Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/30153
Appears in Collections:Computing Science and Mathematics Journal Articles
Peer Review Status: Refereed
Title: Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older?
Author(s): Hapca, Simona
Burton, Jennifer Kirsty
Cvoro, Vera
Reynish, Emma
Donnan, Peter T
Contact Email: emma.reynish@stir.ac.uk
Keywords: Antidementia medication
Acetylcholinesterase inhibitors
Memantine
Emergency admission
Mortality
Issue Date: 2019
Citation: Hapca S, Burton JK, Cvoro V, Reynish E & Donnan PT (2019) Are antidementia drugs associated with reduced mortality after a hospital emergency admission in the population with dementia aged 65 years and older?. Alzheimer's and Dementia: Translational Research and Clinical Interventions, 5, pp. 431-440. https://doi.org/10.1016/j.trci.2019.07.011
Abstract: Introduction: People with dementia experience poor outcomes after hospital admission, with mortality being particularly high. There is no cure for dementia; antidementia medications have been shown to improve cognition and function, but their effect on mortality in real-world settings is little known. This study examines associations between treatment with antidementia medication and mortality in older people with dementia after an emergency admission. Methods: The design is a retrospective cohort study of people aged 65 years, with a diagnosis of dementia and an emergency hospital admission between 01/01/2010 and 31/12/2016. Two classes of antidementia medication were considered: the acetylcholinesterase inhibitors and memantine. Mortality was examined using a Cox proportional hazards model with time-varying covariates for the prescribing of antidementia medication before or on admission and during one-year follow-up, adjusted for demographics, comorbidity, and community prescribing including anticholinergic burden. Propensity score analysis was examined for treatment selection bias. Results: There were 9142 patients with known dementia included in this study, of which 45.0% (n 5 4110) received an antidementia medication before or on admission; 31.3% (n 5 2864) were prescribed one of the acetylcholinesterase inhibitors, 8.7% (n 5 798) memantine, and 4.9% (n 5 448) both. 32.9% (n 5 1352) of these patients died in the year after admission, compared to 42.7% (n 5 2148) of those with no antidementia medication on admission. The Cox model showed a significant reduction in mortality in patients treated with acetylcholinesterase inhibitors (hazard ratio [HR] 5 0.78, 95% CI 0.72-0.85) or memantine (HR 5 0.75, 95% CI 0.66-0.86) or both (HR 5 0.76, 95% CI 0.68-0.94). Sensitivity analysis by propensity score matching confirmed the associations between antidementia prescribing and reduced mortality. Discussion: Treatment with antidementia medication is associated with a reduction in risk of death in the year after an emergency hospital admission. Further research is required to determine if there is a causal relationship between treatment and mortality, and whether "symptomatic" therapy for demen-tia does have a disease-modifying effect.
DOI Link: 10.1016/j.trci.2019.07.011
Rights: This article is available under the terms of the Creative Commons Attribution License (CC BY - https://creativecommons.org/licenses/by/4.0/). You may copy and distribute the article, create extracts, abstracts and new works from the article, alter and revise the article, text or data mine the article and otherwise reuse the article commercially (including reuse and/or resale of the article) without permission from Elsevier. You must give appropriate credit to the original work, together with a link to the formal publication through the relevant DOI and a link to the Creative Commons user license above. You must indicate if any changes are made but not in any way that suggests the licensor endorses you or your use of the work.
Licence URL(s): http://creativecommons.org/licenses/by/4.0/

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