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Original Article
- Mortality risk associated with acetylcholinesterase inhibitor use in Parkinson’s disease dementia according to sex and age at disease onset: a nationwide cohort study
- Bora Yoon, Hwa Jung Kim
- Epidemiol Health. 2026;48:e2026015. Published online April 11, 2026
- DOI: https://doi.org/10.4178/epih.e2026015
- 2,136 View
- 86 Download
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Abstract
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AbstractOBJECTIVES
Dementia increases mortality risk; however, most studies evaluating acetylcholinesterase inhibitors (AChEIs) have focused on Alzheimer’s disease. The survival effects of AChEIs in Parkinson’s disease dementia (PDD) remain unclear. This study evaluated the association between AChEI use and mortality in PDD, stratified by sex and age at Parkinson’s disease (PD) onset.METHODSThis retrospective cohort study used data from the Korean National Health Insurance Service from January 2002 to December 2021. Patients diagnosed with PDD after PD onset were included. Propensity score matching (2:1) was performed to match AChEI users with non-users. Kaplan–Meier survival analyses and subgroup analyses were conducted according to sex and age at PD onset.RESULTSAChEI use was associated with a 24% reduction in mortality risk (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.74 to 0.78; p<0.001). The survival benefit persisted throughout follow-up and was more pronounced in females (HR, 0.71; 95% CI, 0.69 to 0.74) than in males (HR, 0.83; 95% CI, 0.80 to 0.86). In late-onset PDD, AChEI use was associated with a 26% reduction in mortality (HR, 0.74; 95% CI, 0.72 to 0.76), whereas no significant association was observed in young-onset PDD (HR, 1.02; 95% CI, 0.92 to 1.33; p=0.665). Survival outcomes were comparable between donepezil and rivastigmine users.CONCLUSIONSAChEI use improved survival in patients with PDD, particularly in females and in those with late-onset PD, with the greatest benefit observed during early and medium-term follow-up periods. These findings suggest that AChEIs may confer a survival advantage in PDD regardless of the specific agent used. -
SummaryKorean summary
본 연구는 국민건강보험 데이터를 활용해 파킨슨병 치매(PDD) 환자의 아세틸콜린에스테라제 억제제(AChEI) 사용과 사망률의 상관관계를 분석했다. 분석 결과, AChEI 사용은 사망 위험을 24% 감소시켰으며, 특히 여성과 후기 발병 환자군에서 생존 혜택이 더욱 뚜렷했다. 반면 조기 발병 환자군에서는 유의한 차이가 없었고, 약제 종류(도네페질, 리바스티그민)에 따른 차이도 관찰되지 않았다. 결론적으로 AChEI는 PDD 환자의 생존율 개선에 기여하며, 특히 특정 하위 집단에서 유효함을 시사한다.Key Message
• The use of AChEIs was associated with a lower risk of mortality in patients with PDD in a nationwide cohort. • The survival advantage was particularly evident among females and those with late-onset PD. • These findings suggest that tailored use of AChEIs may improve long-term outcomes in PDD.
Epidemiologic Investigation
- Epidemiologic research on lung damage caused by humidifier disinfectants
- Moo-Song Lee, Hwa Jung Kim
- Epidemiol Health. 2016;38:e2016031. Published online July 20, 2016
- DOI: https://doi.org/10.4178/epih.e2016031
- 30,246 View
- 289 Download
- 8 Web of Science
- 8 Crossref
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Abstract
Summary
PDFSupplementary Material
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AbstractIn April 2011 a tertiary hospital located in Seoul, Korea reported several cases of severe respiratory distress of unknown origin in young adults. To find the route of transmission, causative agent and patient risk factors of the outbreak, an investigation of the epidemic was initiated. A hospital based case-control study was conducted to indicate that humidifier detergent use was the cause of the outbreak. This information led the Ministry of Health and Welfare of Korea issued an order that humidifier detergents should be withdrawn from the market. Here, we describe the major events of planning, execution, and interpretation of the study, and discussions between researchers and public authorities following the decision to perform an epidemiologic study, chronologically.
