Acetylcholinesterase inhibitors and risk of stroke and death in people with dementia

Edwin C.K. Tan, Kristina Johnell, Sara Garcia-Ptacek, Miriam L. Haaksma, Johan Fastbom, J. Simon Bell, Maria Eriksdotter

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Introduction: The aim of this study was to investigate the association between acetylcholinesterase inhibitor (AChEI) use and risk of ischemic stroke and death in people with dementia. 

Methods: A cohort study of 44,288 people with dementia registered in the Swedish Dementia Registry from 2007 to 2014. Propensity score-matched competing risk regression models were used to compute hazard ratios and 95% confidence intervals for the association between time-dependent AChEI use and risk of stroke and death. 

Results: Compared with matched controls, AChEI users had a lower risk of stroke (hazard ratio: 0.85, 95% confidence interval: 0.75–0.95) and all-cause death (hazard ratio: 0.76, 95% confidence interval: 0.72–0.80). After considering competing risk of death, high doses (≥1.33 defined daily doses) of AChEI remained significantly associated with reduced stroke risk. 

Discussion: The use of AChEIs in people with dementia may be associated with reduced risk of ischemic stroke and death. These results call for a closer examination of the cardiovascular effects of AChEIs.

Original languageEnglish
Pages (from-to)944-951
Number of pages8
JournalAlzheimer's and Dementia
Issue number7
Publication statusPublished - 2018


  • Alzheimer disease
  • Cholinesterase inhibitors
  • Cohort studies
  • Dementia
  • Registries
  • Stroke

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