Department of Translational Medicine, University of Ferrara, 44124, Ferrara, Italy.
Geriatria, Accettazione Geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy.
Sci Rep. 2022 Jul 16;12(1):12214. doi: 10.1038/s41598-022-16476-w.
We evaluated the effect of Acetyl-cholinesterase-inhibitors (AChEIs) on cognitive decline and overall survival in a large sample of older patients with late onset Alzheimer's disease (LOAD), vascular dementia (VD) or Lewy body disease (LBD) from a real world setting. Patients with dementia enrolled between 2005 and 2020 by the "Alzheimer's Disease Research Centers" were analysed; the mean follow-up period was 7.9 years. A 1:1 propensity score matching was performed generating a cohort of 1.572 patients (786 treated [AChEIs +] and 786 not treated [AChEIs-] with AChEIs. The MMSE score was almost stable during the first 6 years of follow up in AChEIs + and then declined, while in AChEIs- it progressively declined so that at the end of follow-up (13.6 years) the average decrease in MMSE was 10.8 points in AChEIs- compared with 5.4 points in AChEIs + (p < 0.001). This trend was driven by LOAD (Δ-MMSE:-10.8 vs. -5.7 points; p < 0.001), although a similar effect was observed in VD (Δ-MMSE:-11.6 vs. -8.8; p < 0.001). No effect on cognitive status was found in LBD. At multivariate Cox regression analysis (adjusted for age, gender, dependency level and depression) a strong association between AChEIs therapy and lower all-cause mortality was observed (H.R.:0.59; 95%CI: 0.53-0.66); this was confirmed also in analyses separately conducted in LOAD, VD and LBD. Among older people with dementia, treatment with AChEIs was associated with a slower cognitive decline and with reduced mortality, after a mean follow-up of almost eight years. Our data support the effectiveness of AChEIs in older patients affected by these types of dementia.
我们从真实世界环境中评估了在大量老年迟发性阿尔茨海默病（LOAD）、血管性痴呆（VD）或路易体痴呆（LBD）患者中，乙酰胆碱酯酶抑制剂（AChEIs）对认知下降和总生存的影响。这些患者是在 2005 年至 2020 年间通过“阿尔茨海默病研究中心”入组的；平均随访时间为 7.9 年。通过 1:1 倾向评分匹配生成了一个 1572 例患者的队列（786 例接受[阿曲库铵+]和 786 例未接受[阿曲库铵-]阿曲库铵治疗）。在 AChEIs+组中，MMSE 评分在随访的前 6 年基本稳定，然后下降，而在 AChEIs-组中，MMSE 评分逐渐下降，以至于在随访结束时（13.6 年），AChEIs-组 MMSE 的平均下降幅度为 10.8 分，而 AChEIs+组为 5.4 分（p<0.001）。这种趋势主要由 LOAD 驱动（Δ-MMSE：-10.8 对-5.7 分；p<0.001），尽管在 VD 中也观察到类似的效果（Δ-MMSE：-11.6 对-8.8；p<0.001）。在 LBD 中，AChEIs 治疗对认知状态没有影响。在多变量 Cox 回归分析（调整年龄、性别、依赖程度和抑郁状况）中，观察到 AChEIs 治疗与较低的全因死亡率之间存在强烈关联（HR：0.59；95%CI：0.53-0.66）；这一结果在分别对 LOAD、VD 和 LBD 进行的分析中也得到了证实。在平均随访近 8 年后，对于患有痴呆的老年人，使用 AChEIs 治疗与认知下降速度较慢和死亡率降低相关。我们的数据支持在这些类型的痴呆症患者中使用 AChEIs 的有效性。
