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Treatment implementation leads to improved outcomes in patients with dementia in Sweden from 2008‐2017: Experience from the Swedish Dementia Registry
Author(s) -
Xu Hong,
GarciaPtacek Sara,
Secnik Juraj,
Hoang Minh Tuan,
Tan Edwin CK,
Religa Dorota,
Eriksdotter Maria
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.042061
Subject(s) - dementia , medicine , vascular dementia , incidence (geometry) , population , mace , pediatrics , disease , environmental health , myocardial infarction , conventional pci , optics , physics
Background The efficacy of available treatments for dementia remains limited and few randomized clinical trials have been able to demonstrate the benefits of treating comorbidities in improving outcomes of patients with dementia. In this study, we evaluated temporal changes in the management of comorbidities and survival rates in incident dementia over a ten‐year period in Sweden. Method We included 40,219 patients with newly diagnosed dementia in memory clinics from the Swedish Dementia Registry (SveDem) during 2008‐2017 and stratified all data by one‐year blocks. We evaluated trends in the use of dementia drug treatments and selected key medications within 1‐year blocks. We then evaluated the incidence of death, major cardiovascular events (MACE), and fracture within one‐year from the diagnosis date using standardized incidence rates to account for differences in patient characteristics over time. Via Cox regression models, we explored whether adjustment for implementation of new treatments modified survival, MACE and fracture risk. Finally, survival trends were also compared against an age‐sex‐calendar year‐matched general Swedish population using standardized incidence ratios (SIR). Result Across 1‐year blocks, there was no difference in Mini‐Mental State Examination, and proportion of Alzheimer’s and vascular dementia over time. However, age and proportion of females and unspecified dementia decreased. The use of renin‐angiotensin‐system‐inhibitors, calcium‐channel‐blockers, statins and dementia medication memantine increased while antipsychotics, antidepressants and cholinesterase‐inhibitors decreased. After standardization for demography and comorbidities, the 1‐year risk of mortality, MACE or fracture decreased by 13%, 7% and 19%, respectively, in the year 2016 compared to the year 2008. In multivariable Cox models, per 1‐year increase, the risk of death within 1‐year decreased by 4% (HR 0.96[95% CI 0.95‐0.97]), MACE by 3% (0.97[0.96‐0.98]) and fracture by 3% (0.97[0.95‐0.98]). Compared with general population, the risk of death corresponding to a SIR reduced by 11% in the year 2016 compared to 2008. Conclusion Over the last 10 years, a reduction in the short‐term risk of death, MACE and fracture risk in patients with dementia was found in association with changes in drug prescribing practices. This suggests that implementation of established treatments for comorbidities may be beneficial for patients with dementia.