Short-Term Response to Cholinesterase Inhibitors in Alzheimer’s Disease Delays Time to Nursing Home Placement

Wattmo, Carina; Londos, Elisabet; Minthon, Lennart

doi:10.2174/1567205015666180507105326

Cited by 10 publications

(10 citation statements)

References 42 publications

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“…Anti-dementia drugs, particularly acetylcholinesterase inhibitors, were among the most commonly prescribed medications of questionable benefit, a finding which is in line with previous studies [14][15][16]. Acetylcholinesterase inhibitors are indicated for mild to moderate dementia in order to attenuate the manifestation of dementia [30][31][32][33]. However, the indication for acetylcholinesterase inhibitors among nursing home residents with advanced dementia is less clear, and their use in this population is considered off label in Germany [33][34][35][36].…”

Section: Comparison With Other Studiessupporting

confidence: 61%

Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

Rausch

Hoffmann

2020

Eur J Clin Pharmacol

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Purpose We studied the prevalence of medications of questionable benefit in the last 6 months of life among older nursing home residents with and without dementia in Germany. Methods A retrospective cohort study was conducted on claims data from 67,328 deceased nursing home residents aged 65+ years who were admitted between 2010 and 2014. We analyzed prescription regimens of medications of questionable benefit in the 180-91-day period and the 90-day period prior to death for residents with dementia (n = 29,052) and without dementia (n = 38,276). Factors associated with new prescriptions of medications of questionable benefit prior to death were analyzed using logistic regression models among all nursing home residents and stratified by dementia. Results A higher proportion of nursing home residents with dementia were prescribed at least one medication of questionable benefit in the 180-91-day (29.6%) and 90-day (26.8%) periods prior to death, compared with residents without dementia (180-91 days, 22.8%; 90 days, 20.1%). Lipid-lowering agents were the most commonly prescribed medications. New prescriptions of medications of questionable benefit were more common among residents with dementia (9.8% vs. 8.7%). When excluding antidementia medication, new prescriptions of these medications were more common among residents without dementia (6.4% vs. 8.0%). The presence of dementia (odds ratio [OR] 1.40, 95% confidence interval [95%CI] 1.32-1.48) and excessive polypharmacy were associated with new prescriptions of medications of questionable benefit prior to death (OR 4.74, 95%CI 4.15-5.42). Conclusion Even when accounting for anti-dementia prescriptions, the prevalence of nursing home residents with dementia receiving medications of questionable benefit is considerable and may require further attention.

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Section: Comparison With Other Studiessupporting

confidence: 61%

Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

Rausch

Hoffmann

2020

Eur J Clin Pharmacol

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“…The current pharmaceutical treatment options for Alzheimer disease are still limited to symptomatic interventions by cholinesterase inhibitors (ChEIs) and N -methyl- d -aspartate receptor (NMDA) antagonist memantine, which were both shown to improve functional and cognitive outcomes in a significant percentage of Alzheimer disease patients (Trinh et al ., 2003 ; Howard et al ., 2012 ; Zhu et al ., 2013 ; Dou et al ., 2018 ). Furthermore, studies on Alzheimer disease medication have also reported significant benefits for mortality (Zhu et al ., 2013 ; Black et al ., 2018 ; Mueller et al ., 2018 a ; Pilotto et al ., 2018 ) and a delay in nursing home placement (NHP) (Black et al ., 2018 ; Wattmo et al ., 2018 ) in this patient group. However, until now there have been only very few comprehensive epidemiologic studies investigating the association between the use of Alzheimer disease medications and hospitalisations.…”

Section: Introductionmentioning

confidence: 50%

“…Even though current Alzheimer disease medication use also tended to be associated with lower rates of NHP, in-hospital mortality and mortality after hospitalisation, with the exception of NHP after the third hospitalisation these associations did not reach statistical significance. Although some studies have shown positive effects of Alzheimer disease medication on NHP and mortality (Zhu et al ., 2013 ; Black et al ., 2018 ; Mueller et al ., 2018 a ; Pilotto et al ., 2018 ; Wattmo et al ., 2018 ) none of those studies assessed these outcomes specifically after hospitalisation. A study among PWD hospitalised for pneumonia reported lower in-hospital mortality for PWD receiving donepezil, a ChEI.…”

Section: Discussionmentioning

confidence: 99%

Alzheimer's disease medication and outcomes of hospitalisation among patients with dementia

Möllers

Perna

Stocker

et al. 2019

Epidemiol Psychiatr Sci

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Aims The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia. Methods A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses. Results A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance. Conclusions Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.

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“…Although not RCTs, follow-up of ChEI-treated Alzheimer´s dementia cohorts has shown small cognitive benefits at 2-, 3-and more than 10-years [23][24][25] . Moreover, a positive short-term response to ChEIs can delay nursing home placement 26 . Other studies have shown associations between ChEI-use and decreased risk of myocardial infarction, stroke and death in patients with dementia [27][28][29][30] .…”

Section: Introductionmentioning

confidence: 99%

Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality

García-Ptacek

Jönsson

et al. 2021

Neurology

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Objective:To investigate whether Cholinesterase inhibitors (ChEIs) are associated with slower cognitive decline in Alzheimer’s dementia, and decreased risk of severe dementia or death.Methods:Alzheimer’s dementia patients from the Swedish Dementia Registry (SveDem) starting on ChEIs within three months of the dementia diagnosis were included and compared to non-treated Alzheimer’s dementia patients. In a propensity score matched cohort, the association between ChEI-use and cognitive trajectories assessed by MMSE scores were examined with a mixed model, and severe dementia (MMSE<10) or death as outcomes with Cox proportional hazards models.Results:The matched cohort included 11,652 ChEI-users and 5,826 non-users. During an average of 5 years follow up, 255 cases developed severe dementia and 6,055 (35%) died. ChEI-use was associated with higher MMSE at each visit (0.13 MMSE points/year; 95% confidence interval-CI 0.06, 0.20). ChEI-use had a 27% lower risk of death (0.73; CI 0.69, 0.77) compared with non-users. Galantamine was associated with lower risk of death (0.71; CI 0.65, 0.76), lower risk of severe dementia (0.69; CI 0.47-1.00), and had the strongest effect on cognitive decline of all the ChEIs (0.18 MMSE points/year, CI 0.07, 0.28).Conclusions:ChEIs are associated with cognitive benefits which are modest but persist over time and with reduced mortality risk, which could be explained partly by their cognitive effects. Galantamine was the only ChEI demonstrating a significant reduction in the risk of developing severe dementia.Classification of Evidence:This study provides Class III evidence that for patients with Alzheimer’s dementia, ChEIs decrease long term cognitive decline and risk of death, and that galantamine decreases the risk of severe dementia.

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Short-Term Response to Cholinesterase Inhibitors in Alzheimer’s Disease Delays Time to Nursing Home Placement

Cited by 10 publications

References 42 publications

Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

Prescribing medications of questionable benefit prior to death: a retrospective study on older nursing home residents with and without dementia in Germany

Alzheimer's disease medication and outcomes of hospitalisation among patients with dementia

Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality

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