Journal
AGE AND AGEING
Volume 47, Issue 1, Pages 88-94Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ageing/afx098
Keywords
Alzheimer's disease; acetylcholinesterase inhibitors (AChEIs); treatment effect; survival; predictors
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Funding
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London
- Maudsley NHS Foundation Trust
- King's College London
- Guy's and St Thomas' Charity
- Maudsley Charity
- Medical Research Council (MRC) fellowship
- Medical Research Council [MR/J01219X/1] Funding Source: researchfish
- National Institute for Health Research [CL-2016-17-003] Funding Source: researchfish
- MRC [MC_PC_17214, MR/J01219X/1] Funding Source: UKRI
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Background: dementia is increasingly recognised as life-limiting condition. Although the benefits of acetylcholinesterase inhibitors (AChEIs) on cognition and function are well established, their effect on survival is less clear. Objective: to investigate associations between AChEI prescription and mortality in patients with Alzheimer's dementia (AD) in a naturalistic setting, using detailed baseline data on cognition, functioning, and mental and physical wellbeing. Methods: we used a large mental healthcare database in South London, linked to Hospital Episode Statistics and Office for National Statistics mortality data, to assemble a retrospective cohort. We conducted a survival analysis adjusting for a wide range of potential confounders using propensity scores to reduce the impact of confounding by indication. Results: of 2,464 patients with AD, 1,261 were prescribed AChEIs. We detected a strong association between AChEI receipt and lower mortality (hazard ratio = 0.57; 95% CI 0.51-0.64). This remained significant after controlling for a broad range of potential confounders including psychotropic co-prescription, symptom severity, functional status and hospital admissions (hazard ratio = 0.77; 95% CI 0.67-0.87). Conclusions: in a large cohort of patients with AD, AChEI prescription was associated with reduced risk of death by more than 20% in adjusted models. This has implications for individual care planning and service development.
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