title: Use of antidementia drugs and risk of pneumonia in older persons with Alzheimer's disease.
abstract: Persons with Alzheimer's disease are at an increased risk of pneumonia, but the comparative risks during specific antidementia treatments are not known. We compared the risk of pneumonia in the use of donepezil, rivastigmine (oral, transdermal), galantamine and memantine.
  
  
  
  We used data from a nationwide cohort of community-dwelling individuals diagnosed with Alzheimer's disease during 2005-2011 in Finland, who initiated monotherapy with acetylcholinesterase inhibitor or memantine (n = 65,481). The risk of hospitalization or death due to pneumonia was investigated with Cox proportional hazard models.
  
  
  
  The risk of pneumonia was higher in persons using rivastigmine patch (n = 9709) (adjusted hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.04-1.27) and memantine (n = 11,024) (HR 1.59, 95% CI 1.48-1.71) compared with donepezil users (n = 26,416) whereas oral rivastigmine (n = 7384) (HR 1.08, 95% CI 0.98-1.19) and galantamine (n = 10,948) (HR 0.91, 95% CI 0.83-1.00) were not associated with an increased risk. These results did not change when adjusting for comorbid conditions, use of psychotropic drugs or with inverse probability of treatment weighting.
  
  
  
  The increased risk of pneumonia in this fragile group of aged persons should be taken into account. Memantine is associated with the highest risk in the comparison of antidementia drugs. KEY Message Pneumonia risk is increased in persons with Alzheimer's disease who use memantine or rivastigmine patches.
authors: a Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland , Kuopio , Finland.
authors: Pasi
authors: P
authors: Lampela
authors: b Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland , Kuopio , Finland.
authors: Anna-Maija
authors: AM
authors: Tolppanen
authors: c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.|d Department of Forensic Psychiatry , Niuvanniemi Hospital, University of Eastern Finland , Kuopio , Finland.|e National Institute for Health and Welfare , Helsinki , Finland.
authors: Antti
authors: A
authors: Tanskanen
authors: c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.|d Department of Forensic Psychiatry , Niuvanniemi Hospital, University of Eastern Finland , Kuopio , Finland.
authors: Jari
authors: J
authors: Tiihonen
authors: f Department of Pharmacology, Drug Development and Therapeutics , University of Turku , Turku , Finland.
authors: Piia
authors: P
authors: Lavikainen
authors: a Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland , Kuopio , Finland.
authors: Sirpa
authors: S
authors: Hartikainen
authors: a Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland , Kuopio , Finland.|b Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland , Kuopio , Finland.|c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.
authors: Heidi
authors: H
authors: Taipale
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000077265:Donepezil; D005260:Female; D005387:Finland / Q000453:epidemiology; D005702:Galantamine / Q000009:adverse effects* / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007189:Indans / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008559:Memantine / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D010880:Piperidines / Q000009:adverse effects* / Q000627:therapeutic use; D011014:Pneumonia / Q000139:chemically induced* / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D012306:Risk; D000068836:Rivastigmine / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine; D008559:Memantine
keywords: Aged; Alzheimer disease; cholinesterase inhibitors; memantine; pneumonia