# Behavioral Control and Alzheimer's Disease: Policies, Medication Use, and Health Effects Across Care Settings

> **NIH NIH P01** · BROWN UNIVERSITY · 2022 · $252,775

## Abstract

PROJECT SUMMARY
Neuropsychiatric symptoms (NPS) eventually affect >90% of people who live with Alzheimer’s Disease and
related dementias (ADRD): they reduce patients’ and caregiver’s quality of life, are difficult to manage, and
often prompt decisions for institutional placement. Antipsychotic medications were commonly used until
evidence emerged linking these medications to increased risk of stroke and death. Recent federal efforts to
reduce unnecessary harm from long-term antipsychotic exposure include nursing home (NH) quality reporting
requirements under the Affordable Care Act (ACA) and the National Partnership to Improve Dementia Care in
Nursing Homes Centers (both in 2012). Since 2011, antipsychotic exposure has declined by 31.8% in nursing
homes. The ACA/Partnership focused only on people with ADRD living nursing homes, but the majority of
people with ADRD reside in settings other than nursing homes, where NPS are also common but there is less
oversight over medication exposures. Our central hypothesis is that while federal initiatives led to reduced
antipsychotic use in the NH, trade-offs toward greater exposure to other psychoactive medications may have
limited the anticipated net health effects, and that racial and ethnic minorities face a differential burden of the
consequences of psychotropic exposure. Our approach entails analyzing national Medicare data, including
medications, individual characteristics, and clinical outcomes, over a decade (2007-2017). The specific aims
will evaluate substitution of other psychotropic medications for antipsychotics in NH residents; the impact of
federal antipsychotic initiatives on assisted living and community dwellers; racial/ethnic differences in
exposures across settings; and their effect on mortality, stroke, major fractures and psychiatric admissions.
Using novel approaches developed by the P01 Data Management and Methods Core, we will assess important
policies intended to reduce the adverse outcomes of antipsychotics in older adults with ADRD across care
settings and among minorities with potential to guide further policy refinement as necessary.

## Key facts

- **NIH application ID:** 10436252
- **Project number:** 5P01AG027296-14
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Theresa I. Shireman
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $252,775
- **Award type:** 5
- **Project period:** 2007-09-15 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10436252

## Citation

> US National Institutes of Health, RePORTER application 10436252, Behavioral Control and Alzheimer's Disease: Policies, Medication Use, and Health Effects Across Care Settings (5P01AG027296-14). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10436252. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*