DOI: 10.1002/alz.076465 ISSN: 1552-5260

Analysis of persistence rate of cognitive enhancers in Alzheimer’s disease using the common data model

Jae Won Jang
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



AchEIs are used by first‐diagnosed Alzheimer’s dementia patients. The effect of drug has been proven in safety and efficacy but it is known that the drug cannot be taken continuously due to side effects of about 10% in existing studies. However, studies report higher drug discontinuation rates. Cognitive function improvers or ‘nootropics’ such as choline alfocerate are used together with AchEI. Therefore, purpose of this study was to analyze the usage patterns of cognitive enhancers in Alzheimer’s patients and to confirm retention rate using a common data model.


From 2010 to 2019, using the data of Alzheimer’s patients registered in the common data model server of Kangwon National University Hospital, we will investigate the prescription rate of cognitive function improving drugs (choline alfocerate) and drug analysis patterns such as ChEI and combination therapy. The analysis is conducted using the FeederNet‐based ATLAS WEB tool, and additional analysis is compared with the results obtained through the DBMS approach using SQL.


As a result of the analysis of treatment trends and persistence for 10 years, among 2,658 newly diagnosed patients with Alzheimer’s disease, donepezil was prescribed the most with 1,518 patients (57.11%), choline alfocerate with 654 patients (24.6%), and memantine with 214 patients. (8.05%), rivastigmine in 74 (2.78%), and galantamine in 147 (5.53%) each. During observation, trend of increasing prescriptions was Donepezil (31.5% in 2010 to 68.7% in 2019), Nootropics (24.6% in 2010 to 34.2% in 2019), Memantine (3.7% in 2010 to 7.9% in 2019), and Rivastigmine(0.53% in 2010 to 3.32% in 2019), while galantamine decreased (12.2% in 2010 to 0.3% in 2019). Persistence was approximately 50% for donepezil and memantine and approximately 40% for rivastigmine, galantamine and choline alfocerate over 12 months


Comparing treatment trends of cognitive function improvers, donepezil, memantine, ribistigmine, and choline alfocerate showed a tendency to increase, whereas galantamine showed a tendency to decrease. Also, donepezil and memantine were associated with longer persistence than rivastigmine and galantamine and choline alfocerate. In particular, in case of Nootropics, a high rate of initial prescription is given to patients with dementia, but rate of continuous prescription is not high.

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