Abstract
Background: Whether gender differences exist in late-onset of Alzheimer’s disease (LOAD) treated with cholinesterase inhibitors (ChEIs) is not fully understood. This study investigated demographic and pharmacological characteristics in LOAD patients to determine gender differences in LOAD patients treated with ChEIs alone and ChEIs with other medications. Methods: This 5-year retrospective data analysis included 9290 LOAD AD patients with 2949 men patients and 6341 women. Potential predictors of demographic and pharmacological characteristics associated gender differences in patients treated with and without ChEIs therapy were determined using univariate analysis, while multivariable models adjusted for demographic and pharmacological variables. Results: In the adjusted analysis, men patients with LOAD that presented with a history of alcohol use (ETOH) (OR = 1.339, 95% CI, 1.072–1.672, p = 0.010), treated with second generation antipsychotics (SGAs) (OR = 1.271, 95% CI, 1.003–1.610, p = 0.047), citalopram (OR = 5.103, 95% CI, 3.423–7.607, p < 0.001), memantine (OR = 4.409, 95% CI, 3.704–5.249, p < 0.001), and buspirone (OR = 2.166, 95% CI, 1.437–3.264, p < 0.001) were more likely to receive ChEIs therapy, whereas older men were less likely to be treated with ChEIs therapy. Women who were African Americans (OR = 1.387, 95% CI, 1.168–1.647, p < 0.001), that received memantine (OR = 3.412, 95% CI, 3.034–3.837, p < 0.001), selective serotonin reuptake inhibitor (SSRIs) (OR = 1.143, 95% CI, 1.016–1.287, p = 0.026), and a history of ETOH (OR = 2.109, 95% CI, 1.724–2.580, p < 0.001) were more likely to receive ChEIs therapy, whereas older women were less likely to receive ChEIs therapy. Conclusion: In both men and women patients, those with increasing age were less likely to be treated with ChEI therapy, while patients treated with memantine were also likely to receive ChEI therapy. Our findings highlight the importance for clinicians to optimize ChEI in LOAD to improve treatment effectiveness and eliminate gender differences in ChEI therapy.
Highlights
African American women with late-onset of Alzheimer’s disease (LOAD) and a history of ETOH and taking Selective serotonin reuptake inhibitors (SSRIs) such as memantine were more likely to be treated with cholinesterase inhibitors (ChEIs) therapy
While citalopram and buspirone were associated with ChEI therapy for the men patients, African American women with a history of ETOH and taking SSRIs were more likely to be treated with ChEI therapy
Our finding that a combined treatment using SSRIs with memantine or that SSRIs including memantine, citalopram, and buspirone were more likely to be treated with ChEI therapy supports the synergistic interaction between ChEI such as galantamine and memantine and SSRIs on cognition of Alzheimer’s disease (AD) patients [55]
Summary
The observed gender difference is linked to women’s greater longevity, especially since the risk of developing dementia increases with age [5]. The extent to which gender differences are associated with women relative to men at older ages or of women’s having a greater risk than men at the same age has been investigated in different studies [5,6,7,8,9,10]. The higher number of AD cases reported among women tend to indicate that women present with a higher incidence of AD when compared with men [5,6,7]. Several studies that found that gender differences [8,9,10] tend to show later in life, and the variation point at which incidence rates begin to differ between men and women vary in different studies
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