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. 2018 Feb;19(2):162-168.
doi: 10.1016/j.jamda.2017.08.017. Epub 2017 Oct 12.

Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

Alberto Pilotto  1 , Maria Cristina Polidori  2 , Nicola Veronese  3 , Francesco Panza  4 , Rosa Arboretti Giancristofaro  5 , Andrea Pilotto  6 , Julia Daragjati  7 , Eleonora Carrozzo  8 , Camilla Prete  9 , Pietro Gallina  7 , Alessandro Padovani  6 , Stefania Maggi  10 ; Multidimensional Prognostic Index (MPI)_Age Project Investigators
Collaborators, Affiliations

Association of Antidementia Drugs and Mortality in Community-Dwelling Frail Older Patients With Dementia: The Role of Mortality Risk Assessment

Alberto Pilotto et al. J Am Med Dir Assoc. 2018 Feb.

Abstract

Objective: To evaluate whether treatment with antidementia drugs is associated with reduced mortality in older patients with different mortality risk at baseline.

Design: Retrospective.

Setting: Community-dwelling.

Participants: A total of 6818 older people who underwent a Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) evaluation to determine accessibility to homecare services or nursing home admission from 2005 to 2013 in the Padova Health District, Italy were included.

Measurements: Mortality risk at baseline was calculated by the Multidimensional Prognostic Index (MPI), based on information collected with the SVaMA. Participants were categorized to have mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) mortality risk. Propensity score-adjusted hazard ratios (HR) of 2-year mortality were calculated according to antidementia drug treatment.

Results: Patients treated with antidementia drugs had a significant lower risk of death than untreated patients (HR 0.82; 95% confidence interval [CI] 0.73-0.92 and 0.56; 95% CI 0.49-0.65 for patients treated less than 2 years and more than 2 years treatment, respectively). After dividing patients according to their MPI-SVaMA grade, antidementia treatment was significantly associated with reduced mortality in the MPI-SVaMA-1 mild (HR 0.71; 95% CI 0.54-0.92) and MPI-SVaMA-2 moderate risk (HR 0.61; 95% CI 0.40-0.91, matched sample), but not in the MPI-SVaMA-3 high risk of death.

Conclusions: This large community-dwelling patient study suggests that antidementia drugs might contribute to increased survival in older adults with dementia with lower mortality risk.

Keywords: Dementia; antidementia drugs; comprehensive geriatric assessment; frailty; mortality; multidimensional prognostic index (MPI).

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Nonparametric survival plot (Kaplan-Meier method) for treatment with anti-dementia drugs in total samples.
Fig. 2.
Fig. 2.
Nonparametric survival plot (Kaplan-Meier method) for treatment with anti-dementia drugs in matched samples.
See this image and copyright information in PMC

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