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P1‐569: EARLY ADVERSITY, BRAIN INJURY AND LATER LIFE OUTCOMES: A DEMENTIAS PLATFORM UK INVESTIGATION USING MULTI‐COHORTS AND MACHINE LEARNING
Author(s) -
Prince John
Publication year - 2019
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.2019.06.1174
Subject(s) - dementia , medicine , cognition , population , traumatic brain injury , longitudinal study , clinical psychology , retrospective cohort study , cohort , depression (economics) , poison control , cohort study , cognitive skill , cognitive decline , psychology , psychiatry , medical emergency , disease , environmental health , pathology , economics , macroeconomics
medications will enable assessment of new treatments. This study estimated the probabilities of transitioning between AD severity stages in patients using or not using FDA-approved AD medications; donepezil, galantamine, rivastigmine, and memantine. Methods: We sampled 9,365 patients aged 65 years or older with a diagnosis of AD enrolled in an Alzheimer’s Disease Centers across the United States between 2005-2015 from the National Alzheimer’s Coordinating Center (NACC) database. Those with dementias other than AD were excluded. We used the msm package in R to develop a multistate model to estimate annual transition probabilities across mild, moderate, and severe stages of AD and death for patients taking or not taking currently available FDAapproved drugs for the treatment of AD. Results:Current users of the AD drugs had a lower probability of death frommild, moderate, and severe health states (1.6%, 8.5%, and 24.8%, respectively) compared with nonusers (1.7%, 13.9%, and 30.5%, respectively). However, the annual transition probabilities of moving to severe AD were higher for users (3.1% and 25.1% respectively) compared with nonusers (0.7% and 23.4%, respectively). The probability of remaining in moderate or severe health states was higher in users (62.9% and 75.2%, respectively) compared with nonusers (57.6% and 69.5%). Conclusions: The use of FDA-approved medications to treat patients with mild or moderate AD may lead to worsening cognition compared with nonusers. Our results corroborate findings from Kennedy et al., 2018 where they found that the use of these medications is associated with greater cognitive decline. However, their use might be associated with a reduced likelihood of death at any stage of AD.