Acetylcholinesterase inhibitors may have potential protective effect against AMD

In the treatment of individuals with Alzheimer’s disease (AD), acetylcholinesterase inhibitors (AChEIs) appear to confer a small reduction in the risk of age-related macular degeneration (AMD), as shown in a study.

The propensity score–matched retrospective cohort study included 21,823 veterans with AD (mean age 72.3 years, 97.7 percent men), of which 13,337 received treatment. In the treated group, 12,847 were exposed to an AChEI and 4,898 patients were exposed to memantine.

Most patients in both cohorts received their AD diagnosis between ages 65 and 80 years. On average, the treated group had a lower Charlson comorbidity burden (1.55 vs 2.16), a lower proportion of smokers (12.37 percent vs 14.06 percent), and a lower rate of hypertension (54.40 percent vs 59.80 percent) but a higher rate of pure hypercholesterolemia (6.30 percent vs 5.70 percent).

After propensity score matching, a total of 4,821 patients were included each in the treated and untreated groups. The median number of eye examination visits/clinic visits per year was higher in the untreated than in the treated group (1.5 vs 1.32).

Multivariable Cox analysis showed a 6-percent lower risk of AMD for every additional year of AChEI treatment (hazard ratio [HR], 0.94, 95 percent CI, 0.89–0.99). Factors associated with a risk of AMD included age (HR, 1.08, 95 percent CI, 1.06–1.09), White race (HR, 2.96, 95 percent CI, 2.13–4.10), and other/unknown race (HR, 2.84, 95 percent CI, 1.94–4.16).

More studies are needed to validate the findings across diverse populations and to determine whether there is a cause-and-effect relationship between AChEI treatment and AMD risk.