Long-term associations between cholinesterase inhibitors and memantine use and health outcomes among patients with Alzheimer's disease

Carolyn W. Zhu, Elayne E. Livote, Nikolaos Scarmeas, Marilyn Albert, Jason Brandt, Deborah Blacker, Mary Sano, Yaakov Stern

Research output: Contribution to journalArticlepeer-review


Objectives: To examine in an observational study (1) relationships between cholinesterase inhibitors (ChEI) and memantine use, and functional and cognitive end points and mortality in patients with Alzheimer's disease (AD); (2) relationships between other patient characteristics and these clinical end points; and (3) whether effects of the predictors change across time. Methods: The authors conducted a multicenter, natural history study that included three university-based AD centers in the United States. A total of 201 patients diagnosed with probable AD with modified Mini-Mental State Examination (MMSE) scores ≥ 30 at study entry were monitored annually for 6 years. Discrete-time hazard analyses were used to examine relationships between ChEI and memantine use during the previous 6 months reported at each assessment, and time to cognitive (MMSE score ≤ 10) and functional (Blessed Dementia Rating Scale score ≥ 10) end points and mortality. Analyses controlled for clinical characteristics, including baseline cognition, function, and comorbid conditions, and presence of extrapyramidal signs and psychiatric symptoms at each assessment interval. Demographic characteristics included baseline age, sex, education, and living arrangement at each assessment interval. Results: ChEI use was associated with delayed time in reaching the functional end point and death. Memantine use was associated with delayed time to death. Different patient characteristics were associated with different clinical end points. Conclusions: Results suggest long-term beneficial effects of ChEI and memantine use on patient outcomes. As for all observational cohort studies, observed relationships should not be interpreted as causal effects.

Original languageEnglish (US)
Pages (from-to)733-740
Number of pages8
JournalAlzheimer's and Dementia
Issue number6
StatePublished - Nov 2013


  • Alzheimer's disease
  • Cholinesterase inhibitors
  • Longitudinal studies
  • Memantine
  • Outcomes

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Developmental Neuroscience
  • Clinical Neurology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience


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