الفهرس 
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Abstract
D
ementia is an irreversible neurodegenerative disorder characterized by a cluster of signs and symptoms, including difficulties in memory, disturbances in language, psychosocial and psychiatric changes, and impairments in activities of daily living (Wu et al., 2016).
Rising life expectancy has led to an increasing prevalence of diseases more common at old age, such as Alzheimer’s disease (AD) and related dementias. The number of Americans aged 65 and older with AD and other dementias was about 7 million in 2012 and is projected to increase to almost 12 million by 2040 (Zissimopoulos et al., 2018). Also, (sabry et al., 2021) reported that prevalence of dementia and cognitive impairment are 1.74 to 51.4% in Egypt.
There is no single agreed definition of polypharmacy (Guthrie et al., 2011). For example, should the term refer to only simultaneous opposed to consecutive medications, include short-term as well as long-term therapy, be restricted to prescription-only medications, or include non-pharmacological products? (Payne,2016). Bushardt et al., 2008 defined polypharmacy as the use of multiple medications or the use of a medication that is not indicated.
Polypharmacy is a complex issue. The potential risks of polypharmacy are evident; however, so are
the benefits to slow the progression of the disease and improve quality of life (Bushardt et al., 2008). So, Balancing the risks and benefits of polypharmacy in elderly becomes challenging for prescribers (Bushardt et al., 2008).
Aim of the study:
The aim of the study is to detect the prevalence of polypharmacy and potentially inappropriate medication (PIM) use in demented elderly patients and its effect on recurrent hospital admission.
Subjects & methods:
A cross-sectional study was conducted to detect the prevalence of polypharmacy and potentially inappropriate medication (PIM) use in demented elderly patients and its effect on recurrent hospital admission in outpatient clinics of Ain shams university hospital from February 2022 to December 2022.Our study included 90 demented elderly patients were interviewed to know their personal history, degree of dementia, drug history, medical history, and number of hospital admission in the last year.
Study included elderly above sixty years old, both males and females, those who have dementia (early, moderate, moderately severe, and severe dementia) according to Global Deterioration Scale (Reisberg et al., 1982), but patients who have mild cognitive impairment were excluded.
Mini mental status examination (MMSE) was used for assessment of cognitive function, using the Arabic version (El-Okl et al., 2002), polypharmacy will be determined by the categorization suggested in the development of multidimensional prognostic index for polypharmacy (i.e., 4–6 medications are considered minor polypharmacy, and ≥7 medications are considered severe polypharmacy (Veronese et al., 2017), and potentially inappropriate medications will be determined by STOPP START tool(Gallagher et al., 2008) and Consensus Panel Survey for severely demented patients (Holmes et al., 2008).
Results:
As regard characteristics of patients:
Most of patients were females (64.4%), their mean age= 74.60 ± 7.83 years, widow/widower (62.2%), high education (37.8%), and reported having an unsatisfactory income (54.4%).
The mean number of charlson score was 4.73 ± 2.84, also 51.1% of the study was severe dementia (stage 7), and 24.4% of the study was moderately severe dementia (stage 6), and 15.6% of the study was moderate dementia (stage 5), and8.9% of the study was early dementia (stage 4) according to Global deterioration scale.
The most prevalent medical comorbidity with dementia was cardiac diseases (62.3%) followed by neurological diseases (60%), endocrine diseases (37.8%), renal diseases (36.7%), cancer (21.1%), chest diseases (15.6%), anemia (13.3%), and finally hepatic diseases.
The most prevalent drug in demented patients was antihypertensive drugs (17.8% of them was inappropriate), followed by antiplatelets, hypoglycemics, NMDA receptors antagonists, anti-depressants, antipsychotics, and finally cholinesterase inhibitors.
As regard prevalence of polypharmacy in demented patients:
The mean number of medications was 4.39±2.43, prevalence of polypharmacy in demented patients was 54.4 %. Most of them had minor polypharmacy (38.9 %) who received 4–6 medications, and 15.6% of them had severe polypharmacy who received ≥ 7 medications.
As regard factors affecting polypharmacy in demented patients:
There was no significant relationship between gender, marital state, education, income, and polypharmacy, but there was significant relationship between charlson score (multiple comorbidities score) and polypharmacy in demented patients, also revealed that some comorbidities had significant effect on polypharmacy: 77.6% of all cardiac patients, 53.1% of all patients that had endocrine disease, 49.0% of all patients that had renal disease, and 73.5% all patients that had neurological disease had polypharmacy in demented patients.
Some classes had significant values: 73.5 % of demented patients that used antihypertensive drugs had polypharmacy (28.6% of them was inappropriate), also there was no significant relationship between stages of dementia according to Global Deterioration Scale and polypharmacy.
As regard effect of polypharmacy in demented patients on recurrent hospital admission:
The prevalence of demented patients who was not admitted to hospital in the last year was 18.9%, and 81.1 % of elderly demented patients was admitted at the hospital in the last year, 55% of the patients was admitted at hospital once, 16.7% was admitted twice in the last year. 51.0% of demented patients who were admitted once in the last year had polypharmacy, but there was no significant relationship between polypharmacy and recurrent hospital admission.
As regard prevalence of PIM in elderly demented patients:
56.7% of elderly demented patients had PIM according to STOPP-START criteria and consensus panel survey in severely demented patients, 68.6% of them had one drug as PIM, and 19.6% of them had two drugs.
As regard relationship between polypharmacy and PIM in demented elderly patients:
Our study showed that there was significant relationship between polypharmacy and PIM in demented patients: 73.5% of patients that had polypharmacy had PIM.
As regard factors affecting potentially inappropriate medication:
In our study, there was significant relationship between PIM and marital state: 72.5% of demented patients that had PIM was widow or divorced, and none of them was single.
According to comorbidities, there was significant relationship between PIM and comorbidities: 72.5% of patients that had cardiac diseases, 52.9% of patients that had endocrine disease, and 70.6% of patients that had neurological diseases had PIM.
In addition, there was significant relationship between PIM and charlson comorbidities score: the higher the score, the higher the prevalence of PIM, also there was significant relationship between mean of number of medications and PIM.
According to stages of dementia, there was significant relationship between stages of dementia and PIM: 56.9% of demented patients that had PIM was stage 7 (severe dementia) according to Global Deterioration Score.
As regard relationship between PIM and recurrent hospital admission in elderly demented patients:
82.4% of elderly demented patients that had potentially inappropriate medication were admitted to hospital in last year, 52.9% them was admitted once in last year, but there there was no significant relationship between PIM and recurrent hospital admission.
CONCLUSION
T
he prevalence of polypharmacy and potentially inappropriate medication is high among elderly demented patients. Interventions aimed at reducing the prevalence of polypharmacy should be considered, also improvements to medication guidelines are needed for decision making around prescribing of long-term medications in patients with dementia. 81.1 % of elderly demented patients were admitted to the hospital in the last year, but there was no significant relationship between polypharmacy and recurrent hospital admission.
RECOMMENDATIONS
1. Awareness campaigns for physicians about concept of polypharmacy and its effect on recurrent hospitalization.
2. Giving attention for new guidelines to reduce polypharmacy and potentially inappropriate medication especially in demented patients.
3. Polypharmacy in demented patients may be influenced by cultures, percentage of elderly in population, and care giver goals, so we need more researches about that.