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.

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.