by Lori Solomon

Discontinuing cholinesterase inhibitors upon memantine initiation is not associated with an increased risk for long-term care institutionalization among older adults with dementia, according to a study published online Nov. 19 in JAMA Network Open.

Yu-Chien Lee, M.D., M.P.H., from Chang Gung Memorial Hospital in Taoyuan, Taiwan, and colleagues examined the association of cholinesterase inhibitor discontinuation and long-term care institutionalization among older adults with dementia who initiate memantine. The analysis included claims data (2014 through 2019) for 16,292 Medicare beneficiaries who initiated memantine.

The researchers found that when propensity-matching a cohort of 3,612 beneficiaries, over one year, long-term care institutionalization occurred in 2.8 percent of beneficiaries who discontinued cholinesterase inhibitors versus 3.4 percent of beneficiaries who continued, with no statistically significant difference in the one-year mean institutionalization-free days between the discontinuation and continuation groups (360.6 versus 359.1 days; mean difference, 1.5 days). Similarly, there were no mean differences in long-term care institutionalization-free days by age category, sex, dementia type, frailty, or dementia stage. There was a lower rate of fall-related injury in individuals who discontinued (0.9 versus 2.0 per 100 person-years; hazard ratio [HR], 0.47; 95 percent confidence interval [CI], 0.25 to 0.88). There was no difference between the groups for all-cause death (10.4 versus 11.6 per 100 person-years; HR, 0.89; 95 percent CI, 0.72 to 1.10).

"These findings offer valuable insights for clinicians aiming to reduce treatment burden in this population," the authors write.

One author disclosed ties to Alosa Health and VillageMD.

More information: Yu-Chien Lee et al, Discontinuation of Cholinesterase Inhibitors Following Initiation of Memantine and Admission to Long-Term Care Among Older Adults, JAMA Network Open (2024). DOI: 10.1001/jamanetworkopen.2024.45878

Journal information: JAMA Network Open 

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