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 lit...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-01-01
|
| Series: | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
| Subjects: | |
| Online Access: | https://doi.org/10.1016/j.trci.2019.07.011 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849423332714217472 |
|---|---|
| author | Simona Hapca Jennifer Kirsty Burton Vera Cvoro Emma Reynish Peter T. Donnan |
| author_facet | Simona Hapca Jennifer Kirsty Burton Vera Cvoro Emma Reynish Peter T. Donnan |
| author_sort | Simona Hapca |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-cf467c7a032b4113916b56a501039bbb |
| institution | Kabale University |
| issn | 2352-8737 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
| spelling | doaj-art-cf467c7a032b4113916b56a501039bbb2025-08-20T03:30:39ZengWileyAlzheimer’s & Dementia: Translational Research & Clinical Interventions2352-87372019-01-015143144010.1016/j.trci.2019.07.011Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older?Simona Hapca0Jennifer Kirsty Burton1Vera Cvoro2Emma Reynish3Peter T. Donnan4Population Health and GenomicsSchool of Medicine, University of DundeeDundeeUKInstitute of Cardiovascular and Medical SciencesGlasgow Royal InfirmaryUniversity of GlasgowGlasgowUKNHS FifeKirkcaldyUKDementia and Ageing Research Group, Faculty of Social ScienceUniversity of StirlingStirlingUKPopulation Health and GenomicsSchool of Medicine, University of DundeeDundeeUKAbstract 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.https://doi.org/10.1016/j.trci.2019.07.011Antidementia medicationAcetylcholinesterase inhibitorsMemantineEmergency admissionMortality |
| spellingShingle | Simona Hapca Jennifer Kirsty Burton Vera Cvoro Emma Reynish Peter T. Donnan Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older? Alzheimer’s & Dementia: Translational Research & Clinical Interventions Antidementia medication Acetylcholinesterase inhibitors Memantine Emergency admission Mortality |
| title | Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older? |
| title_full | Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older? |
| title_fullStr | Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older? |
| title_full_unstemmed | Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older? |
| title_short | Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older? |
| title_sort | are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older |
| topic | Antidementia medication Acetylcholinesterase inhibitors Memantine Emergency admission Mortality |
| url | https://doi.org/10.1016/j.trci.2019.07.011 |
| work_keys_str_mv | AT simonahapca areantidementiadrugsassociatedwithreducedmortalityafterahospitalemergencyadmissioninthepopulationwithdementiaaged65yearsandolder AT jenniferkirstyburton areantidementiadrugsassociatedwithreducedmortalityafterahospitalemergencyadmissioninthepopulationwithdementiaaged65yearsandolder AT veracvoro areantidementiadrugsassociatedwithreducedmortalityafterahospitalemergencyadmissioninthepopulationwithdementiaaged65yearsandolder AT emmareynish areantidementiadrugsassociatedwithreducedmortalityafterahospitalemergencyadmissioninthepopulationwithdementiaaged65yearsandolder AT petertdonnan areantidementiadrugsassociatedwithreducedmortalityafterahospitalemergencyadmissioninthepopulationwithdementiaaged65yearsandolder |