Medication use to manage comorbidities for people with dementia: a systematic review

Aim: People with dementia commonly live with multiple comorbidities. This review aimed to review medications to manage chronic conditions in people who also have a diagnosis of dementia. The secondary aim was to determine whether drug utilisation for other conditions change as a result of dementia diagnosis. Methods: Data source: We included experimental and observational studies where participants with dementia were diagnosed and treated for one or more comorbid conditions that reported health outcomes or drug utilisation. Study selection: MedLine and Embase databases were searched from inception to March 2016 (updated September 2016). Three researchers screened titles, abstracts and full-text articles, then extracted data using a data extraction sheet. Results: Six studies met inclusion criteria with 51 696 participants (mean age 81.1 ± 2.0 years, 78% female). One experimental study compared bisphosphonate use with placebo in people with mid-stage dementia and found reduced risk of non-vertebral fractures (OR = 0.27, 95% CI 0.12–0.61) in the bisphosphonate group. Five observational studies reported drug utilisation for people with dementia to treat comorbidities, namely depression, osteoporosis, diabetes and cardiovascular disease. Drug utilisation was found to be similar for depression, diabetes and cardiovascular disease for people with and without dementia, although bisphosphonate use was significantly reduced. Conclusion: Evidence on medication use for comorbidities in people with dementia is currently limited to drug utilisation patterns and treatment of one comorbidity: osteoporosis. Comorbidities for people with dementia appear to be managed pharmacologically until the late stages of disease without considering time to benefit or that it is a life-limiting condition.