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P2‐258: Cholinesterase inhibitors for Alzheimer's disease: Do they provide more than symptomatic benefits?
Author(s) -
Suh GukHee
Publication year - 2009
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 - 10.1016/j.jalz.2009.04.572
Subject(s) - medicine , hazard ratio , dementia , galantamine , confounding , cohort , cholinesterase , proportional hazards model , disease , cohort study , gerontology , donepezil , confidence interval
Background: If the benefits of cholinesterase inhibitors (ChEIs) for Alzheimer’s disease (AD) are supposed to translate to mortality reduction, all treatments for severe dementia are predicted to increase costs because the additional survival incurs further costs. This study aims to examine survival of AD patients receiving ChEIs and to compare their survival with those of AD patients who never received ChEIs and cognitively intact old psychiatric outpatients. Methods: The retrospective cohort study used national mortality data provided by the Korean National Statistics Office and electronic database of 15 general hospitals on older patients who began outpatient treatment with psychiatric medications including ChEIs (N1⁄4 3,813). Six-year mortality rate of AD patients receiving ChEIs was compared with those of AD patients who never received ChEIs and cognitively intact old psychiatric outpatients. The authors controlled for confounding by using multivariate models and propensity-scoring methods. Results: Observed additional survival of AD patients receiving ChEIs (mortality rate: 13.1%) when compared to AD patients who never received ChEIs (15.4%) was not statistically significant (hazard ratio: 1.03, 95% CI 1⁄4 0.67 1.59). AD patients receiving ChEIs showed higher mortality rate (13.1%) compared to that of cognitively intact old psychiatric outpatients (8.6%) (hazard ratio: 1.60, 95% CI1⁄4 0.96 2.68). Conclusions: This study does not support that ChEIs provide more than symptomatic benefits to AD patients. All ChEIs should be considered for symptomatic use only, and not to be capable of modifying either the course of AD or its longer-term clinical expression.