Clinical and Medication Factors Associated with Cognitive Decline in Dementia: A Healthcare Database Study

Dementia is the most common neurodegenerative disease, but the risk factors associated with its progression remain incompletely understood. Identifying clinical and medication-related determinants of cognitive decline may inform patient management and guide treatment strategies.

Individuals with dementia who underwent paired Mini-Mental State Examination (MMSE) assessments between 2013 and 2019 were identified from the Taipei Medical University Clinical Research Database. To ensure adequate follow-up, paired assessments were required to be at least 90 days apart, with an actual mean follow-up interval of 21.5 ± 18.0 months. Demographic data, comorbidities, medication prescriptions, and blood biochemistry results were extracted. Generalized estimating equations were applied to evaluate associations between these factors and MMSE changes.

A total of 3,054 individuals with dementia were included (mean age 78.0 ± 9.2 years, 61.1% women). The mean baseline MMSE score was 18.5 ± 6.7 and it declined to 16.0 ± 7.5 at follow-up. Male sex was significantly associated with greater MMSE decline (estimate: -0.920, 95% CI: -1.552 to -0.289, p = 0.004). Antidementia medications were significantly associated with less decline in MMSE scores (estimate: 1.245, 95% CI: 0.676 to 1.815, p < 0.001). In contrast, non-aspirin antiplatelet agent use was associated with a greater decline among men (estimate: -1.346, 95% CI: -2.518 to -0.173, p = 0.025).

These findings highlighted that both clinical and pharmacological factors influence cognitive decline in dementia. Antidementia medications were linked to slower deterioration, supporting their role in disease management. Conversely, the association of non-aspirin antiplatelet agents with faster decline in men suggested potential adverse effects that warrant further investigation.

In this large real-world cohort, sex and medication use were key determinants of cognitive decline in dementia. Antidementia medications mitigated decline. Notably, only non-aspirin antiplatelet agents, but not aspirin, were associated with greater cognitive decline in men., underscoring the need for personalized treatment approaches.