Although TCAs are a treatment option for DPN, evidence suggests the prolonged use of TCA therapy increases the risk of cognitive decline and dementia.
Purdue University–led researchers stated that is likely due to the anticholinergic effects of the medications. “The anticholinergic activity is thought to contribute significantly to the observed increase in cognitive decline and dementia risks associated with long-term TCA use,” the researchers wrote. “There is little information available to describe the usage patterns of TCAs in DPN, particularly within underserved populations who receive care at Federally Qualified Health Centers (FQHCs).”
In a report in the Journal of the American Pharmacists Association, the study team discussed prescribing patterns of TCAs as a treatment for DPN and evidence of deprescribing attempts in a FQHC population.
The researchers performed a retrospective chart review of electronic medical record data for patients at two different FQHCs. Also, a convenience sample of 100 adults was stratified into two age groups: 18 to 55 years and 55+ years. All of the patients had a diagnosis of type 1 or type 2 diabetes mellitus and had been prescribed TCAs in the previous 4 years, as well as a visit with a primary care provider in the past 12 months.
Of the 100 members in the study population, 74 members were persistent users of TCAs at the time of data collection, and the mean duration of utilization was 54.8 months. Overall, 104 TCAs were prescribed across 100 individual patients.
“Of all 104 prescribed TCAs, 66 (63%) were prescribed at a rate that exceeded thresholds associated with a higher risk of dementia,” the authors emphasized. “Black older adults prescribed TCAs were more likely to exceed this dose threshold.”
The researchers recommended that “interventions preventing use of or deprescribing TCAs in patients with DPN should be conducted for the potential benefits of preventing or delaying cognitive impairment and promoting equitable care.”
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