2017-2018 Alzheimer’s and Related Diseases Research Award*

Changes in Physician Approaches to Behavioral and Psychological Symptoms of Dementia since CMS's National Partnership to Improve Dementia Care

VCoA*The Virginia Center on Aging which administers the Alzheimer’s and Related Diseases Research Award Fund for the Commonwealth of Virginia, provides seed money to researchers in Virginia to stimulate innovative research into biomedical and psychosocial aspects of dementia, including cell biology, caregiving, and animal modeling.


Changes in Physician Approaches to Behavioral and Psychological
Symptoms of Dementia since CMS’s National Partnership to Improve Dementia Care

Jonathan Winter, MD

Virginia Commonwealth University – Shenandoah Family Practice Residency

After CMS’s 2012 initiative to reduce ‘inappropriate’ antipsychotic use in nursing homes, such prescribing decreased 27% in 4 years. Excluded from this calculation however were anti psychotics ‘appropriately’ prescribed for schizophrenia, Tourette’s, and Huntington’s. Over this same period, CMS described a greater than 20 percent increase in the reporting of these diagnoses. In addition, since the initiative’s debut CMS has been careful to trend the prescribing of other psychiatric medications commonly used for dementia symptoms including anxiolytics, antidepressants, and sedative-hypnotics to ensure that medication substitution is not occurring as the use of anti-psychotics decreases. The investigator’s previously funded ARDRAF study hinted that the use of other risky medications also used off-label for dementia symptoms in nursing homes (i.e., lithium and anticonvulsant mood stabilizers) have increased since 2012. Because utilization of these is not being trended by CMS, this study will retrospectively query de-identified data from the VA Department of Medical Assistance Services for rates of these diagnoses and medications since 2011. The objective is to better clarify how reactionary changes in diagnosing and prescribing distort the apparent reduction in pharmacologic solutions to dementia symptoms since CMS’s 2012 National Initiative.

(Dr. Winter may be contacted at 540/6313700, jwinter@valleyhealthlink.com)

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