Abstract
BACKGROUND: Limited real-world evidence exists on the patterns of symptomatic treatment use for Alzheimer’s disease and related dementias (ADRD). METHODS: Using data from the Merative(®) MarketScan Research Databases, we analyzed treatment patterns in ADRD patients aged ≥ 65 from 2011 to 2021. Initial treatment choices, subsequent changes, and factors influencing these changes were evaluated over an 18-month period. RESULTS: Among 74,212 acetylcholinesterase inhibitor (AChEI) and 15,917 memantine initiators, 56% switched or discontinued their initial treatment within 6 months. By 18 months, 15% of monotherapy initiators remained on initial treatment and 19% escalated to dual therapy, with 13% of AChEI initiators switching to memantine. After discontinuation, 73% reinitiated treatment within 18 months. Patients with milder dementia severity, fewer comorbidities, and lower frailty levels were more likely to switch to alternative treatments. CONCLUSIONS: Patients with ADRD demonstrated low persistence with their initial symptomatic therapy, coupled with high rates of re-initiation following discontinuation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-025-06745-4.