{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:47:36Z","timestamp":1782312456209,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T00:00:00Z","timestamp":1782000000000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG074957"],"award-info":[{"award-number":["R01AG074957"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Central nervous system (CNS) \u2013active polypharmacy, defined as concurrent use of antidepressants, antipsychotics, anti\u2010seizure medications, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, opioids, or skeletal muscle relaxants for \u2265 31 consecutive days, poses significant risks patients with dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Among community\u2010dwelling patients in Medicare plans aged \u2265 65 with dementia and Medicare Part D coverage in 2021, we determined the rate of CNS\u2010active polypharmacy initiation as well as medication and prescribing clinician characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Among beneficiaries with dementia (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a01,214,928, mean age 81.6 years), 7.8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a094,190) experienced incident polypharmacy. Antidepressants were the most frequent class (92.3%), and quetiapine (30.9%), gabapentin (29.0%), and trazodone (28.3%) the top individual medications. At the time of initiation, 43.8% of patients were prescribed all CNS\u2010active medications by a single clinician; primary care clinicians accounted for most polypharmacy prescriptions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Interventions to address polypharmacy should focus on development of guidelines targeting individual prescribers to help clarify appropriate use of CNS\u2010active medications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71608","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T03:17:38Z","timestamp":1782098258000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing treatment initiation with central nervous system\u2013active polypharmacy among adults with dementia"],"prefix":"10.1002","volume":"22","author":[{"given":"Donovan T.","family":"Maust","sequence":"first","affiliation":[{"name":"Department of Psychiatry Michigan Medicine University of Michigan  Ann Arbor Michigan USA"},{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel C.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Michigan Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Strominger","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C.","family":"Marcus","sequence":"additional","affiliation":[{"name":"School of Social Policy and Practice University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyungjin Myra","family":"Kim","sequence":"additional","affiliation":[{"name":"Office of the Vice President for Research University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanner","family":"Caverly","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Michigan Medicine University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Learning Health Sciences Michigan Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic C.","family":"Blow","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Michigan Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren P.","family":"Wallner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Michigan Medicine University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Epidemiology School of Public Health University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Krein","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"},{"name":"Department of Internal Medicine Michigan Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Vordenberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy College of Pharmacy University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2022.3543"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12362"},{"key":"e_1_2_8_4_1","first-page":"33","article-title":"Comorbidity and polypharmacy in people with dementia: insights from a large, population\u2010based cross\u2010sectional analysis of primary care data","volume":"46","author":"Clague F","year":"2017","journal-title":"Age Ageing"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18372"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2008.02127.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h2698"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1195"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19256"},{"key":"e_1_2_8_10_1","unstructured":"Accessed January 16 2026.The Henry J. 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