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The effect of cholinesterase inhibitors on decline in multiple functional domains in Alzheimer's disease: a two-year observational study in the Sunnybrook dementia cohort

Published online by Cambridge University Press:  08 July 2008

Pearl Behl ,
Krista L. Lanctôt ,
David L. Streiner  and
Sandra E. Black
Pearl Behl
Affiliation:
Linda C. Campbell Cognitive Neurology Research Unit, University of Toronto, Canada Faculty of Medicine, University of Toronto, Canada
Krista L. Lanctôt
Affiliation:
Sunnybrook Health Sciences Center, University of Toronto, Canada Faculty of Medicine, University of Toronto, Canada Department of Psychiatry, University of Toronto, Canada Neuroscience Research Program, Sunnybrook Research Institute, University of Toronto, Canada
David L. Streiner
Affiliation:
Faculty of Medicine, University of Toronto, Canada Department of Psychiatry, University of Toronto, Canada Kunin-Lunenfeld Applied Research Unit, Baycrest Centre, University of Toronto, Canada
Sandra E. Black*
Affiliation:
Linda C. Campbell Cognitive Neurology Research Unit, University of Toronto, Canada Sunnybrook Health Sciences Center, University of Toronto, Canada Department of Medicine (Neurology), University of Toronto, Canada Faculty of Medicine, University of Toronto, Canada Neuroscience Research Program, Sunnybrook Research Institute, University of Toronto, Canada Kunin-Lunenfeld Applied Research Unit, Baycrest Centre, University of Toronto, Canada Rotman Research Institute, University of Toronto, Canada
*
Correspondence should be addressed to: Dr. Sandra E. Black, Brill Chair of Neurology (Medicine), Sunnybrook Health Sciences Centre, Room A421, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada, Tel: +1 416 480 4551, Fax: +1 416 480 4552. Email: [email protected].
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Abstract

Background: Despite widespread use of second-generation cholinesterase inhibitors (CHEIs) for the symptomatic treatment of Alzheimer's disease (AD), little is known about possible long-term effects in different functional domains. This study seeks to assess change in activities of daily living (ADLs) over two years in AD patients treated with CHEIs matched to untreated patients in the same longitudinal cohort study.

Methods: This study is based on the two-year prospective cohort study at the Memory Clinic in Sunnybrook Health Sciences Centre, University of Toronto. Probable AD patients (N = 130: untreated = 65, treated = 65) underwent standardized neuropsychological assessments including the Disability Assessment for Dementia Scale (DAD), at baseline, one-year and two-year follow-up. Groups received a careful evaluation of comorbid illnesses, concomitant medication use, and vascular risk factors.

Results: At baseline, there were no significant differences in demographics and characteristics. Treated patients showed less decline in overall function and in instrumental and basic ADLs. Furthermore, less decline was seen in the overall scores for initiation and planning over two years with moderate to large effect sizes.

Conclusion: These findings have clinical relevance since functional ability has been increasingly recognized as a key outcome variable in AD treatment. It is also of note that the subscores reflecting executive functioning appear to drive these beneficial differences.

Keywords

functional declineinstrumental ADLbasic ADLDisability Assessment for Dementia Scale (DAD)executive functionAlzheimer's disease
Type
Research Article
Information
International Psychogeriatrics , Volume 20 , Issue 6 , December 2008 , pp. 1141 - 1159
Copyright
Copyright © International Psychogeriatric Association 2008

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