Sociodemographic factors and psychotropic medication use among Alzheimer’s dementia patients diagnosed with normal pressure hydrocephalus and mild cognitive impairment: Sex variation in a retrospective cohort analysis

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Objective This study aimed to examine the relationship between sociodemographic factors, psychotropic medication, and Alzheimer’s Dementia (AD) in patients with a history of Normal Pressure Hydrocephalus (ADNPH) and Mild Cognitive Impairment (ADMCI) and how it varies by sex, using the Social Determinants of Health (SDH) model. Method The study analyzed 33,735 patients who presented with ADMCI (n=33,064) or ADNPH (n=671) between February 2016 and August 2021 at Prisma Health-Upstate. Multivariable logistic regression identified key factors associated with ADNPH and ADMCI, including age, race, and medication use. Results African Americans (OR = 0.388, 95% CI: 0.277–0.542), individuals with a history of tobacco use (OR = 1.175, 95% CI: 1.004–1.375), and those treated with buspirone (OR = 1.415, 95% CI: 1.116–1.794) were associated with ADNPH, whereas treatment with risperidone (OR = 0.217, 95% CI: 0.103–0.459) was linked to ADMCI. In sex-stratified analyses, males with ADNPH were more likely to report a history of tobacco use (OR = 1.818, 95% CI: 1.370–2.411, p < 0.001) and treated with citalopram (OR = 2.102, 95% CI: 1.561–2.831, p < 0.001). Males with ADMCI were more frequently African Americans (OR = 0.312, 95% CI: 0.174–0.559, p < 0.001) and reported alcohol use (OR = 0.685, 95% CI: 0.531–0.885, p = 0.004). Among females, ADNPH were associated with alcohol use (OR = 1.684, 95% CI: 1.359–2.087, p < 0.001) and treated with aripiprazole (OR = 1.690, 95% CI: 1.163–2.458, p = 0.006) or memantine (OR = 1.752, 95% CI: 1.283–2.392, p < 0.001). Females with ADMCI were African Americans (OR = 0.470, 95% CI: 0.311–0.710, p < 0.001) and treated with donepezil (OR = 0.552, 95% CI: 0.399–0.765, p < 0.001) or risperidone (OR = 0.046, 95% CI: 0.006–0.330, p = 0.002). Conclusion Our findings highlight the need for targeted interventions that address social factors, psychotropic medication access, and disparities in healthcare to improve outcomes for patients with NPH and MCI.

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