Associations of acetylcholinesterase inhibitor treatment with reduced mortality in Alzheimer's disease: a retrospective survival analysis

作者：Mueller Christoph^*; Perera Gayan; Hayes Richard D; Shetty Hitesh; Stewart Robert

来源：Age and Ageing, 2018, 47(1): 88-94.

DOI：10.1093/ageing/afx098

• Alzheimer's disease
• acetylcholinesterase inhibitors (AChEIs)
• treatment effect
• survival
• predictors

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.

• 出版日期2018-1