Dementia-related neuropsychiatric symptoms: inequalities in pharmacological treatment and institutionalization

Figures & data

Table 1 Characteristics of patients with dementia disaggregated by psychoactive treatment type

		Type of treatment
Type of treatment		Without treatment	Antidepressants	Antipsychotics	Antidepressants + Antipsychotics	Total
		10,026 (33.6%)	10,148 (34.0%)	3,279 (11.0%)	6,411 (21.5%)	29,864 (100.0%)
Female Gender	*	6,528 (65.1%)	7,452 (73.4%)	2,125 (64.8%)	4,612 (71.9%)	20,717 (69.4%)
Nursing Home	*	1,988 (19.8%)	2,722 (26.8%)	1,041 (31.7%)	2,495 (38.9%)	8,246 (27.6%)
Arterial hypertension	*	1,394 (13.9%)	1,877 (18.5%)	498 (15.2%)	974 (15.2%)	4,743 (15.9%)
Diabetes	*	2,247 (22.4%)	2,622 (25.8%)	803 (24.5%)	1,461 (22.8%)	7,133 (23.9%)
Dyslipidemia	*	1,491 (14.9%)	1,861 (18.3%)	588 (17.9%)	1,219 (19.0%)	5,159 (17.3%)
Thyroid disease	*	1,252 (12.5%)	1,805 (17.8%)	475 (14.5%)	1,100 (17.2%)	4,632 (15.5%)
Parkinson’s disease	*	369 (3.7%)	375 (3.7%)	232 (7.1%)	286 (4.5%)	1,262 (4.2%)
Stroke	*	1,650 (16.5%)	2,118 (20.9%)	639 (19.5%)	1,158 (18.1%)	5,565 (18.6%)
Cardiovascular disease	*	927 (9.2%)	1,085 (10.7%)	332 (10.1%)	624 (9.7%)	2,968 (9.9%)
Traumatic brain injury	*	1,002 (10.0%)	1,520 (15.0%)	465 (14.2%)	1,084 (16.9%)	4,071 (13.6%)
Depressive disorder	*	395 (3.9%)	1,478 (14.6%)	242 (7.4%)	896 (14.0%)	3,011 (10.0%)
Neuropsychiatric symptoms	*	867 (8.6%)	1,377 (13.6%)	400 (12.2%)	1,119 (17.5%)	3,763 (12.6%)
Deprivation index	*
Quintile 1		1,945 (19.4%)	2,033 (20.0%)	656 (20.0%)	1,389 (21.7%)	6,023 (20.2%)
Quintile 2		1,981 (19.8%)	2,100 (20.7%)	608 (18.5%)	1,315 (20.5%)	6,004 (20.1%)
Quintile 3		2,036 (20.3%)	2,087 (20.6%)	642 (19.6%)	1,154 (18.0%)	5,919 (19.8%)
Quintile 4		2,070 (20.6%)	1,979 (19.5%)	691 (21.1%)	1,325 (20.7%)	6,065 (20.3%)
Quintile 5		1,994 (19.9%)	1,949 (19.2.0%)	682 (20.8%)	1,228 (19.2%)	5,853 (19.6%)
Age mean (SD)		84.18 (9.59)	83.96 (8.10)	83.54 (6.62)	83.48 (6.65)	83.88 (8.22)

Notes: Quintile 1: least deprived; Quintile 5: most deprived. *Existence of statistically significant differences at α=0.05.

Abbreviation: SD, standard deviation.

Table 2 Logistic regressions analyzing the probability of patients being treated with antidepressants, antipsychotics or both

	Antidepressants		Antipsychotics		Antipsychotics and Antidepressants
	OR		OR		OR
(Intercept)	1.384	**	0.934	NS	0.488	***
Time with dementia (Continuous)	0.993	*	0.995	NS	1.027	***
Age (Continuous)	0.994	***	0.992	***	0.991	***
Gender (Female)	1.399	***	1.018	NS	1.128	***
Deprivation index (Quintile 2)	0.982	NS	0.913	*	0.929	NS
Deprivation index (Quintile 3)	0.902	**	0.847	***	0.804	***
Deprivation index (Quintile 4)	0.894	**	0.968	NS	0.932	NS
Deprivation index (Quintile 5)	0.855	***	0.929	NS	0.864	**

Notes: Adjusted by diagnosis of arterial hypertension, diabetes mellitus, dyslipidemia, thyroid disease, Parkinson’s disease, stroke, cardiovascular disease and traumatic brain injury. Statistical Significance codes: P<0.001 “***”; P<0.01 “**”; P≤0.05 “*”. Quintile 1: least deprived; Quintile 5: most deprived.

Abbreviations: OR, odds ratio; NS, not significant.

Table 3 Logistic regression analyzing the probability that patients were living in a nursing home

	OR	Std. Error
(Intercept)	0.005	0.169	***
No psychoactive treatment (reference)	-
Type of treatment (Antidepressants)	1.556	0.035	***
Type of treatment (Antipsychotics)	2.075	0.046	***
Type of treatment (Antidepressants and Antipsychotics)	2.741	0.037	***
Age	1.040	0.002	***
Gender (Female)	1.286	0.032	***
Arterial hypertension	0.970	0.038	NS
Diabetes	1.082	0.032	*
Dyslipidemia	1.012	0.036	NS
Thyroid disease	0.866	0.038	***
Parkinson’s disease	1.116	0.066	NS
Stroke	1.155	0.034	***
Cardiovascular disease	0.939	0.046	NS
Traumatic brain injury	1.472	0.037	***
Depressive disorder (Yes)	0.881	0.045	**
Deprivation index (Quintile 2)	1.087	0.043	NS
Deprivation index (Quintile 3)	1.085	0.043	NS
Deprivation index (Quintile 4)	1.131	0.042	**
Deprivation index (Quintile 5)	1.309	0.0424	***

Notes: Statistical Significance codes: P<0.001 “***”; P<0.01 “**”; P≤0.05 “*”. Quintile 1: least deprived; Quintile 5: most deprived.

Abbreviations: OR, odds ratio; NS, not significant.

Table 4 Logistic regression models including gender and deprivation index interactions (subgroup analysis) analyzing the probability of living in a nursing home and being treated with antidepressants, antipsychotics or both

	Nursing home	Antidepressant treatment	Antipsychotic treatment	Antidepressant + Antipsychotic treatment
	OR	OR	OR	OR
Gender (Male) # Deprivation index Q1-Q3	1	1	1	1
Gender (Female) # Deprivation index Q1-Q3	1.27*	1.43*	0.99	1.11*
Gender (Male) # Deprivation index Q4-Q5	1.12*	0.95	0.99	0.96
Gender (Female) # Deprivation index Q4-Q5	1.03	0.94	1.07	1.04
(Intercept)	0.01*	1.31*	0.87	0.45*

Notes: *Interaction statistically significant (p<0.05). Adjusted by age, diagnosis of arterial hypertension, diabetes mellitus, dyslipidemia, thyroid disease, Parkinson’s disease, stroke, cardiovascular disease and traumatic brain injury. Quintile 1: least deprived; Quintile 5: most deprived. #Interaction between two variables.

Abbreviation: OR, odds ratio.