Early Start of Anti-Dementia Medication Delays Transition to 24-Hour Care in Alzheimer's Disease Patients: A Finnish Nationwide Cohort Study

J Alzheimers Dis. 2021;81(3):1103-1115. doi: 10.3233/JAD-201502.


Background: Dementia is one of the strongest predictors of admission to a 24-hour care facility among older people, and 24-hour care is the major cost of Alzheimer's disease (AD).

Objective: The aim of this study was to evaluate the association of early start of anti-dementia medication and other predisposing factors with 2-year risk of transition to 24-hour care in the nationwide cohort of Finnish AD patients.

Methods: This was a retrospective, non-interventional study based on individual-level data from Finnish national health and social care registers. The incident cohort included 7,454 AD patients (ICD-10, G30) comprised of two subgroups: those living unassisted at home (n = 5,002), and those receiving professional home care (n = 2,452). The primary outcome was admission to a 24-hour care facility. Exploratory variables were early versus late anti-dementia medication start, sociodemographic variables, care intensity level, and comorbidities.

Results: Early anti-dementia medication reduced the risk of admission to 24-hour care both in patients living unassisted at home, with a hazard ratio (HR) of 0.58 (p < 0.001), and those receiving professional home care (HR, 0.84; p = 0.039). Being unmarried (HR, 1.69; p < 0.001), having an informal caregiver (HR, 1.69; p = 0.003), or having a diagnosis of additional neurological disorder (HR, 1.68; p = 0.006) or hip fracture (HR, 1.61; p = 0.004) were associated with higher risk of admission to 24-hour care in patients living unassisted at home.

Conclusion: To support living at home, early start of anti-dementia medication should be a high priority in newly diagnosed AD patients.

Keywords: Alzheimer’s disease; Finland; cholinesterase inhibitors; dementia; healthcare; institutionalization; memantine; nursing homes; register.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / drug therapy*
  • Cholinesterase Inhibitors / therapeutic use*
  • Cohort Studies
  • Donepezil / therapeutic use
  • Female
  • Finland
  • Galantamine / therapeutic use
  • Humans
  • Male
  • Memantine / therapeutic use
  • Nootropic Agents / therapeutic use*
  • Nursing Homes*
  • Retrospective Studies
  • Rivastigmine / therapeutic use
  • Time-to-Treatment


  • Cholinesterase Inhibitors
  • Nootropic Agents
  • Galantamine
  • Donepezil
  • Rivastigmine
  • Memantine