BACKGROUND AND OBJECTIVES: Previous studies have reported a lower use of analgesics in patients with Alzheimer's disease (AD) than in non-AD elderly. To date, no study has focused on persistent analgesic use in patients with mild-to-moderate AD. METHODS: The "Réseau sur la maladie d'Alzheimer Français" (REAL.FR) cohort study enrolled community-dwelling patients with mild-to-moderate AD. Persistent analgesic use was defined as the consumption of at least one analgesic drug during two consecutive visits (6 months). Associated factors were identified in a nested case-control study. RESULTS: In REAL.FR, 595 patients were present during at least two consecutive visits [mean age = 77.5 ± 6.8 years, mini-mental state examination (MMSE) = 20.1 ± 4.2]. Prevalence of persistent analgesic use was 13.1 % (95 % CI = 10.4-15.9). The incidence of persistent analgesic use was 5.9/100 patient-years (95 % CI = 5.2-6.6). Women (adjusted odds ratio [OR] = 3.1, 95 % CI = 1.2-8.1), patients with musculoskeletal disorders (OR = 3.4, 95 % CI = 1.6-7.3) and patients treated with numerous medications (OR = 3.0, 95 % CI = 1.5-5.8) were more likely to use analgesics persistently. Statistically significant associations were found with disease duration and disease progression but not with AD severity at baseline. CONCLUSIONS: Our results suggest a low use of analgesics in AD patients, which could vary with AD progression.