Pharmacists Play a Critical Role in Treating Alzheimer Disease

Alzheimer disease (AD) is the seventh-leading cause of death in the US and the most common cause of dementia among older adults.¹ Medication therapy management (MTM) is an essential component of disease state management in patients with AD. Identifying medication-related problems such as potentially inappropriate medications (PIMs) is critical. First-generation antihistamines such as diphenhydramine (Benadryl; Kenvue Brands, LLC) are an example of a PIM for patients 65 years and older.² These and other PIMs can worsen dementia symptoms due to their anticholinergic properties.2 As medication experts, pharmacists play a vital role in providing MTM services for patients with AD.

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MTM and AD

The World Health Organization (WHO) developed a global action plan on the public health response to dementia with goals to implement by 2025 to improve the lives of individuals living with dementia.³ One of the worldwide goals is for 75% of countries to provide support and training programs for families of patients living with dementia by 2025. Another area of focus for the WHO goals is involvement of a multidisciplinary team.³ Pharmacists can provide education to patients, family members, caregivers, and health care professionals about pharmacotherapy options for AD and lifestyle modifications. Additionally, they can assess for drug interactions.

One systematic review evaluated the impact of MTM programs on PIM use.⁴ Studies were included if they had a Medicare population, were based in the US, evaluated an MTM program, focused on the impact of an MTM program on PIM use as the primary outcome, were a randomized controlled trial or observational study, and were available in English.⁴ There were 7 studies included in the analysis, with settings including tertiary medical centers, outpatient clinics, community pharmacy chains, and nationwide telehealth MTM providers.⁴ Three out of the 7 studies focused on patients with AD or dementia. The systematic review found that MTM reduced PIM use in 5 of the 7 studies.⁴ Other notable findings include that MTM services resulted in higher odds of discontinuing an inappropriate anticholinergic medication.⁴ These study findings highlight the important role pharmacists play in MTM services.

In a randomized controlled trial, dementia care via telephone and internetbased intervention was evaluated through the Care Ecosystem model over a 12-month study period.⁵ Study participants included persons with dementia (PWD) and their caregivers. Participants were randomly assigned to either the Care Ecosystem or usual care group. Participants in the Care Ecosystem group received dementia care consults performed by care team navigators and dementia expert providers (pharmacist, advanced practice nurse, and social worker). Pharmacists reviewed all patient medication lists, and their recommendations were sent to physicians. Additionally, medication changes were discussed with caregivers. Participants in the usual care group were given contact information for various organizations and sent a quarterly newsletter. The study found that the Care Ecosystem improved quality of life for PWD compared with usual care (P = .04). Additionally, the Care Ecosystem reduced the number of emergency department visits (P = .04) and caregiver burden (P = .046).⁵

REFERENCES

1. Alzheimer’s disease fact sheet. National Institute on Aging. Updated April 5, 2023. Accessed November 14, 2024. https://www.nia.nih.gov/health/alzheimers-and-dementia/alzheimers-disease-fact-sheet

2. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372

3. Global action plan on the public health response to dementia, 2017-2025. 2017. Accessed November 14, 2024. https://iris.who.int/bitstream/handle/10665/259615/9789241513487-eng.pdf?sequence=1

4. Rao P, Hung A. Impact of medication therapy management programs on potentially inappropriate medication use in older adults: a systematic review. J Manag Care Spec Pharm. 2024;30(1):3-14. doi:10.18553/jmcp.2024.30.1.03

5. Possin KL, Merrilees JJ, Dulaney S, et al. Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the care ecosystem randomized clinical trial. JAMA Intern Med. 2019;179(12):1658-1667. doi:10.1001/jamainternmed.2019.4101