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SummaryKorean summary
본 역학조사는 일개 병원에서 신고한 질병 유행에 대해 다학제적 연구 결과로써, 질병의 임상적 특성과 역학적 원인 파악 후 정책적 대책으로 이어진 사례이다. 향후 가습기 살균제 이외에도 일반국민의 건강에 영향을 미칠 수 있는 다양한 생활환경요인에 관심을 가지고, 필요 시 적극적인 조사와 대응이 필요할 것이다. -
Citations
Citations to this article as recorded by
- Prenatal and Childhood Exposure to Humidifier Disinfectants and Attention-Deficit/Hyperactivity Disorder (ADHD): Insights from a Retrospective Cohort Design
Hyowon Choi, Hunju Lee, Yeon-Soon Ahn
Toxics.2025; 13(2): 78. CrossRef - Evaluating Metabolic Signatures in the Serum of South Korean Patients with Humidifier Disinfectant–Associated Lung Injury Identified through Untargeted Metabolomics
Jinwoo Kim, Mi-Jin Kang, So-Yeon Lee, Sang-Bum Hong, Ho Cheol Kim, Myung Hee Nam, Soo-Jong Hong
Environmental Health Perspectives.2025;[Epub] CrossRef - Seropositive Rheumatoid Arthritis and Polyhexamethylene Guanidine/Oligo(2‐(2‐Ethoxy)ethoxyethyl)guanidinium Chloride Exposure Are Associated With a Synergistic Effect on the Risk of Developing Interstitial Lung Disease: Registry Based Cohort‐Study
Hyowon Choi, Seungjun Ryu, Yeon‐Soon Ahn
International Journal of Rheumatic Diseases.2025;[Epub] CrossRef - Is Polyhexamethylene Guanidine and Oligo(2-(2-Ethoxy) Ethoxyethyl Guanidium Chloride Exposure Related to Gestational Diabetes?
Hyowon Choi, Nam-Yun Kim, Nalai Kim, Yeon-Soon Ahn
Toxics.2024; 12(12): 841. CrossRef - Evaluation of polyhexamethylene guanidine-induced lung injuries by chest CT, pathologic examination, and RNA sequencing in a rat model
Cherry Kim, Sang Hoon Jeong, Jaeyoung Kim, Ki Yeol Lee, Jaehyung Cha, Chang Hyun Lee, Eun-Kee Park, Ju-Han Lee
Scientific Reports.2021;[Epub] CrossRef - Comparison of Long Term Follow-up Chest CT Imaging in Adult and Pediatric Patients with Humidifier Disinfectant-related Lung Injury
Soyeoun Lim, Jong Han Leem, Young-Seoub Hong, Jungwon Kim, Soyoung Park, Joon-Sung Joh, Woon-Jung Kwon, Yangho Kim
Journal of Korean Medical Science.2020;[Epub] CrossRef - Guanidine-based disinfectants, polyhexamethylene guanidine-phosphate (PHMG-P), polyhexamethylene biguanide (PHMB), and oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride (PGH) induced epithelial-mesenchymal transition in A549 alveolar epithelial cells
Yong Joo Park, Mi Ho Jeong, In Jae Bang, Ha Ryong Kim, Kyu Hyuck Chung
Inhalation Toxicology.2019; 31(4): 161. CrossRef - Development of QSAR Model for Subchronic Inhalation Toxicity Using Random Forest Regression Method
Jae Hong Shin, Byeong Hun Lee, Sung Kwang Lee
Bulletin of the Korean Chemical Society.2019; 40(8): 819. CrossRef
- Prenatal and Childhood Exposure to Humidifier Disinfectants and Attention-Deficit/Hyperactivity Disorder (ADHD): Insights from a Retrospective Cohort Design
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