Impact of Anti-Dementia Medication on the Risk of Death and Causes of Death in Alzheimer’s Disease

Article type: Research Article

Authors: Linna, Miika^{a; *} | Vuoti, Sauli^b | Silander, Katariina^a | Hörhammer, Iiris^a | Halminen, Olli^a | Mikkola, Teija^c | Koivuranta-Vaara, Päivi^c | Virta, Lauri J.^d | Koivusalo, Mirkka^e | Ylisaukko-oja, Tero^{e; f}

Affiliations: [a] Aalto University/Health Care, Engineering, Management and Architecture (HEMA), Aalto, Finland | [b] Merck Sharpe & Dohme (MSD), Espoo, Finland | [c] Finnish Local and Regional Authorities, Helsinki, Finland | [d] Research Department, Social Insurance Institution of Finland, Turku, Finland | [e] MedEngine, Helsinki, Finland | [f] University of Oulu, Center for Life Course Health Research, Oulu, Finland

Correspondence: [*] Correspondence to: Miika Linna, PhD, Aalto University/Health Care, Engineering, Management and Architecture (HEMA), FI-00076 Aalto, Finland, Tel.: +358 50 362 0796; E-mail: mika.linna@aalto.fi.

Abstract: Background:The Finnish population offers many advantages for evaluating the impact of anti-dementia medication on mortality in Alzheimer’s disease (AD) due to broad range of individual-level data collected in national health and social care registries and the fact that Finland has one of the highest mortality rates for dementia globally. Objective:The aim of this study was to investigate the association of anti-dementia medication with 2-year risk of death and all-cause mortality in patients with AD. Methods:This was a retrospective, non-interventional registry study based on individual-level data using Finnish national health and social care registries. An incident cohort of 9,204 AD patients (first AD diagnosis in 2012) was formed from a population of 316,470 individuals ≥74 years of age. The main outcome measure was overall 2-year risk of death. Statistical modelling was used to assess mortality (Kaplan-Meier) and adjusted hazard ratios (HR) (Cox proportional hazard model). Results:Early start of anti-dementia medication (treatment started ≤3 months from AD diagnosis) reduced significantly the risk of all-cause death compared to AD patients who had late medication initiation (defined as treatment started >3 months from AD diagnosis/no medication; HR, 0.51; 95% confidence interval (CI), 0.46–0.57). Dementia was the most common recorded cause of death in both groups. Conclusion:This study places importance on early diagnosis of AD and subsequent early initiation of drug treatment in decreasing 2-year risk of death.

Keywords: Alzheimer’s disease, cause of death, cholinesterase inhibitors, dementia, Finland, memantine, registry study, risk of death

DOI: 10.3233/JAD-190288

Journal: Journal of Alzheimer's Disease, vol. 71, no. 4, pp. 1297-1308, 2019