The Effects of Anti-Dementia and Nootropic Treatments on the Mortality of Patients with Dementia: A Population-Based Cohort Study in Taiwan

Wu, Chengyuan; Hu, Hsiao Yun; Chow, Lok-Hi; Chou, Yiing Jenq; Huang, Nicole; Wang, Pei Ning; Li, Chung Pin

doi:10.1371/journal.pone.0130993

Cited by 23 publications

(25 citation statements)

References 48 publications

(49 reference statements)

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“…The effect of antidementia drugs on survival in people without Down syndrome is uncertain; some studies report increased survival in people prescribed antidementia drugs, 21 , 22 yet other studies do not 23 24 A underlying mechanism by which antidementia medications might reduce mortality has not been established but it has been hypothesised that the effect is mediated by protective effects of the drugs on atherosclerotic cardiovascular risk 25 .…”

Section: Discussionmentioning

confidence: 99%

Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study

Eady

Sheehan

Rantell³

et al. 2018

Br J Psychiatry

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Cholinesterase inhibitors appear to offer benefit for people with Down syndrome and Alzheimer's disease that is comparable with sporadic Alzheimer's disease; a trial to test the effect of earlier treatment (prodromal Alzheimer's disease) in Down syndrome may be indicated. Declaration of interest A.S. has undertaken consulting for Ono Pharmaceuticals, outside the submitted work. Z.W. has received a consultancy fee and grant from GE Healthcare, outside the submitted work.

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Section: Discussionmentioning

confidence: 99%

Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study

Eady

Sheehan

Rantell³

et al. 2018

Br J Psychiatry

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“…The NHI program was launched in 1995 to provide health care to all residents, and currently services more than 23 million people, representing approximately 99% of Taiwan’s population. The NHI database contains registration files and original claims data for care reimbursements for all enrollees, making it one of the world’s largest and most complete nation-wide, population-based health care services datasets [ 17 , 18 ]. In this dataset, the diagnostic codes are formatted according to the International Classification of Diseases , Ninth Revision , Clinical Modification (ICD-9-CM) .…”

Section: Methodsmentioning

confidence: 99%

Comorbidity profiles of psoriasis in Taiwan: A latent class analysis

Hu²,

et al. 2018

PLoS ONE

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BackgroundPsoriasis is associated with many comorbidities. An understanding of these comorbidity patterns can help foster better care of patients with psoriasis.ObjectiveTo identify the heterogeneity of psoriasis comorbidities using latent class analysis (LCA).MethodsLCA was used to empirically identify psoriasis comorbidity patterns in a nationwide sample of 110,729 incident cases of psoriasis (2002–2012) from the National Health Insurance database in Taiwan.ResultsThe mean age of incident psoriasis was 46.1 years. Hypertension (28.8%), dyslipidemia (18.9%), and chronic liver disease/cirrhosis/hepatitis (18.1%) were the top three comorbidities in patients with psoriasis. LCA identified four distinct comorbidity classes among these patients, including 9.9% of patients in the “multi-comorbidity” class, 17.9% in the “metabolic syndrome” class, 11.3% in the “hypertension and chronic obstructive pulmonary disease (COPD)” class, and 60.9% in the “relatively healthy” class. Psoriatic arthritis was evenly distributed among each class. Relative to membership in the “relative healthy” class, an increase of one year of age had a higher probability of membership in the “multi-comorbidity” (odds ratio [OR], 1.25), “metabolic syndrome” (OR, 1.11), or “hypertension and COPD” (OR, 1.34) classes. Relative to membership in the “relative healthy” class, compared to women, men had a higher probability of membership in the “multi-comorbidity” (OR, 1.39), “metabolic syndrome” (OR, 1.77), or “hypertension and COPD” (OR, 1.22) classes.ConclusionWe observed four distinct classes of psoriasis comorbidities, including the “multi-comorbidity”, “metabolic syndrome”, “hypertension and COPD”, and “relatively healthy” classes, as well as the clustering of liver diseases with metabolic syndrome and clustering of COPD with hypertension.

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“…Previous studies have reported associations between antidementia drug use and reduced mortality in the community [18] , [21] , [22] , [23] , [39] , [40] . There is no previous reporting on associations between antidementia treatment and mortality after admission in this high-risk population of in-patients.…”

Section: Discussionmentioning

confidence: 95%

“…In a recent systematic review and meta‐analysis of randomized placebo‐controlled clinical trials, the use of AChEIs was associated with reduced mortality [20], and the authors suggest this finding may indicate some disease‐modifying effect of these drugs. This finding however is not consistent across all studies: some studies show a reduction in mortality in people who were prescribed antidementia medication [18,21–23], one study shows a reduction in cardiovascular deaths [24], and another has failed to find an association [15].…”

Section: Introductionmentioning

confidence: 93%

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

Hapca

Burton

Cvoro

et al. 2019

A&D Transl Res & Clin Interv

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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.

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The Effects of Anti-Dementia and Nootropic Treatments on the Mortality of Patients with Dementia: A Population-Based Cohort Study in Taiwan

Cited by 23 publications

References 48 publications

Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study

Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study

Comorbidity profiles of psoriasis in Taiwan: A latent class analysis

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

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