Contributory and developmental social participation and depressive symptoms among older adults in China: urban-rural and gender disparities.

In 2019, Alzheimer’s Disease International estimated that 50 million individuals were affected by dementia worldwide. This figure is projected to reach 152 million by 2050 []. In individuals aged at least 65 years, Alzheimer’s disease is the leading cause of dementia, followed by other neurodegenerative disorders, grouped under the term Alzheimer’s disease and related dementias (ADRD). These conditions result in a progressive cognitive and functional decline [], which may significantly affect caregiver burden and healthcare costs [, ]. As ADRD progresses, behavioral and psychological symptoms of dementia (BPSD) become more frequent and severe, further worsening patient prognosis. Consequently, the management of BPSD through non-pharmacological and pharmacological therapies represents a significant challenge for non-specialized healthcare professionals []. To address this issue at Hospices Civils de Lyon, France, a mobile team dedicated to the management of BPSD in patients with ADRD (MTAD) visiting patients’ homes or nursing homes has been implemented []. Polypharmacy is highly prevalent in older patients with dementia (62%) given the need to treat both comorbidities and BPSD [, ]. Medication exposure – defined here as polypharmacy, the use of potentially inappropriate medications (PIMs), and the use of medications with anticholinergic and/or sedative properties - is a potentially modifiable factor associated with cognitive iatrogenic risk and dementia in several studies [–]. A cognitive iatrogenic risk is an adverse drug event defined as a decrease in the cognitive reserve as well as an onset or worsening of cognitive disorders []. It results from a complex interaction between predisposing and precipitating risk factors that must be taken into account in older patients’ care pathway. Therefore, identifying potentially inappropriate medications and considering their dose reduction or discontinuation when appropriate is essential to optimize pharmacological therapy in older patients with neurocognitive disorders (NCD). The MEMORIAS (Medication Exposure of older community-dwelling patients with neurocognitive disorders treated by a MObile team dedicated to behavioRal dIsorders linked to Alzheimer’s disease or related dementiaS) study was designed to better understand the medication exposure of older patients with BPSD living at home. In this study, patients were examined at home by the MTAD as part of support for the management of BPSD. Thus, the main objective of this study was to assess the theoretical impact of the MTAD medication recommendations on the medication exposure of older patients with BPSD living at home in the context of neurocognitive disorders. The secondary objectives were to describe the MTAD medication recommendations and the BPSD course during a 60-day follow-up period.