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Clinical Summary

Cholinesterase inhibitors lower mortality risk in patients with diabetes and dementia

Takeaway

  • Cholinesterase inhibitors (ChEI) use was associated with reduction in mortality among patients with diabetes mellitus (DM) with Alzheimer's disease (AD) or mixed-pathology dementia.
  • Among the specific ChEIs, donepezil and galantamine had overall positive effects on mortality in patients with DM.

Why this matter

  • Finding warrants further studies to investigate whether a “prescription hierarchy” for patients with dementia could be created with the aim of informing caregivers on which drugs to use and which to omit.

Study design

  • Open-cohort study included 22,660 patients diagnosed with AD or mixed-pathology dementia (3176 with DM and 19,484 without DM).
  • Funding: supported by the Swedish Brain Power, Swedish Research Council and others.

Key results

  • ChEI use was associated with a reduction in all-cause mortality in DM (HR, 0.76; 95% CI, 0.67-0.86) vs non-DM (HR, 0.80; 95% CI, 0.75-0.84; P<.001 for both groups) group.
  • Donepezil and galantamine use was linked to reduction in all-cause mortality in DM (HR, 0.84 [95% CI, 0.74-0.96] and HR, 0.80 [95% CI, 0.66-0.97]; P<.05, respectively) and non-DM (HR, 0.85 [95% CI, 0.80-0.90]; P<.001 and HR, 0.93 [95% CI, 0.86-0.99]; P<.05, respectively) groups.
  • In non-DM group, donepezil was associated with a reduction in cardiovascular mortality (HR, 0.84; 95% CI, 0.75-0.94; P<.05).
  • In DM group, ChEI use was associated with a reduction in diabetes-related mortality (HR, 0.52; 95% CI, 0.32-0.87; P<.05).
  • Reduction in mortality did not differ in low- and high-dose ChEIs.

Limitations

  • Risk of confounding.

References


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