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Clinical Diagnosis of Dementia, Not Presence of Behavioral and Psychological Symptoms, Is Associated With Psychotropic Use in Community-Dwelling Elders Classified as Having Dementia

Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, Harvard Geriatric Medicine Fellowship Program, Boston, Massachusetts, National Taiwan University Hospital, Department of Geriatrics and Gerontology, doctord6226{at}yahoo.com

Judith D. Kasper, PhD

Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

Betty S. Black, PhD

Department of Psychiatry and Behavioral Science, School of Medicine, Johns Hopkins University, Baltimore, Maryland

Peter V. Rabins, MD, MPH

Department of Health Policy and Management, Bloomberg School of Public Health, Department of Psychiatry and Behavioral Science, School of Medicine, Johns Hopkins University, Baltimore, Maryland

Little is known about the prevalence and correlates of psychotropic use in community-dwelling elders with dementia. Baseline data from 285 community-dwelling elders with a research classification of dementia (based on a neuropsychological battery of 4 tests) and their knowledgeable informants enrolled in the observational Memory and Medical Care Study were analyzed. A total of 33.3% of subjects with a research classification of dementia were clinically diagnosed, 28.8% used at least 1 psychotropic drug, and 61.8% had at least 1 behavioral or psychological symptom of dementia (BPSD). Presence of BPSD was associated with a higher likelihood of a clinical diagnosis of dementia. Multivariate logistic regression showed a clinical diagnosis of dementia, not BPSD, was associated with psychotropic use; clinical recognition of dementia appears to be an intermediate step between presence of BPSD and prescription of psychotropics. In addition, most community-dwelling elders meeting the research criteria for dementia were not clinically diagnosed, despite contact with a physician (89%) in the previous year.

Key Words: dementia • elderly • behavioral and psychological symptoms of dementia • psychotropic drug • community diagnosis

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