Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil or galantamine

Background: few studies have analysed the effect of the long-term use of cholinesterase inhibitors (ChEIs) on mortality. Objective: to compare the long-term effects of galantamine and donepezil treatment on the mortality rate in Alzheimer's disease (AD) patients. Design: a retrospective cohort study. Setting and subjects: 404 patients referred by primary care centres to a Memory Clinic who were diagnosed with probable AD and who were prescribed treatment with donepezil or galantamine. Methods: standardised review of the patient's medical records. Results: 14.5% of the patients showed intolerance to the treatment with ChEIs during the first 15 days. Of those patients who initially tolerated the treatment, 18.5% gave it up after a mean duration of 13.36 months and a mean dose of 7.5 mg/ day of donepezil or 14.3 mg/ day of galantamine. The mean duration of the treatment in patients who did not abandon the treatment was 25.4 months and the mean dose was 8.1 mg/ day of donepezil or 20.0 mg/ day of galantamine. There were no differences in the mortality rate between patients treated with donepezil or galantamine (13.7 versus 12.2; P = 0.75). The multivariate analysis through binary logistic regression showed that the variables associated with mortality were male gender, older age, heart failure, treatment with antipsychotic drugs and a high score on the Global Deterioration Scale. Conclusions: the duration and the dose of donepezil or galantamine are not related to an increase in mortality. The related variables were advanced age, the severity of the dementia, being male, heart failure and treatment with antipsychotic drugs.