TOPLINE:

Anti-dementia medications, acetyl cholinesterase (AChE) inhibitors and memantine, were prescribed to 63.1% of patients with dementia. Patients from the most deprived areas, those of Asian or Black ethnicity, and individuals with learning disabilities had a lower likelihood of being prescribed AChE inhibitors or memantine.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using data from the Clinical Practice Research Datalink Aurum database comprising records from 1489 general practices in England between 2006 and 2024.
• They included 242,007 adult patients with Alzheimer's disease, Lewy body dementia, or mixed dementia comprising one of these subtypes, with data linked to patient-level Index of Multiple Deprivation 2019 data and ethnicity information.
• The frequency of ever being prescribed memantine or AChE inhibitors (donepezil, rivastigmine, or galantamine), including the co-prescribing of both medications and switching patterns from AChE inhibitors to memantine over time, was examined.
• Associations between patient-level characteristics (such as socioeconomic status, age, sex, ethnicity, diagnostic subtype, and comorbidity profile) and the receipt of AChE inhibitors and/or memantine at least once after the patient's first recorded dementia diagnosis were assessed. The median follow-up duration was 672 days.

TAKEAWAY:

• Overall, 63.1% of patients were ever prescribed an AChE inhibitor or memantine: 47.3% were ever prescribed an AChE inhibitor and 24.1% were ever prescribed memantine.
• Patients in the most deprived quintile were less likely to be prescribed an AChE inhibitor than those in the least deprived quintile (hazard ratio [HR], 0.82; 95% CI, 0.78-0.86), and those of Asian ethnicity (HR, 0.88; 95% CI, 0.84-0.93) or Black ethnicity (HR, 0.90; 95% CI, 0.85-0.95) were also less likely to receive AChE inhibitors than those of White ethnicity.
• Patients of Asian ethnicity (HR, 0.89; 95% CI, 0.84-0.96) or Black ethnicity (HR, 0.79; 95% CI, 0.73-0.86) were significantly less likely to be prescribed memantine than those of White ethnicity. Individuals with learning disabilities were substantially less likely to be prescribed AChE inhibitors (HR, 0.46; 95% CI, 0.42-0.50) or memantine (HR, 0.58; 95% CI, 0.50-0.67) than those without learning disabilities.
• Co-prescribing of both AChE inhibitors and memantine peaked at 4.2% in the 28 days preceding February 2022, with notable increases observed from 2% to a little over 4% between 2018 and 2023.

IN PRACTICE:

"[The study] findings require urgent clinical and academic action. As dementia healthcare increasingly shifts to primary care, it is important that existing effective treatments are utilised equitably, laying the groundwork for fair access to future therapies," the authors wrote.

SOURCE:

This study was led by Charlotte Morris, Division of Population Health, Health Services Research and Primary Care School of Health Sciences, The University of Manchester, Manchester, England. It was published online on June 01, 2026, in PLoS One.

LIMITATIONS:

The severity of dementia could not be determined because the coding in the database was complex. The reliance on initial diagnostic codes may have left out cases that were later diagnosed with specific types for which anti-dementia medication was needed. If there were no diagnostic codes, it was interpreted as the absence of conditions, which might have led to an underestimation of the comorbidity burden of some patients. The study also did not look at how often patients were referred to or started treatment in secondary care.

DISCLOSURES:

The Wellcome Trust provided funding for this study, with support received from the National Institute for Health and Care Research (NIHR) School for Primary Care Research. Three authors received funding from the NIHR Greater Manchester Patient Safety Research Collaboration. Two other authors received support from various organisations. One author disclosed having affiliation with the NIHR Policy Research Unit in Dementia and Neurodegeneration University of Exeter. All authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.