UCC) or the CI-PCM Program. Psychotropic medications used to treat other conditions were excluded. Subjects were evaluated at baseline and weeks 4, 12 and 28. We examined the ratio of daily psychotropic medication usage in the two groups. Psychotropic medications were compared by examining the percent of the maximum daily dosage of each medication taken cumulatively throughout each study observation period from week 4 to week 28. The Wilcoxon rank sum test was used to analyze the difference between the two groups.

RESULTS: At baseline, the group randomized to UCC consumed significantly more psychotropic medication than subjects randomized to the CIPCM program (p<0.05). Because there was a significant difference between groups at baseline, we analyzed usage in comparison with baseline (see figure 1). The UCC subjects used more psychotropic medication on a per day average relative to baseline from week 4 to week 28 than the CI-PCM subjects (p<0.01). The total amount of psychotropic medication taken, in comparison with baseline, was significantly lower in CI-PCM subjects from weeks 4 to 28 (p<0.0001).

CONCLUSIONS: CI-PCM subjects took significantly less psychotropic medication and their BPSD symptomatology significantly improved. The CI-PCM program is a safe, highly efficacious nonpharmacologic intervention that significantly reduces both BPSD symptomatology and psychotropic medication usage in advanced AD persons.