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Antiseizure Medication Dispensing Before and After Initiation of Antidementia Medicines: A Population‐Based Matched Cohort Study

Year: 2026

Type: article

Abstract: PURPOSE: Seizures and behavioural and psychiatric features may prompt antiseizure medication (ASM) use in dementia. We examined whether increased ASM dispensing precedes or follows initiation of antidementia treatment to inform hypotheses about when these indications emerge. METHODS: Using the Australian Pharmaceutical Benefits Scheme (PBS) 10% sample, we matched people aged ≥ 50 years with incident antidementia dispensing in 2018-2021 1:1 to controls without antidementia dispensing (2013-2024) by age, sex, index year and diabetes and hypertension treatment. We compared annual ASM dispensing (ATC N03, excluding gabapentinoids) from 5 years before to 3 years after initiation using McNemar's test and interrupted time series analysis. Sensitivity analyses re-matched on Rx-Risk comorbidity and removed the survival requirement. RESULTS: Among 4385 matched pairs (59.8% women; mean age 78.3 years), ASM dispensing was higher in cases 5 years before initiation (2.7% vs. 1.8%; ratio 1.53, 95% CI = 1.15-2.03) and the difference widened after initiation (year 3: 9.1% vs. 2.4%; ratio 3.85, 95% CI = 3.13-4.75). Valproate accounted for most of the excess (year 3 ratio 6.97, 95% CI = 4.80-10.12). Levetiracetam dispensing rose gradually from year -3 and was higher after initiation (year 3 ratio 2.30, 95% CI = 1.51-3.50). Matching on comorbidity attenuated pre-initiation differences (year -5 ratio 1.42). The excess was greater at ages 50-79 years. CONCLUSIONS: ASM dispensing, most noticeably valproate, was higher in people with antidementia medicine dispensing than in controls, modestly before and markedly after initiation. Behavioural and psychiatric indications seem to predominate, with a smaller seizure-related contribution possibly beginning before treatment, although dispensing data cannot confirm indications. Valproate use warrants review.

Source: Pharmacoepidemiology and Drug Safety

DOI: 10.1002/pds.70530

Authors: Osvaldo P. Almeida, Christopher Etherton‐Beer, Frank M. Sanfilippo, David B. Preen, Amy Page

Institutions: The University of Western Australia, The University of Notre Dame Australia, La Trobe University

Language: English

Topic: Dementia and Cognitive Impairment Research

Subfield: Psychiatry and Mental health

Field: Medicine

Domain: Health Sciences

Open Access status: hybrid

Estimated APC paid: $4,650

OpenAlex ID: W7225823653

FWCI:

Cites: 33

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