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Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality
Xu H, Garcia-Ptacek S, Jönsson L, Wimo A, Nordström P, Eriksdotter M.. Neurology, 2021-03-19
Topic: Risk, prevention and care in population studies
Plain-language summary
Objective To investigate whether cholinesterase inhibitors (ChEIs) are associated with slower cognitive decline in Alzheimer dementia and decreased risk of severe dementia or death. Methods Patients with Alzheimer dementia from the Swedish Dementia Registry starting on ChEIs within 3 months of the dementia diagnosis were included and compared to nontreated patients with Alzheimer dementia. In a propensity score-matched cohort, the association between ChEI use and cognitive trajectories assessed by Mini-Mental State Examination (MMSE) scores was examined with a mixed model, and severe dementia (MMSE score Results The matched cohort included 11,652 ChEI users and 5,826 nonusers.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Xu, H., Garcia-Ptacek, S., Jönsson, L., Wimo, A., Nordström, P., & Eriksdotter, M. (2021). Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality. Neurology. https://doi.org/10.1212/wnl.0000000000011832
Vancouver
Xu H, Garcia-Ptacek S, Jönsson L, Wimo A, Nordström P, Eriksdotter M. Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality. Neurology. 2021. doi:10.1212/wnl.0000000000011832. PMID: 33741639.
BibTeX
@article{xu2021-33741639,
author = {Xu, H. and Garcia-Ptacek, S. and Jönsson, L. and Wimo, A. and Nordström, P. and Eriksdotter, M.},
title = {{Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality}},
journal = {Neurology},
year = {2021},
doi = {10.1212/wnl.0000000000011832},
pmid = {33741639},
url = {https://doi.org/10.1212/wnl.0000000000011832}
}
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Key findings
- Methods Patients with Alzheimer dementia from the Swedish Dementia Registry starting on ChEIs within 3 months of the dementia diagnosis were included and compared to nontreated patients with Alzheimer dementia.
- In a propensity score-matched cohort, the association between ChEI use and cognitive trajectories assessed by Mini-Mental State Examination (MMSE) scores was examined with a mixed model, and severe dementia (MMSE score Results The matched cohort included 11,652 ChEI users and 5,826 nonusers.
- During an average of 5 years of follow-up, 255 cases developed severe dementia, and 6,055 (35%) died.
- ChEI use was associated with higher MMSE score at each visit (0.13 MMSE points per year; 95% confidence interval [CI] 0.06-0.20).
Why it matters
This registry study compared 11,652 patients with Alzheimer dementia who started cholinesterase inhibitors within 3 months of diagnosis to 5,826 nontreated patients, examining cognitive decline and risk of severe dementia or death. It reports an association between cholinesterase inhibitor use and outcomes but does not prove that these drugs cure or prevent Alzheimer's disease.
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Study details
- Participants11,652
- Evidence strengthModerate
How this study scored 65/100
Published in a leading specialty journal. Scored zero for study design, effect reported and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| 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 | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 11,652 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 181 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 25.9 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 5 / 6 | Cited 20.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 5 other studies in this library |
| Still being cited | 3 / 4 | Cited 79 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) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 33741639) |
| Free to read | 2 / 2 | Free to read |
| Total | 65 / 100 | — |
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