Abstract
BackgroundCholinesterase inhibitors (ChEIs) such as donepezil have the effect of delaying progression of Alzheimer’s disease (AD), but their effect on life expectancy is unclear. We analyzed the influence of donepezil on life expectancy after onset of AD, together with the effects of antipsychotic drugs and residency in a nursing home.MethodsAll outpatients at the Tajiri Clinic from 1999–2012 with available medical records and death certificates were included in a retrospective analysis. The entry criteria were a dementia diagnosis based on DSM-IV criteria and diagnosis of AD using NINCDS-ADRDA criteria; medical treatment for more than 3 months; and follow up until less than 1 year before death.ResultsWe identified 390 subjects with medical records and death certificates, of whom 275 had a diagnosis of dementia that met the entry criteria. Of 100 patients diagnosed with AD, 52 had taken donepezil and 48 patients had not received the drug due to treatment prior to the introduction of donepezil in 1999 in Japan. The lifetime expectancies after onset were 7.9 years in the donepezil group and 5.3 years in the non-donepezil group. There was a significant drug effect with a significant covariate effect of nursing home residency. Other covariates did not reach a significant level.ConclusionsAlthough this report has the limitation of all retrospective analyses: the lack of randomization, we found a positive effect of donepezil on lifetime expectancy after onset of AD. This may be due to a decreased mortality rate caused by reduction of concomitant diseases such as pneumonia. The similar life expectancies in patients taking donepezil at home and those not taking donepezil in a nursing home indicated a positive health economic effect of the drug.
Highlights
Cholinesterase inhibitors (ChEIs) such as donepezil have the effect of delaying progression of Alzheimer’s disease (AD), but their effect on life expectancy is unclear
We examined whether donepezil has an effect on life expectancy in AD
Of the 100 patients with AD and AD with CVD, 52 received donepezil and 48 patients did not receive the drug due to treatment prior to the introduction of donepezil in 1999 in Japan
Summary
Cholinesterase inhibitors (ChEIs) such as donepezil have the effect of delaying progression of Alzheimer’s disease (AD), but their effect on life expectancy is unclear. Several longitudinal studies have shown that cognitive impairment with advancing age is a negative predictor of subsequent survival [1]. This association remains after adjusting for medical conditions and self-rated health, and has been attributed to the effects of decreased biological vitality [2]. Possible positive effects of psychosocial activities such as exercise and mental activities may be decreased by cognitive impairment. In addition to these effects, dementia itself is a risk factor for decreased life expectancy
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