Researchers at the University of Plymouth are launching a study to explore whether artificial intelligence (AI) technologies can be used to support safer prescribing for older adults with intellectual disabilities and epilepsy.
The research, supported by the Bailey Thomas Charitable Fund, will fund the development of an AI-driven decision support tool.
The team is planning to use the technology to identify clinical factors that contribute to Drug Burden Index (DBI) scores, which defines the functional impact of a medicine based upon its anticholinergic and sedative properties.
They will also look at how the medicines interact with each other, and which factors influence the DBI scores the most.
With this information, the team hope to be able to produce a tool that will support GPs prescribing for older adults with intellectual disabilities and epilepsy. They will also assess the anticholinergic status of the patient and then safely optimise their medication accordingly.
Rohit Shankar MBE, Professor of Neuropsychiatry in the Peninsula Medical School, and Shangming Zhou, Professor of e-Health in the Centre for Health Technology, are leading the project.
Assisted by Professor of Medical Statistics Victoria Allgar, this project will use REDCap cloud technology to collect patient data including demographics, levels of intellectual disability, genetic variants, epilepsy history, seizure profile, all prescribed medication, and medical co-morbidities.
Professor Shankar said:
“There is a strong association between intellectual disability and epilepsy. Epilepsy-related mortality remains one of the most common causes of premature and potentially avoidable deaths. People with intellectual disability and epilepsy have high rates of multi-morbidity (two or more chronic conditions) and are specifically at risk of mental health and neurological conditions. It is essential that we gain a better understanding of the pharmacological burden in people with epilepsy and intellectual disability and its impact upon clinical parameters including quality of life, constipation, day time sedation, and life expectancy.”
As people age, the risk of inappropriate prescribing and polypharmacy (the taking of more than five regular medications) increases.
Recent research by the University has shown that people with dementia are likely to have taken more than three medications for other health conditions in the five years directly before their diagnosis.
However, while there are currently several screening tools for assessing this risk for the general population, there is currently no clinical guidance or support tool available for older people with intellectual disabilities or epilepsy.
Drug classes including antipsychotics, antidepressants and anti-seizure medicines – all of which are regularly used in the treatment of these conditions – all have anticholinergic effects.
As a result, there is a cumulative impact on the patient from taking these drugs and several negative clinical outcomes associated with the multiple usage of anticholinergic drugs.
The assessment of appropriate prescribing in older patients with intellectual disabilities is complex, requiring specific expertise and a holistic approach.
Professor Zhou added:
“People with intellectual disability are known to have markedly higher anticholinergic burden than the general population. AI and machine learning tools will be developed to reveal influential clinical factors that contribute towards the anticholinergic exposure. This tool will provide an evidence base for assessing the functional impact of medicines in older adults with intellectual disability and epilepsy.”