Dementia and osteoporosis are common and debilitating conditions that often coexist in older adults. We investigated mortality in patients with and without dementia as the primary outcome in a prospective memory clinic cohort. Falls and fractures were assessed as secondary outcomes, and associations with baseline acetylcholinesterase inhibitor (AChEI) use were explored. In a prospective observational cohort study, data were collected during routine clinical visits over four years. Data included demographics, dementia diagnosis, AChEI use, falls, fractures, bone mineral density (BMD) when clinically available, and mortality. Analysis included chi-square tests, Kaplan-Meier survival curves, Cox proportional hazards models, and recurrent-event models. Because AChEI analyses were exploratory and included several related endpoints, Benjamini-Hochberg false discovery rate (FDR) correction was applied to endpoint-level AChEI -values. 744 patients were enrolled; the mean age was 80.99 ± 6.8 years; 58.5% female; 55.8% with dementia. AChEI use was recorded in 113 patients (15.2%) at baseline. Over 4 years, 16.61% of participants experienced at least one fall with a cumulative fracture risk of 30.90%. Mortality was significantly higher in dementia patients (44.58% vs. 27.05%; < 0.001). Dementia patients had double the mortality risk (OR: 1.956; 95% CI: 1.425-2.686). Annual and cumulative mortality rates increased progressively from 5.51% and in year 1 to 17.69% and 36.83% respectively by year 4. Baseline AChEI use was not significantly associated with mortality. Risk/100 for patient with dementia vs. without dementia for falls was 4.04 vs. 4.32 and fracture was 4.37 vs. 3.01. AChEI users had a trend of lower incidence/100 patient-years for falls of 3.01 vs. 4.37 and fractures 6.78 vs. 10.09. Dementia patients have higher mortality risk but not falls or fracture risk in this cohort. Although clinical cohort and animal studies suggest a benefit for AChEIs, this was not evident in this study possibly due to clinical cohort limitations. The trend of reduced falls and fracture in the AChEI cohort warrants further study.
Keywords: acetylcholinesterase inhibitors, dementia, fractures, mortality, osteoporosis
Journal of clinical medicine
Journal Article
English
42513304
Guideline Central and select third party use “cookies” on this website to enhance the user experience.
This technology helps us gather statistical and analytical information to optimize the relevant content for you.
The user also has the option to opt-out which may have an effect on the browsing experience.