King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Age Ageing. 2018 Jan 1;47(1):88-94. doi: 10.1093/ageing/afx098.
dementia is increasingly recognised as life-limiting condition. Although the benefits of acetylcholinesterase inhibitors (AChEIs) on cognition and function are well established, their effect on survival is less clear.
to investigate associations between AChEI prescription and mortality in patients with Alzheimer's dementia (AD) in a naturalistic setting, using detailed baseline data on cognition, functioning, and mental and physical wellbeing.
we used a large mental healthcare database in South London, linked to Hospital Episode Statistics and Office for National Statistics mortality data, to assemble a retrospective cohort. We conducted a survival analysis adjusting for a wide range of potential confounders using propensity scores to reduce the impact of confounding by indication.
of 2,464 patients with AD, 1,261 were prescribed AChEIs. We detected a strong association between AChEI receipt and lower mortality (hazard ratio = 0.57; 95% CI 0.51-0.64). This remained significant after controlling for a broad range of potential confounders including psychotropic co-prescription, symptom severity, functional status and hospital admissions (hazard ratio = 0.77; 95% CI 0.67-0.87).
in a large cohort of patients with AD, AChEI prescription was associated with reduced risk of death by more than 20% in adjusted models. This has implications for individual care planning and service development.
痴呆症日益被认为是一种生命有限的疾病。虽然乙酰胆碱酯酶抑制剂 (AChEIs) 在认知和功能方面的益处已得到充分证实，但它们对生存的影响尚不清楚。
在自然环境中，使用认知、功能、心理和身体健康的详细基线数据，研究阿尔茨海默病 (AD) 患者使用 AChEI 处方与死亡率之间的关联。
我们使用了伦敦南部的一个大型精神保健数据库，与医院发病统计数据和国家统计局死亡率数据相关联，以组建一个回顾性队列。我们使用倾向评分进行生存分析，调整了广泛的潜在混杂因素，以减少指示性混杂的影响。
在 2464 名 AD 患者中，有 1261 名患者开了 AChEI。我们发现 AChEI 接受与死亡率降低之间存在很强的关联（风险比=0.57；95%CI 0.51-0.64）。在控制了广泛的潜在混杂因素后，包括精神药物联合处方、症状严重程度、功能状态和住院治疗，这一关联仍然显著（风险比=0.77；95%CI 0.67-0.87）。
在一个大型 AD 患者队列中，在调整后的模型中，AChEI 处方与死亡风险降低 20%以上相关。这对个人护理计划和服务发展具有影响。
