• Sonal Singh, Noelle M Cocoros, Kevin Haynes, Vinit P Nair, Thomas P Harkins, Paula A Rochon, Richard Platt, Inna Dashevsky, Juliane Reynolds, Kathleen M Mazor, Sarah Bloomstone, Kathryn Anzuoni, Sybil L Crawford, and Jerry H Gurwitz.
• University of Massachusetts Medical School & Meyers Primary Care Institute, Worcester, Massachusetts, USA.
• J Am Geriatr Soc. 2021 May 1; 69 (5): 1328-1333.

ObjectivesPersons living with Alzheimer's disease (AD) may be at increased risk for prescribing cascades due to greater multimorbidity, polypharmacy, and the need for more complex care. Our objective was to assess the proportion of the antidopaminergic-antiparkinsonian medication prescribing cascades among persons living with Alzheimer's disease.SettingTwo large administrative claims databases in the United States.ParticipantsWe identified patients aged ≥50 on January 1, 2017, who were dispensed a drug used to treat Alzheimer's disease for at least 1 day in the 365 days prior to or on cohort entry date and who had medical and pharmacy coverage in the 365 days prior to the cohort entry date. We excluded individuals with a recent institutional stay. We identified incident antidopaminergic (antipsychotic/metoclopramide) use in the 183 days following cohort entry and identified subsequent incident antiparkinsonian drug use within 8 to 365 days.ResultsThere were 121,538 patients with Alzheimer's disease eligible for inclusion. Approximately 62% were women with a mean age of 79.5 (SD ± 8.6). The mean number of drugs dispensed was 9.2 (SD ± 4.9). There were 36 incident antiparkinsonian users among 4,534 incident antipsychotic/metoclopramide users (0.8%).ConclusionWe determined that the proportion of antidopaminergic-antiparkinsonian medication prescribing cascades, widely considered as high-priority, was low. Our approach can be used to assess the proportion of prescribing cascades in populations considered to be at high risk and to prioritize system-level interventional efforts to improve medication safety in these patients.© 2021 The American Geriatrics Society.

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