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KCE Reports 111 Interventions in Alzheimer’s Disease 71
6.3.5.4 What happens after ChEI therapy is discontinued?
We selected those patients who started ChEIs in 2002-2006 but for whom there were
no ChEI prescriptions during the last 6 months of 2006. Of the 1186 patients thus
identified, 310 (26%) died during the 3 month period following the last ChEI
prescription, while another 76 patients (6.5%) died 4 to 6 months after the last ChEI
prescription. These data suggest ChEI prescriptions are continued in some patients until
the end of life.
In this context, monitoring the use of ChEIs in patients with a MMSE < 5 has been
suggested as a role of the coordinating physician of the ROB/RVT-MR/MRS (Domino
woon en zorgcentrum presentation, “De CRA en het geneesmiddelen verbruik in het
RVT”, 18 FEB 2009).
6.3.6 Concomitant use of antipsychotics and antidepressants
Table 19: Concomitant use of antipsychotics and antidepressants in AD
patients receiving ChEIs (sample, full 2002-2006 period).
Antipsychotics Antidepressants
N n % %
Any use
Timing of start of medication compared to ChEI
2502 844 33.7 908 36.3
Before or concomitant to start of ChEI treatment 2502 438 17.5 608 34.3
After start of ChEI treatment 2502 406 16.2 300 12.0
Chronic use (a single versus multiple prescriptions over time)
Only a single prescription of antipsychotic or
antidepressant
By setting of first prescription of ChEI
Before or concomitant to start of ChEI treatment
2502 125 5.0 99 4.0
First prescription of ChEl in Hospital 699 264 37.8 271 38.8
First prescription of ChEl in ROB/RVT-MR/MRS 214 46 21.5 71 33.2
First prescription of ChEl in Ambulatory (= care
at home)
1588 128 8.1 266 16.7
On the 844 patients receiving antipsychotics concomitantly with ChEl treatment, about
half of them started antipsychotics before or concomitantly with the start of ChEl
treatment, while for antidepressants this ratio is around two thirds to one third. The
proportion of patients with a single prescription is around 5% for antipsychotics and 4%
for antidepressants. The use of antipsychotics and antidepressants is also very
dependent of the setting of the start of ChEI treatment: 38% of the patients who started
their ChEI treatment in a hospital started antipsychotic treatment before the start of
ChEI or concomitantly. This percentage is only 8% for patients who started their ChEl
treatment at home.
6.3.6.1 Institutionalization and concomitant use of antipsychotics and antidepressants
Next, we considered patients who received prescriptions for ChEIs in 2006 and
grouped those 1497 patients based on residence status in 2006. We considered for
these patient groups the concomitant use (prescription date between first and last ChEI
prescription date) of antipsychotics and antidepressants, overall and for 2006 only.
Nearly half (45%) of the institutionalized patients received at least one prescription for a
antipsychotic in between prescriptions for a ChEI. This proportion is lower (21%) in
non-institutionalised patients. When restricted to the year 2006 these proportions are
24% and 16%.