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Lookup NU author(s): Professor Dame Louise Robinson, Dr Louise Allan
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2026 Morris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective: Evidence suggests that patient-level characteristics such as socio-economic status or ethnicity affect the likelihood of receiving guideline recommended anti-dementia medications. Existing studies often included all-cause dementia, not just the specific subtypes in which medication is indicated. Patterns of prescribing of Acetyl Cholinesterase Inhibitors (AChEIs) and memantine require further exploration, with little evidence about rates of co-prescribing in English primary care. We examined variations in anti-dementia medication prescribing with patient-level characteristics, and over time. Design and setting: Retrospective cohort study, using the Clinical Practice Research Datalink Aurum. Data from 1,489 practices, in England between 2006–2024, were included and linked to patient level Index of Multiple Deprivation data (2019). Cox-regression modelling, clustered at practice level, assessed association between patient-level characteristics and receiving AChEIs, and/or memantine. Time-series analyses examined co-prescribing of memantine and AChEIs. Participants 242,007 patients, aged>=18 years, with Alzheimer’s or Lewy-Body Dementia, or mixed dementia including one of these subtypes, were included. Results: Among the 242,007 patients, 63.1% were prescribed an anti-dementia medication; co-prescribing of memantine and AChEIs peaked at 4.2%. Those in the most deprived quintile were less likely to be prescribed AChEIs (Hazard Ratio (HR) 0.82,0.78-0.86) compared to the most affluent quintile. People with Asian (HR 0.89,0.84−96), or Black (HR 0.79, 0.73-0.86) ethnicities were less likely to be prescribed memantine compared to white people. Those with learning disabilities were substantially less likely to be prescribed AChEIs (HR 0.46,0.42-0.50) or memantine (HR 0.58, 0.50-0.67) compared to those without. Conclusion: Overall rates of prescribing of anti-dementia medications were lower than expected. Rates of co-prescription of AChEIs and memantine were low, despite guideline recommendations. We found inequity in anti-dementia medication prescribing, relating to multiple patient-level characteristics highlighting the need for more equitable access to evidence-based treatments.
Author(s): Morris C, Mok PLH, Robinson L, Allan L, Ashcroft DM, Blakeman T, Kontopantelis E
Publication type: Article
Publication status: Published
Journal: PLoS ONE
Year: 2026
Volume: 21
Issue: 6
Online publication date: 01/06/2026
Acceptance date: 09/04/2026
Date deposited: 15/06/2026
ISSN (electronic): 1932-6203
Publisher: Public Library of Science
URL: https://doi.org/10.1371/journal.pone.0347921
DOI: 10.1371/journal.pone.0347921
Data Access Statement: All relevant codelists are shared within the supplemtary files. The data underlying the results presented in the study are available from CPRD https://www.cprd.com/access-data.
PubMed id: 42224406
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