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

Simona Hapca (Lead / Corresponding author), Jennifer Kirsty Burton, Vera Cvoro, Emma Reynish, Peter T. Donnan

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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.

Original languageEnglish
Pages (from-to)431-440
Number of pages10
JournalAlzheimer's and Dementia: Translational Research and Clinical Interventions
Volume5
Early online date3 Sep 2019
DOIs
Publication statusPublished - 2019

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Dementia
Emergencies
Mortality
Memantine
Cholinesterase Inhibitors
Pharmaceutical Preparations
Population
Propensity Score
Proportional Hazards Models
Therapeutics
Selection Bias
Cholinergic Antagonists
Risk Reduction Behavior
Cognition
Comorbidity
Cohort Studies
Retrospective Studies
Demography
Research

Keywords

  • Acetylcholinesterase inhibitors
  • Antidementia medication
  • Emergency admission
  • Memantine
  • Mortality

Cite this

@article{8a35bff879c44302bdcdb40fc7d7933f,
title = "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.",
keywords = "Acetylcholinesterase inhibitors, Antidementia medication, Emergency admission, Memantine, Mortality",
author = "Simona Hapca and Burton, {Jennifer Kirsty} and Vera Cvoro and Emma Reynish and Donnan, {Peter T.}",
year = "2019",
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language = "English",
volume = "5",
pages = "431--440",
journal = "Alzheimer's and Dementia: Translational Research and Clinical Interventions",
issn = "2352-8737",
publisher = "Elsevier",

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TY - JOUR

T1 - Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older?

AU - Hapca, Simona

AU - Burton, Jennifer Kirsty

AU - Cvoro, Vera

AU - Reynish, Emma

AU - Donnan, Peter T.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - Acetylcholinesterase inhibitors

KW - Antidementia medication

KW - Emergency admission

KW - Memantine

KW - Mortality

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U2 - 10.1016/j.trci.2019.07.011

DO - 10.1016/j.trci.2019.07.011

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VL - 5

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JO - Alzheimer's and Dementia: Translational Research and Clinical Interventions

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