The risk of head injuries associated with antipsychotic use among persons with Alzheimer’s disease
Tapiainen V, Lavikainen P, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, Tolppanen AM. J. Am. Geriatr. Soc. 2020; ePub(ePub): ePub.
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
(Copyright © 2020, John Wiley and Sons)
DOI 10.1111/jgs.16275 PMID 31912482
BACKGROUND/OBJECTIVES: Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer’s disease (AD).

DESIGN: Nationwide register-based cohort study. SETTING: Medication Use and Alzheimer’s Disease (MEDALZ) cohort, Finland. PARTICIPANTS: The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded.

MEASUREMENTS: Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD-10] codes S00-S09) and traumatic brain injuries (TBIs; ICD-10 codes S06.0-S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks.

RESULTS: Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person-years = 1.65 [95% confidence interval {CI} = 1.50-1.81] for users and 1.26 [95% CI = 1.16-1.37] for nonusers; IPT-weighted hazard ratio [HR] = 1.29 [95% CI = 1.14-1.47]) and TBIs (event rate per 100 person-years = 0.90 [95% CI = 0.79-1.02] for users and 0.72 [95% CI = 0.65-0.81] for nonusers; IPT-weighted HR = 1.22 [95% CI = 1.03-1.45]). Quetiapine users had higher risk of TBIs (IPT-weighted HR = 1.60 [95% CI = 1.15-2.22]) in comparison to risperidone users.

CONCLUSIONS: These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies.
Language: en

Keywords Alzheimer’s disease; antipsychotics; dementia; risk factors; traumatic brain injury


Foot care to improve physical function and prevent falling of frail elderly adults with and without dementia
Yamashita T, Yamashita K, Takase Y. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2019; 2019: 321-324.
(Copyright © 2019, IEEE (Institute of Electrical and Electronics Engineers))
DOI 10.1109/EMBC.2019.8857767 PMID 31945906
Feet and toenail abnormalities are common among the elderly and can increase the risk of falls. We examined the changes in physical function after feet and toenails care for frail elderly adults and elderly adults with dementia. As a result, the abnormalities in the subject’s feet and toenails improved, and the individuals’ physical function and social participation increased.
Language: en


Quantitative and qualitative analyses of the clock drawing test in fall and non-fall patients with Alzheimer’s disease
Suzuki Y, Mochizuki H, Oki M, Matsumoto M, Fukushima M, Yoshikawa Y, Nagasawa A, Takakura T, Shimoda N. Dement. Geriatr. Cogn. Dis. Extra 2019; 9(3): 381-388.
Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Saitama, Japan.
(Copyright © 2019, Karger Publishers)
DOI 10.1159/000502089 PMID 31966036
AIM: The clock drawing test (CDT) is widely used as a visual spatial ability test and screening test for dementia patients. The appearance frequency of qualitative errors obtained through the qualitative analysis of CDT may be related to the participant’s falls. The aim of this study was to clarify the difference in the number of people who presented with qualitative errors in the CDT between a fall and non-fall group of patients with Alzheimer’s disease (AD).
METHODS: The CDT was implemented for 47 patients with AD. A quantitative analysis was conducted, and a qualitative analysis was performed for errors. The patients were divided into two groups based on their history of falls over the past year. The results of the CDT quantitative analysis were tested using the Mann-Whitney U test, and Fisher’s exact test was employed to determine the difference in the number of people who presented with error types between the two groups (fall group, non-fall group) in the CDT qualitative analysis.
RESULTS: In the quantitative analysis, a significant difference was found for the total scores, with the total CDT score of the fall group (n = 22) significantly lower than that of the non-fall group (n = 25) (p = 0.006, effect size: φ = 0.40). In the qualitative analysis, a significantly higher number of patients in the fall group than in the non-fall group presented with a conceptual deficit (p =0.001, φ = 0.51). No differences were found in the number of patients in the two groups who presented with the other five error types.
CONCLUSIONS: These results showed that a lower score in the CDT quantitative analysis might suggest an increased risk of falls. It was also clarified that a larger number of patients in the fall group than in the non-fall group presented with a conceptual deficit of the qualitative error types in the CDT. Therefore, these results suggest that the appearance of a conceptual deficit may be an index for the selection of patients with AD prone to falling when implementing fall prevention measures.
Language: en

Alzheimer’s disease; Clock drawing test; Fall; Qualitative analysis