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Central Nervous System-Active Medication Use in Older Adults With and Without Dementia-A Retrospective Cohort Study
Warner Nafisseh S, Van Houten Holly K, Tung Ericka E, Verdoorn Brandon P, Warner David O, Mielke Michelle M, Jeffery Molly M. Journal of general internal medicine, 2025-03-19
Topic: Risk, prevention and care in population studies
Central nervous system (CNS)-active medication use is common in older adults; however, there are limited data on utilization trends over time, differences in utilization amongst those with and without dementia, and modification of utilization surrounding dementia diagnosis. To evaluate CNS-active medication trends in US older adults with and without dementia over 13 years, including evaluation of changes in utilization before and after dementia diagnosis. Retrospective observational cohort study using de-identified administrative claims data. Older adult (age ≥ 65 years) commercial and Medicare Advantage enrollees with continuous medical and pharmacy coverage for at least one calendar year from 2010 through 2022. (1) Annual probability of receiving CNS-active medications; (2) changes in medication use with dementia diagnosis. In total, 6,062,601 enrollees were included; 682,833 (11.3%) with dementia and 5,379,768 (88.7%) without. CNS-active medication use was highest in those with dementia throughout the study time period. Opioid utilization in those with and without dementia was 36.1% and 29.6% in 2010, decreasing to 24.3% and 22.2%, respectively, in 2022. Antidepressant use increased over time (i.e., 45.2 to 52.0% dementia; 15.8 to 24.6% without). Antipsychotic use in those with dementia was 18.1% in 2010, decreased to 15.9% in 2016, and increased back to 18.0% in 2022. A total of 444,587 enrollees experienced incident dementia diagnosis. There were immediate increases in antipsychotic (0.9% [0.5, 1.4] absolute increase, p < 0.001) and antidepressant (4.0% [3.3, 4.6] absolute increase, p < 0.001) use in the month following diagnosis. Increased use of these medications peaked 3-5 years after diagnosis. Dementia diagnosis was associated with decreased slopes of opioid (- 0.2% [- 0.3, - 0.1], p < 0.001) and benzodiazepine (- 0.07% [- 0.11, - 0.03], p < 0.001) use. CNS-active medication use is higher in older adults with dementia when compared to those without dementia. Incident dementia diagnosis is accompanied by marked increases in the use of antidepressants and antipsychotics.
Key findings
- Dementia diagnosis was associated with decreased slopes of opioid (- 0.2% [- 0.3, - 0.1], p < 0.001) and benzodiazepine (- 0.07% [- 0.11, - 0.03], p < 0.001) use.
- CNS-active medication use is higher in older adults with dementia when compared to those without dementia.
Why it matters
This study found that central nervous system-active medication use is higher in older adults with dementia than in those without. It describes medication use patterns and does not test any treatment, cure, or prevention for Alzheimer's disease.
Study details
- Study designcohort study
- Participants444,587
- Effect size11.3%; 88.7%; 36.1%
- Evidence strengthModerate
How this study scored 56/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of general internal medicine) |
| Journal's citation record | 3 / 4 | Journal of General Internal Medicine: journal h-index 283 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 4 / 4 | 444,587 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 3 times (OpenAlex, 2026-10-17) |
| Citations per year | 1 / 5 | 1.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 3 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Molly M. Jeffery: h-index 28 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Mayo Clinic: institution h-index 1,606 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40106139) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 56 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Warner Nafisseh, S., Van Houten Holly, K., Tung Ericka, E., Verdoorn Brandon, P., Warner David, O., Mielke Michelle, M., et al. (2025). Central Nervous System-Active Medication Use in Older Adults With and Without Dementia-A Retrospective Cohort Study. Journal of general internal medicine. https://doi.org/10.1007/s11606-025-09454-1
Vancouver
Warner Nafisseh S, Van Houten Holly K, Tung Ericka E, Verdoorn Brandon P, Warner David O, Mielke Michelle M, et al. Central Nervous System-Active Medication Use in Older Adults With and Without Dementia-A Retrospective Cohort Study. Journal of general internal medicine. 2025. doi:10.1007/s11606-025-09454-1. PMID: 40106139.
BibTeX
@article{warnernafisseh2025-40106139,
author = {Warner Nafisseh, S. and Van Houten Holly, K. and Tung Ericka, E. and Verdoorn Brandon, P. and Warner David, O. and Mielke Michelle, M. and Jeffery Molly, M.},
title = {{Central Nervous System-Active Medication Use in Older Adults With and Without Dementia-A Retrospective Cohort Study}},
journal = {Journal of general internal medicine},
year = {2025},
doi = {10.1007/s11606-025-09454-1},
pmid = {40106139},
url = {https://doi.org/10.1007/s11606-025-09454-1}
}
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