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Medications and cognitive decline in Alzheimer's disease: Cohort cluster analysis of 15,428 patients
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Departmenet of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.
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2025 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 103, no 3, p. 931-940Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Medications for comorbid conditions may affect cognition in Alzheimer's disease (AD). OBJECTIVE: To explore the association between common medications and cognition, measured with the Mini-Mental State Examination. METHODS: Cohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters. RESULTS: 15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15-1.83] at first follow-up, simvastatin (1.41 [1.11-1.78] at second follow-up), warfarin (1.56 [1.22-2.01] first follow-up), zopiclone (1.35 [1.15-1.58], and metformin (2.08 [1.35-3.33] second follow-up. Oxazepam (0.60 [0.50-0.73] first follow-up), paracetamol (0.83 [0.73-0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia. CONCLUSIONS: We performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.

Place, publisher, year, edition, pages
SAGE Publications , 2025. Vol. 103, no 3, p. 931-940
Keywords [en]
Alzheimer's disease, cohort study, comorbidity, metformin, Mini-Mental State Examination, oxazepam, pharmacological treatments, statins, warfarin, zopiclone
National Category
Geriatrics Neurosciences Pharmacology and Toxicology
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URN: urn:nbn:se:kth:diva-361181DOI: 10.1177/13872877241307870ISI: 001432424700022PubMedID: 39772858Scopus ID: 2-s2.0-85219757719OAI: oai:DiVA.org:kth-361181DiVA, id: diva2:1944136
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QC 20250312

Available from: 2025-03-12 Created: 2025-03-12 Last updated: 2025-03-17Bibliographically approved

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Chatterjee, Saikat

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