Acetylcholinesterase Inhibitors May Reduce Psychotropic Prescriptions in Alzheimer Disease

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Use of acetylcholinesterase inhibitors to manage dementia-related behavioral and psychological symptoms in people with Alzheimer disease may reduce the need for psychotropic medications.

The use of acetylcholinesterase inhibitors (AChEIs) was associated with a reduced risk of psychotropic medication use in patients with Alzheimer disease (AD), according to results from a study published in the American Journal of Geriatric Psychiatry.

Researchers conducted a retrospective cohort study of 17,763 individuals with Lewy body dementia and AD. Study participants were excluded if they had previous anxiolytic and antipsychotic use at dementia diagnosis. Data were collected from the Swedish Dementia Registry from 2007 to 2015. The investigators used a propensity score-matched regression model to analyze associations between AChEI use and the risk of psychotropic medication initiation.

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After analysis, the researchers reported that AChEI use was associated with a reduced risk of anxiolytic (hazard ratio, 0.76; 95% CI, 0.72-0.80) and antipsychotic (hazard ratio, 0.85; 95% CI, 0.75-0.95) initiation vs matched comparators. No associations were found between AChEI use and the start of hypnotics or antidepressant therapy.

“In sub-analyses, this association remained significant at higher AChEI doses, and in AD but not Lewy body dementia,” the researchers noted.

One key limitation of the study was the exclusive use of secondary care data.

“Further investigation into the potential benefits of AChEIs in [behavioral and psychological symptoms of dementia] management…are warranted,” they concluded.


Tan ECK, Johnell K, Bell JS, et al. Do acetylcholinesterase inhibitors prevent or delay psychotropic prescribing in people with dementia? [published online June 25, 2019]. Am J Geriatr Psychiatry. doi:10.1016/j.jagp.2019.06.008