Central Nervous System–Active Medication Use in Older Adults With and Without Dementia—A Retrospective Cohort Study

Importance: Central nervous system (CNS)–active medication use is common in older adults; however, there are limited data on utilization trends over time, differences in utilization amongst those with and without dementia, and modification of utilization surrounding dementia diagnosis. Objective: To evaluate CNS-active medication trends in US older adults with and without dementia over 13 years, including evaluation of changes in utilization before and after dementia diagnosis. Design: Retrospective observational cohort study using de-identified administrative claims data. Participants: Older adult (age ≥ 65 years) commercial and Medicare Advantage enrollees with continuous medical and pharmacy coverage for at least one calendar year from 2010 through 2022. Main Measures: (1) Annual probability of receiving CNS-active medications; (2) changes in medication use with dementia diagnosis. Key Results: In total, 6,062,601 enrollees were included; 682,833 (11.3%) with dementia and 5,379,768 (88.7%) without. CNS-active medication use was highest in those with dementia throughout the study time period. Opioid utilization in those with and without dementia was 36.1% and 29.6% in 2010, decreasing to 24.3% and 22.2%, respectively, in 2022. Antidepressant use increased over time (i.e., 45.2 to 52.0% dementia; 15.8 to 24.6% without). Antipsychotic use in those with dementia was 18.1% in 2010, decreased to 15.9% in 2016, and increased back to 18.0% in 2022. A total of 444,587 enrollees experienced incident dementia diagnosis. There were immediate increases in antipsychotic (0.9% [0.5, 1.4] absolute increase, p < 0.001) and antidepressant (4.0% [3.3, 4.6] absolute increase, p < 0.001) use in the month following diagnosis. Increased use of these medications peaked 3–5 years after diagnosis. Dementia diagnosis was associated with decreased slopes of opioid (− 0.2% [− 0.3, − 0.1], p < 0.001) and benzodiazepine (− 0.07% [− 0.11, − 0.03], p < 0.001) use. Conclusions: CNS-active medication use is higher in older adults with dementia when compared to those without dementia. Incident dementia diagnosis is accompanied by marked increases in the use of antidepressants and antipsychotics.