ArticleJournal of the American Geriatrics Society2023
Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications.
Article in Journal of the American Geriatrics Society, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Psychotropic use for behavioral and psychological symptoms of dementia during the COVID-19 pandemic: a systematic review and meta-analysis.BMC geriatrics · 2024Pooled it
- Off-Label Initiation of Gabapentin and Valproic Acid Among Long-Stay Nursing Home Residents With and Without Dementia.Journal of the American Geriatrics Society · 2026Article
- Differences in Survival Associated With the First Antiseizure Medication in People With Dementia and Epilepsy.Neurology · 2026Article
- Lithium therapy and delayed progression of Alzheimer's disease and related dementias in patients with bipolar disorder and mild neurocognitive disorders.medRxiv : the preprint server for health sciences · 2026Article
- Patterns and Characteristics of Gabapentin Use Among Medicare Beneficiaries.Drugs & aging · 2025Article
- A National Survey of Nursing Home Clinicians to Explain Increased Valproate Prescribing.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2025Article
- Beyond epilepsy: The expanding role of valproic acid in Alzheimer disease therapy - a review.The Journal of pharmacology and experimental therapeutics · 2025Review
- Central Nervous System-Active Medication Use in Older Adults With and Without Dementia-A Retrospective Cohort Study.Journal of general internal medicine · 2025Observational
- Modulation of the cognitive impairment associated with Alzheimer's disease by valproic acid: possible drug repurposing.Inflammopharmacology · 2025Article
- Differences in Medication Use by Gender and Race in Hospitalized Persons Living with Dementia.Journal of racial and ethnic health disparities · 2024Article
- Associations between specialized dementia care, COVID-19 and central nervous system medication use in assisted living: a population-based repeated cross-sectional study.BMC geriatrics · 2024Article
- The Impact of Training in Multimodal Communication Skills on Psychotropic Medication Use in Dementia Care.Cureus · 2024Article
- Policy Changes to Promote Better Quality of Life for People with Serious Mental Illness Living in U.S. Nursing Homes.The Public policy and aging report · 2024Article
- Reply to: Comment on: Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications.Journal of the American Geriatrics Society · 2023Article
- Amyloid-targeting treatment in Alzheimer's disease and concomitant antiplatelets: a clinical gray zone?Frontiers in neurologyArticle
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4 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundAntiepileptics are commonly prescribed to nursing home residents with Alzheimer's disease and related dementias (ADRD) but there is little scientific support for their use in this population. It is unclear whether different antiepileptics are targeting different indications.
methodsUsing the Minimum Data Set and Medicare data, including Part D pharmacy claims, we constructed annual cohorts of residents with ADRD with long-term stays in nursing homes from 2015 to 2019. For each year, we measured the proportion of residents with ADRD in nursing homes nationwide with at least one antiepileptic prescription. We also measured trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Finally, we examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain.
resultsOur study sample includes 973,074 persons living with ADRD who had a long-term stay in a nursing home, which was defined as at least 3 months. The proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5% in 2015 to 31.3% in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. Conversely, antipsychotic prescribing rates declined from 32.1% to 27.9% and opioid prescribing rates declined from 39.8% to 31.7%. The risk of valproic acid prescribing was 10.9 percentage points higher among residents with ADRD with disruptive behaviors, while the risk of being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain.
conclusionsAntiepileptic prescribing among nursing home residents with ADRD is increasing, while antipsychotic and opioid prescribing is declining. Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways. Antiepileptic prescribing of questionable risk-benefit for dementia care warrants further scrutiny.
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