I enjoyed reading the article by Dr Scarmeas and colleagues1 detailing the results of their carefully planned cohort study. This study examined the association between the presence of hallucinations and delusions and the development of clinically important outcomes (eg, decline on a cognitive outcome, decline on a functional outcome, institutionalization, and death). In modeling the effects of hallucinations and delusions on these outcomes, the investigators adjusted for the use of neuroleptic drugs (ie, antipsychotics) and cholinesterase inhibitors. The authors provided data on the relationship between neuroleptic drug use and the clinical outcomes, and a recent meta-analysis shed further light on the potential risks of neuroleptic drug treatment in dementia.2 I wonder if Dr Scarmeas and colleagues can provide further insights into the influence of cholinesterase inhibitors on their measured outcomes.
Gill SS. Delusions and Hallucinations in Alzheimer Disease. Arch Neurol. 2006;63(4):627. doi:10.1001/archneur.63.4.627-a