Adherence of Anti-Dementia Medications in Alzheimer's Disease and Related Dementia: A Nationwide Cohort Study in Korea

Abstract

Background: Readily available treatments for Alzheimer&apos;s disease and related dementia (ADRD) include acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists. Non-adherence and early discontinuation of anti-dementia medications are prevalent issues. We aimed to investigate factors associated with suboptimal usage of anti-dementia medications in ADRD. Methods: Based on data extracted from a claim database in South Korea, 508,958 patients with ADRD who began taking anti-dementia medication between 2018 and 2020 were included. The mean possession ratio is the ratio of the sum of prescribed medication supply over one year and non-adherence is defined as mean possession ratio < 80%. Discontinuation is defined as no prescription of anti-dementia medications, or no switch to other anti-dementia medications, within 45 days after the run-out date. The cumulative incidence of discontinuation of anti-dementia medication was estimated using the Kaplan-Meier method. Factors associated with non-adherence were evaluated using logistic regression analyses. Results: Within the first year, the non-adherence ratio was 40.8%, while the discontinuation ratio was 43.6%, and approximately 30% of patients discontinued medication within 90 days after initiation. Younger age at diagnosis, female sex, and prescription at non-tertiary hospitals or clinics other than neurology/psychiatry were associated with increased risk of non-adherence. Compared with Seoul, a prescription issued by neurology/psychiatry departments at a tertiary hospital in other provinces was associated with a 75% higher risk of non-adherence. Conclusion: Strategies targeting non-adherence are warranted to minimize disparities in the management of patients with dementia.