F3‐03‐02: EFFECTS OF A COMPREHENSIVE, INDIVIDUALIZED, PERSON‐CENTERED MANAGEMENT (CI‐PCM) PROGRAM ON ANXIOLYTIC MEDICATION USAGE IN PERSONS WITH MODERATE‐TO‐SEVERE ALZHEIMER'S DISEASE

Last year we published the results of a randomized controlled trial of a Comprehensive, Individualized, Person-Centered Management Program (CI-PCM) on persons with moderate-to-severe Alzheimer's disease (Reisberg, et al., Dement Geriatr Cogn Disord, 2017). The subject-caregiver dyads randomized to the management program (n=10) showed significant improvements globally, which were approximately 10 times those in the usual community care dyads (n=10). Herein we examined the effects of the CI-PCM intervention on anxiolytic medication usage. Subject charts (N=20), were reviewed by a physician (M.A.) who was blind to the subject group randomization assignment. Group 1 had one subject who was receiving clonazepam at baseline, (0.25 mg, 3 times daily), which was discontinued after 36 days and a second subject who received clonazepam, 0.5 mg weekly at baseline, which was discontinued after 29 days. Group 2 had 1 subject who was started on alprazolam, 0.25 mg twice weekly as necessary on an estimated day 18, subsequently increased to twice daily as needed. Total duration of alprazolam usage was an estimated 180 days. Total estimated duration of the group 1 subjects in the study was 2,112 days and of the group 2 subjects was 2,003 days. We compared anxiolytic medication usage in the 2 study groups. Procedures for these analyses are described in Table 1. Briefly, we considered time off anxiolytics in group 1 as positive, since subjects did not take, or discontinued, anxiolytics, during this period. For group 2, we considered time in which anxiolytics were added as a negative result. We then compared group outcomes. Subsequently, the group blind was broken and the detailed results are shown in Table 1 and summarized below. The difference between the groups in terms of days of anxiolytic medication usage was highly significant (the two-tailed p value < 0.0001), with less usage in subjects randomized to the management program. Since anxiolytic usage is associated with numerous negative outcomes including dependency, seizures upon withdrawal, etc. (see Table 2), the CI-PCM program in this study was associated with an important collateral health benefit in terms of decreasing anxiolytic medication usage by community physicians. Suicidal ideation Coma Visual impairment Seizures Steven-Johnson Syndrome Hepatic Failure Physiological dependence Psychological dependence Amnesia Hallucinations Hostility Psychosis Withdrawal Respiratory depression Depression Memory impairment Confusion Excitabilityl Dyspnea Withdrawal Memory impairment Impaired cognition Depression Confusion Amnesia Dyspnea Hallucinations Psychological depression Physiological depression Hostility Conclusion: The management program was associated with a very highly significant outcome in terms of the discontinuation of anxiolytic medication usage and the ostensible prevention of new anxiolytic medication prescribing by physicians.

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