DOI QR코드

DOI QR Code

Effect of Choline Alfoscerate on the Progression From Mild Cognitive Impairment to Dementia: Distributed Network Analysis of a Multicenter Korean Database Using a Common Data Model

  • Jung-Min Pyun (Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Inho Lee (Informatization Project Department, Soonchunhyang University Medical Center) ;
  • Kyungbok Lee (Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine) ;
  • Min-ho Kim (Ewha Medical Data Organization, Ewha Womans University Seoul Hospital) ;
  • ChulHyoung Park (Department of Biomedical Informatics, Ajou University Hospital) ;
  • Hyeon-Jong Yang (Informatization Project Department, Soonchunhyang University Medical Center)
  • 투고 : 2024.08.06
  • 심사 : 2024.09.24
  • 발행 : 2024.10.31

초록

Background and Purpose: Choline alfoscerate (CA) is an acetylcholine precursor known for its beneficial effect on cognition in patient with Alzheimer's disease dementia (ADD). However, there is little evidence of its effects in patients with mild cognitive impairment (MCI). We assessed the influence of CA on the progression from MCI to all-cause dementia or ADD in three observational Korean databases using a Common Data Model (CDM). Methods: Patients who were diagnosed with MCI and were aged over 60 years were included. After propensity score matching, 3,062 matched pairs patients using CA use and those not using CA were included. The Cox regression model was used to analyze the hazard ratio (HR) of CA use for conversion from MCI to all-cause dementia or ADD. Subgroup analyses were performed based on sex, acetylcholine esterase inhibitor (AchEI) use, and donepezil use. Results: A meta-analysis across three hospitals revealed that CA use was not associated with the progression from MCI to all-cause dementia (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.59-1.26) or ADD (HR, 1.05; 95% CI, 0.51-1.59). Subgroup analyses revealed that CA use was not related to progression to all-cause dementia or ADD when stratified by sex, AchEI use, and donepezil use. Conclusions: In this multicenter cohort study based on the Observational Medical Outcomes Partnership CDM real-world data, no association was noted between CA use and disease progression from MCI to all-cause dementia or ADD.

키워드

과제정보

This work was supported by the Soonchunhyang University Research Fund. This work was supported by Electronics and Telecommunications Research Institute (ETRI) grant funded by the Korean government (23ZS1100, Core Technology Research for Self-Improving Integrated Artificial Intelligence System).

참고문헌

  1. 2023 Alzheimer's disease facts and figures. Alzheimers Dement 2023;19:1598-1695.
  2. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR Jr, Kawas CH, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011;7:263-269.
  3. Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011;7:270-279.
  4. Francis PT, Palmer AM, Snape M, Wilcock GK. The cholinergic hypothesis of Alzheimer's disease: a review of progress. J Neurol Neurosurg Psychiatry 1999;66:137-147.
  5. Arendt T, Bigl V, Tennstedt A, Arendt A. Neuronal loss in different parts of the nucleus basalis is related to neuritic plaque formation in cortical target areas in Alzheimer's disease. Neuroscience 1985;14:1-14.
  6. Davies P, Maloney AJ. Selective loss of central cholinergic neurons in Alzheimer's disease. Lancet 1976;2:1403.
  7. Reinikainen KJ, Soininen H, Riekkinen PJ. Neurotransmitter changes in Alzheimer's disease: implications to diagnostics and therapy. J Neurosci Res 1990;27:576-586.
  8. Haense C, Kalbe E, Herholz K, Hohmann C, Neumaier B, Krais R, et al. Cholinergic system function and cognition in mild cognitive impairment. Neurobiol Aging 2012;33:867-877.
  9. Sigala S, Imperato A, Rizzonelli P, Casolini P, Missale C, Spano P. L-alpha-glycerylphosphorylcholine antagonizes scopolamine-induced amnesia and enhances hippocampal cholinergic transmission in the rat. Eur J Pharmacol 1992;211:351-358.
  10. Amenta F, Tayebati SK, Vitali D, Di Tullio MA. Association with the cholinergic precursor choline alphoscerate and the cholinesterase inhibitor rivastigmine: an approach for enhancing cholinergic neurotransmission. Mech Ageing Dev 2006;127:173-179.
  11. Amenta F, Carotenuto A, Fasanaro AM, Rea R, Traini E. The ASCOMALVA trial: association between the cholinesterase inhibitor donepezil and the cholinergic precursor choline alphoscerate in Alzheimer's disease with cerebrovascular injury: interim results. J Neurol Sci 2012;322:96-101.
  12. Amenta F, Carotenuto A, Fasanaro AM, Rea R, Traini E. The ASCOMALVA (Association between the Cholinesterase Inhibitor Donepezil and the Cholinergic Precursor Choline Alphoscerate in Alzheimer's Disease) trial: interim results after two years of treatment. J Alzheimers Dis 2014;42 Suppl 3:S281-S288.
  13. Traini E, Bramanti V, Amenta F. Choline alphoscerate (alpha-glyceryl-phosphoryl-choline) an old choline-containing phospholipid with a still interesting profile as cognition enhancing agent. Curr Alzheimer Res 2013;10:1070-1079.
  14. Hripcsak G, Duke JD, Shah NH, Reich CG, Huser V, Schuemie MJ, et al. Observational Health Data Sciences and Informatics (OHDSI): opportunities for observational researchers. Stud Health Technol Inform 2015;216:574-578.
  15. Voss EA, Makadia R, Matcho A, Ma Q, Knoll C, Schuemie M, et al. Feasibility and utility of applications of the common data model to multiple, disparate observational health databases. J Am Med Inform Assoc 2015;22:553-564.
  16. Yoon D, Ahn EK, Park MY, Cho SY, Ryan P, Schuemie MJ, et al. Conversion and data quality assessment of electronic health record data at a Korean tertiary teaching hospital to a Common Data Model for distributed network research. Healthc Inform Res 2016;22:54-58.
  17. You SC, Lee S, Cho SY, Park H, Jung S, Cho J, et al. Conversion of National Health Insurance Service-National Sample Cohort (NHIS-NSC) database into Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM). Stud Health Technol Inform 2017;245:467-470.
  18. Han SH, Chul Youn Y. Quantitative electroencephalography changes in patients with mild cognitive impairment after choline alphoscerate administration. J Clin Neurosci 2022;102:42-48.
  19. Kwak YT. Quantitative EEG findings in different stages of Alzheimer's disease. J Clin Neurophysiol 2006;23:456-461.
  20. Jelic V, Shigeta M, Julin P, Almkvist O, Winblad B, Wahlund LO. Quantitative electroencephalography power and coherence in Alzheimer's disease and mild cognitive impairment. Dementia 1996;7:314-323.
  21. Han SH, Jeong HB, Park KY, Shin HW, Youn YC, Kim S. P300 latency changes in patients with mild cognitive impairment after taking choline alphoscerate; a preliminary study. eNeurologicalSci 2018;11:5-8.
  22. Beam CR, Kaneshiro C, Jang JY, Reynolds CA, Pedersen NL, Gatz M. Differences between women and men in incidence rates of dementia and Alzheimer's disease. J Alzheimers Dis 2018;64:1077-1083.
  23. Sagaro GG, Traini E, Amenta F. Activity of choline alphoscerate on adult-onset cognitive dysfunctions: a systematic review and meta-analysis. J Alzheimers Dis 2023;92:59-70.