TY - JOUR
T1 - Long-term associations between cholinesterase inhibitors and memantine use and health outcomes among patients with Alzheimer's disease
AU - Zhu, Carolyn W.
AU - Livote, Elayne E.
AU - Scarmeas, Nikolaos
AU - Albert, Marilyn
AU - Brandt, Jason
AU - Blacker, Deborah
AU - Sano, Mary
AU - Stern, Yaakov
N1 - Funding Information:
The Predictors Study is supported by federal grant AG07370 , with additional support from federal grants, RR00645 , and U01AG010483 . Dr Sano is supported by the Department of Veterans Affairs, Veterans Health Administration . The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors all certify that they have no conflict of interest to report in this manuscript. The sponsor had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of this article.
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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.
KW - Alzheimer's disease
KW - Cholinesterase inhibitors
KW - Longitudinal studies
KW - Memantine
KW - Outcomes
UR - http://www.scopus.com/inward/record.url?scp=84887489111&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84887489111&partnerID=8YFLogxK
U2 - 10.1016/j.jalz.2012.09.015
DO - 10.1016/j.jalz.2012.09.015
M3 - Article
C2 - 23332671
AN - SCOPUS:84887489111
SN - 1552-5260
VL - 9
SP - 733
EP - 740
JO - Alzheimer's and Dementia
JF - Alzheimer's and Dementia
IS - 6
ER -