Treatment with rivastigmine or galantamine and risk of urinary incontinence : results from a Dutch database study

Treatment of Alzheimer disease (AD) with cholinesterase inhibitors (ChEIs) may increase the risk of urinary incontinence (UI). Objective: To assess whether ChEI use was associated with the risk of UI among older patients with AD. Methods: A crossover cohort study using the PHARMO Record Linkage System included 10years of data on drug dispensing histories for over two million Dutch residents. Included patients were aged 50 +, free of UI for the last 6months, received a first ChEI prescription during the study period, had at least 12months prior drug exposure history and one subsequent prescription of any drug. UI was defined as a first dispensing of a urinary spasmolytic or of incontinence products for at least 30days. Cox regression with time-varying covariates and multivariate adjustment allowed assessing whether UI incidence was associated with ChEI exposure. Results: Among 3154 patients there were 657 UI cases during a mean follow-up of 5.1years before a first ChEI dispensing, and 499 cases after ChEI initiation, during a mean follow-up of 2.0years. Among the 2700 participants free of UI one year before ChEI initiation, the adjusted hazard ratio (HR) for UI was 1.13 (95% CI: 0.97-1.32) when periods with ChEI use were compared to periods without ChEI use. Sensitivity analyses may suggest an increased risk in the 1st month after ChEI initiation (HR: 1.72, p=0.09) Conclusion: Worsening AD may increase incidence of UI, but no firm association between ChEI treatment and risk of UI could be shown from these data

Understanding the evolution of multimorbidity: evidences from the North West Adelaide Health Longitudinal Study (NWAHS).

OBJECTIVE: The aim of this study is to describe the evolution of multimorbidity. STUDY DESIGN AND SETTING: Data from 1854 South Australians who participated in the North West Adelaide longitudinal Health Study (NWAHS) was collected between baseline (2000-2002) and follow-up (2008-2010). Status for eight chronic diseases (CDs) was determined by biomedical measurement or self-report. Chronic disease (CD) mean age of occurrence and order of appearance was investigated. RESULTS: The prevalence of multimorbidity increased from 32% to 64% during the 7.8±1.1 years of follow-up. The estimated mean age of onset of a new CD was significantly older for hypertension, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) and younger for hypercholesterolemia, asthma and other mental problem. Hypercholesterolemia was more likely to develop as a first than as a subsequent CD (39%vs.16%, p<0.0001) while CVD (1%vs.5%, p<0.0001), diabetes (5%vs.11%, p<0.001) and COPD (6%vs.16%, p<0.0001) were less likely. The presence of mood disorders at baseline was associated with an increased risk of developing other mental disorders (36%vs.12%, p<0.0001), diabetes (18%vs.9%, p<0.01) and asthma (30%vs.21%, p<0.05). CONCLUSION: Longitudinal data could be used to study the evolution of multimorbidity and could provide information on CDs mean age of occurrence, order of appearance and impact on the development of future CDs

Comparison of chronic diseases developed during follow-by mean age of occurrence (Panel A), pre-existing CD status (Panel B, table) and percent occurring as a first CD (Panel B, Figure).

<p>The Y axis of Panel A correspond to the estimated mean age (59) at which CD were developed during follow-up. Error bar from panel A are confidence interval (95%). The Light and dark gray bars correspond to CD developed as a first and a subsequent CD respectively ^* and ^§significantly different from the first CD group in every models and in the age and sex adjusted models respectively.</p

Relationship of the CD mean age of occurrence with its order of appearance (Panel A) and the risk to develop CD during the follow-up period (Panel B) and an overview of the evolution of multimorbidity (Panel C).

<p>CVD: cardiovascular disease, COPD: chronic obstructive pulmonary disease.</p

Proportion of individuals with a specific CD at baseline that developed at least one CD during the follow-up.

<p>The X-axis correspond to the proportion (60%) of those that developed at least one CD during follow-up among those that had at least one CD at baseline. *significantly different from the mean proportion of individual that developed CD. Error bar are confidence interval (95%).</p

Proportion of the 1854 participants by number of CD and by individual CD status at baseline and follow-up and the number and type of CD developed during the 7.8 years of follow-up.

<p>COPD: Chronic obstructive pulmonary disease and CVD: Cardiovascular disease and stroke.</p

Physical and socio-demographic characteristics of the 1854 participants to the North West Adelaide Health Study at baseline (2002).

<p>Physical and socio-demographic characteristics of the 1854 participants to the North West Adelaide Health Study at baseline (2002).</p

Impact of the presence of asthma or mood and anxiety disorders at baseline on CD development as compared to those with a another CD at baseline that also developed CD.

<p>*significantly different between individuals with either Asthma or Mood and anxiety disorders groups and the rest of the individuals in the progressive multimorbidity groups at baseline; NS: no significant difference;</p>?<p>Model adjusted for age, sex, BMI, marital status, education, income and working status at baseline,</p>§<p>The sum of this column is not 100% since some individuals developed more than one CD; CD: chronic disease; COPD: chronic obstructive pulmonary disease; and CVD =  cardiovascular disease and stroke.</p