1. Medications and cognitive decline in Alzheimer's disease : Cohort cluster analysis of 15,428 patientsPol Grau-Jurado, Shayan Mostafaei, Hong Xu, Minjia Mo, Bojana Petek, Irena Kalar, Luana Naia, Julianna Kele, Silvia Maioli, Joana Carvalho, Maria Eriksdotter Jönhagen, Saikat Chatterjee, Sara Garcia-Ptacek, 2025, original scientific article Abstract: BackgroundMedications for comorbid conditions may affect cognition in Alzheimer's disease (AD). ObjectiveTo explore the association between common medications and cognition, measured with the Mini-Mental State Examination. MethodsCohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters. Results15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15–1.83] at first follow-up, simvastatin (1.41 [1.11–1.78] at second follow-up), warfarin (1.56 [1.22–2.01] first follow-up), zopiclone (1.35 [1.15–1.58], and metformin (2.08 [1.35–3.33] second follow-up. Oxazepam (0.60 [0.50–0.73] first follow-up), paracetamol (0.83 [0.73–0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia. ConclusionsWe performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.
Keywords: Alzheimer's disease, cohort study, comorbidity, metformin, Mini-Mental State Examination, oxazepam, pharmacological treatments, statins, warfarin, zopiclone
Published in DiRROS: 15.04.2026; Views: 170; Downloads: 168
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2. Statins, cholesterol and cognition at the time of Alzheimer's disease diagnosis : cross-sectional study from the Swedish registry for cognitive/dementia disordersBojana Petek, Minjia Mo, Hong Xu, Jakob Norgren, Minh Tuan Hoang, Marta Villa-Lopez, Henrike Häbel, Julianna Kele, Luana Naia, Milica Gregorič Kramberger, 2025, original scientific article Abstract: Background: Evidence suggests statins may influence cognition in Alzheimer's disease (AD), but specific use patterns in AD patients remain unclear. Objective: To identify factors influencing statin use in AD and explore associations between statins, cholesterol, and cognition, evaluated with Mini-Mental State Examination (MMSE) at dementia diagnosis. Methods: A cross-sectional study using data from the Swedish Registry for Dementia and Cognitive Disorders (SveDem) and Stockholm Creatinine Measurements (SCREAM) from 2007 to 2018. Multivariable logistic regression examined associations between baseline characteristics and statin use, while linear regression analyzed relationships between statins, cholesterol levels, and MMSE scores. Results: We included 3074 AD patients (mean age 78.1 years; 59.4% women), of whom 1028 used statins (79.6% simvastatin, 20.4% atorvastatin). Patients with diabetes mellitus, ischemic heart disease, or stroke had greater odds of receiving statins. Older patients had slightly lower odds of receiving any statin at baseline (simvastatin use OR 0.98, 95% CI 0.97–0.99). Simvastatin users had 0.53 points higher MMSE on average at baseline compared to non-users of statins (se 0.23, p = 0.021). Higher low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels were associated with higher MMSE in non-users of statins, but not in statin users. Conclusions: Younger AD patients and those with cardiovascular disease were more likely to use statins. Simvastatin use was linked to higher cognitive scores at diagnosis. In non-users, higher LDL-C, TC, and HDL-C levels correlated with better baseline cognitive scores. Longitudinal studies are needed to investigate the effects of statins on cognitive decline in AD.
Keywords: Alzheimer's disease, cholesterol, dementia, drug repurposing, mini-mental state examination
Published in DiRROS: 15.04.2026; Views: 207; Downloads: 92
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