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Long-term effects of cholinesterase inhibitors and memantine on cognitive decline, cardiovascular events, and mortality in dementia with Lewy bodies: An up to 10-year follow-up study
Xu H, Habich A, Ferreira D, Elisabet L, Westman E, Eriksdotter M. Alzheimer's & Dementia, 2024-08-23
Topic: Brain proteins, microglia and lab models
Introduction We aimed to assess the impact of cholinesterase inhibitors (ChEIs) and memantine on cognition, major adverse cardiovascular events (MACE) and mortality in dementia with Lewy bodies (DLB). Methods A total of 1,095 incident DLB patients from the Swedish Registry on cognitive/dementia disorders were included. Using an inverse probability of treatment weighting, the effect of initiating ChEI or memantine within 90 days of DLB diagnosis and nonuse was evaluated on cognitive trajectories and risks of MACE and death. Results The use of ChEIs significantly slowed cognitive decline at follow-ups (Mini-Mental State Examination [MMSE] -0.39 points/y; 95% confidence interval [CI], -0.96 to 0.18) compared to memantine (-2.49 points/y; -4.02 to -0.97) and nonuse (-2.50 points/y; -4.28 to -0.73). Treatment groups did not differ in MACE events. ChEI use was associated with lower risk of death in the first year after DLB diagnosis (adjusted hazard ratio [HR] 0.66, 95% CI 0.46, 0.94). Discussion Our findings illuminate the potential benefits of ChEI treatment in DLB patients. Highlights Cholinesterase inhibitors slow cognitive decline over a 5-year follow-up period when compared to both memantine treatment and nonuse in patients with dementia with Lewy bodies. Cholinesterase Inhibitors reduce risk of mortality within the initial year, but this effect is not sustained after 1 year in patients with dementia with Lewy bodies.
Key findings
- Results The use of ChEIs significantly slowed cognitive decline at follow-ups (Mini-Mental State Examination [MMSE] -0.39 points/y; 95% confidence interval [CI], -0.96 to 0.18) compared to memantine (-2.49 points/y; -4.02 to -0.97) and nonuse (-2.50 points/y; -4.28 to -0.73).
- ChEI use was associated with lower risk of death in the first year after DLB diagnosis (adjusted hazard ratio [HR] 0.66, 95% CI 0.46, 0.94).
- Discussion Our findings illuminate the potential benefits of ChEI treatment in DLB patients.
- Highlights Cholinesterase inhibitors slow cognitive decline over a 5-year follow-up period when compared to both memantine treatment and nonuse in patients with dementia with Lewy bodies.
Why it matters
This cohort study of 1,095 people with dementia with Lewy bodies found that cholinesterase inhibitor use significantly slowed cognitive decline compared with memantine and nonuse, and was associated with lower risk of death in the first year after diagnosis. It suggests cholinesterase inhibitors may help slow cognitive decline in this specific type of dementia, though the mortality benefit was not sustained after one year.
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Study details
- Study designcohort
- Participants1,095
- Effect sizeMMSE decline -0.39 vs -2.50 points/year (cholinesterase inhibitor vs non-use); first-year death aHR 0.66 (0.46-0.94)
- Evidence strengthModerate
Limitations
Observational registry data; confounding by indication despite weighting; the mortality benefit did not persist beyond one year.
How this study scored 64/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for randomised / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 63 of the 98 points we could judge it on, which is 64 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,095 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 21 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 5.2 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 3 / 6 | Cited 5.7× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 21 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Maria Eriksdotter: h-index 62 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Karolinska Institutet: institution h-index 1,477 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 3 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39177108) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 63 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 63 of the 98 points we could judge it on is 64 out of 100. |
| Total | 64 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Xu, H., Habich, A., Ferreira, D., Elisabet, L., Westman, E., & Eriksdotter, M. (2024). Long-term effects of cholinesterase inhibitors and memantine on cognitive decline, cardiovascular events, and mortality in dementia with Lewy bodies: An up to 10-year follow-up study. Alzheimer's & Dementia. https://doi.org/10.1002/alz.14118
Vancouver
Xu H, Habich A, Ferreira D, Elisabet L, Westman E, Eriksdotter M. Long-term effects of cholinesterase inhibitors and memantine on cognitive decline, cardiovascular events, and mortality in dementia with Lewy bodies: An up to 10-year follow-up study. Alzheimer's & Dementia. 2024. doi:10.1002/alz.14118. PMID: 39177108.
BibTeX
@article{xu2024-39177108,
author = {Xu, H. and Habich, A. and Ferreira, D. and Elisabet, L. and Westman, E. and Eriksdotter, M.},
title = {{Long-term effects of cholinesterase inhibitors and memantine on cognitive decline, cardiovascular events, and mortality in dementia with Lewy bodies: An up to 10-year follow-up study}},
journal = {Alzheimer's \& Dementia},
year = {2024},
doi = {10.1002/alz.14118},
pmid = {39177108},
url = {https://doi.org/10.1002/alz.14118}
}
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