Patients with dementia with Lewy bodies (DLB) who took cholinesterase inhibitors had significantly slower cognitive decline over five years compared with patients who took memantine or no medication, according to a study published by Alzheimer’s and Dementia.
Hong Xu, Ph.D., of the Karolinska Institutet in Stockholm, Sweden, and colleagues tapped into a Swedish registry on cognitive/dementia disorders to assess 1,095 individuals who were diagnosed with DLB between May 2007 and December 2018. All individuals had taken the Mini-Mental State Examination (MMSE) at the time of diagnosis and were treated within 90 days with a cholinesterase inhibitor (814), memantine (133), or neither (148). Among those treated with a cholinesterase inhibitor, 69% received rivastigmine, 21% received donepezil, and 10% received galantamine.
Researchers analyzed the individuals’ MMSE scores for up to five years, as well as the incidence of major cardiovascular events (hospitalizations for myocardial infarction, congestive heart failure, or stroke) and all-cause mortality for up to 10 years.
Researchers reported the following results:
- The average MMSE score among individuals at baseline was 21.9; after five years, the average MMSE score among those taking cholinesterase inhibitors was 19.81, compared with 9.62 among those taking memantine and 9.61 among those taking neither. A dose-response relationship suggested higher cholinesterase inhibitor doses provided greater cognitive benefits.
- Among individual cholinesterase inhibitors, donepezil and galantamine significantly slowed cognitive decline, but rivastigmine did not. One possible explanation is that rivastigmine users in the study, unlike those taking donepezil or galantamine, did not achieve the recommended dose, researchers said.
- Patients treated with cholinesterase inhibitors had a 34% lower mortality risk during the first year of follow-up compared with those taking no medications; however, these drugs did not reduce long-term risk of major adverse cardiovascular events or death.
Potential limitations of the study include the inherent challenge of accurately diagnosing DLB and a lack of information on patients’ lifestyle habits, frailty, severity of comorbidities, blood pressure, or presence of co-occurring Alzheimer’s disease, all of which could have influenced the findings.
“Our findings shed light on the potential cognitive benefits of [cholinesterase inhibitor] treatment in DLB patients,” the researchers wrote. “Further research is necessary to elucidate the underlying mechanisms and explore potential pleiotropic effects of [cholinesterase inhibitors] on long-term outcomes.”
For related information, see the Psychiatric News article, “New Medication, Staging Criteria Signal a Potential Shift in Alzheimer’s Care.”
(Image: Getty Images/iStock/Chinnapong)
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