Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older?

Abstract

Introduction People with dementia experience poor outcomes after hospital admission, with mortality being particularly high. There is no cure for dementia; antidementia medications have been shown to improve cognition and function, but their effect on mortality in real-world settings is little known. This study examines associations between treatment with antidementia medication and mortality in older people with dementia after an emergency admission. Methods The design is a retrospective cohort study of people aged ≥65 years, with a diagnosis of dementia and an emergency hospital admission between 01/01/2010 and 31/12/2016. Two classes of antidementia medication were considered: the acetylcholinesterase inhibitors and memantine. Mortality was examined using a Cox proportional hazards model with time-varying covariates for the prescribing of antidementia medication before or on admission and during one-year follow-up, adjusted for demographics, comorbidity, and community prescribing including anticholinergic burden. Propensity score analysis was examined for treatment selection bias. Results There were 9142 patients with known dementia included in this study, of which 45.0% (n = 4110) received an antidementia medication before or on admission; 31.3% (n = 2864) were prescribed one of the acetylcholinesterase inhibitors, 8.7% (n = 798) memantine, and 4.9% (n = 448) both. 32.9% (n = 1352) of these patients died in the year after admission, compared to 42.7% (n = 2148) of those with no antidementia medication on admission. The Cox model showed a significant reduction in mortality in patients treated with acetylcholinesterase inhibitors (hazard ratio [HR] = 0.78, 95% CI 0.72–0.85) or memantine (HR = 0.75, 95% CI 0.66–0.86) or both (HR = 0.76, 95% CI 0.68–0.94). Sensitivity analysis by propensity score matching confirmed the associations between antidementia prescribing and reduced mortality. Discussion Treatment with antidementia medication is associated with a reduction in risk of death in the year after an emergency hospital admission. Further research is required to determine if there is a causal relationship between treatment and mortality, and whether “symptomatic” therapy for dementia does have a disease-modifying effect.

Amyloid Positron Emission Tomography and Subsequent Health Care Use Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia

“…This overall outcome was more pronounced in patients with dementia and those who completed amyloid PET. In the context of the increased morbidity and mortality associated with hospitalization in patients with dementia, 19 even a small reduction in hospitalization rates may have important implications for…”

“…This overall outcome was more pronounced in patients with dementia and those who completed amyloid PET. In the context of the increased morbidity and mortality associated with hospitalization in patients with dementia, even a small reduction in hospitalization rates may have important implications for public health given the high prevalence of dementia. Furthermore, greater integration and coordination of care, including the establishment of more standardized care pathways, could help better translate an early and accurate diagnosis into improved health outcomes for Medicare beneficiaries with cognitive impairment …”

Antidementia Medication Use in Nursing Home Residents

“…49 Despite these early adverse effects, antidementia drugs have been associated with reduced mortality. 31,32,[51][52][53][54][55][56][57] Memantine has been shown to produce short term benefits in cognitive and daily living function, as well as global functional status, for NH residents with severe dementia, 58 as well as community dwelling residents with moderate to severe dementia, 59,60 but with minor side effects including headaches, somnolence, and constipation. [1][2][3][4] The magnitude of the reported beneficial effects has also been described as small 4 or minimal 49 optimal drug treatment may involve combination therapy with ChEIs to overcome this limitation.…”

The Association Between a Previous Diagnosis of Mild Cognitive Impairment as a Proxy for an Early Diagnosis of Dementia and Mortality: A Study of Secondary Care Electronic Health Records

“…The findings of this study indicate that people with a previous diagnosis of MCI are more likely to be diagnosed with dementia in the earlier stages of the disease and are more likely to receive treatment with AChEIs at diagnosis. Although antidementia medications have been linked with a reduced risk for mortality and severe cardiovascular events in several observational studies [23,34,35], it remains unclear whether this reflects a bias by indication or a direct effect of these medications. As antidementia medications are not appropriate for all people diagnosed with dementia [36], more research is needed to investigate the relationship between and early diagnosis of dementia and mortality related to pharmacological and non-pharmacological treatments.…”