Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-31T17:02:35.301Z Has data issue: false hasContentIssue false
  • English
  • Français

Initial cognitive response to cholinesterase inhibitors and subsequent long-term course in patients with mild Alzheimer's disease

Published online by Cambridge University Press:  17 March 2015

Erika Droogsma ,
Dieneke van Asselt ,
Marjolein Diekhuis ,
Nic Veeger ,
Cornelis van der Hooft  and
Peter Paul De Deyn
Erika Droogsma*
Affiliation:
Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
Dieneke van Asselt
Affiliation:
Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
Marjolein Diekhuis
Affiliation:
Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
Nic Veeger
Affiliation:
Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Cornelis van der Hooft
Affiliation:
Department of Geriatric Medicine, Medical Center Leeuwarden, Leeuwarden, the Netherlands
Peter Paul De Deyn
Affiliation:
Department of Neurology and Alzheimer Research Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands Department of Neurology and Memory Clinic, ZNA and Laboratory of Neurochemistry and Behavior, Institute, Born-Bunge, University of Antwerp, Antwerp, Belgium
*
Correspondence should be addressed to: Erika Droogsma, Department of Geriatric Medicine, Medical Center Leeuwarden, PO Box 888, 8901 BR Leeuwarden, the Netherlands. Phone: +(31) 582863512; Fax: +(31) 582866837. Email: [email protected].
Get access

Abstract

Background:

Some guidelines recommend to discontinue treatment with cholinesterase inhibitors (ChEIs) in patients with Alzheimer's disease (AD) without an initial response to ChEI treatment. Evidence supporting this recommendation, however, is limited. This study aimed to investigate the relation between the initial cognitive response to ChEI treatment and the subsequent long-term course of cognition of AD patients.

Methods:

The Frisian Alzheimer's Disease Cohort study is a retrospective longitudinal study of 576 community-dwelling AD patients treated with ChEIs in a “real-life” setting at a large memory clinic. A repeated measures analysis using a marginal model (population based averaged model) was applied to investigate whether there is a difference in the subsequent long-term course of cognition (Mini-Mental State Examination (MMSE)) between initial non-responders and responders. Absence of an initial response was defined as a lower MMSE score after the first six months of treatment compared to baseline, a positive response as the same or a higher MMSE score.

Results:

At baseline, median age was 80 years and the median MMSE score 23. Non-responders showed a slower rate of cognitive decline in the three subsequent years than responders, with a mean annual MMSE decline of 0.9 points versus 1.2 points, respectively (p < 0.0001).

Conclusions:

Our results suggest that it is not appropriate to discontinue ChEI treatment solely based on the absence of an initial cognitive response.

Keywords

Alzheimer's disease“real-life” settingcholinesterase inhibitorstreatment responsecourse of cognitionlongitudinal study
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 8 , August 2015 , pp. 1323 - 1333
Copyright
Copyright © International Psychogeriatric Association 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Burns, A. and Iliffe, S. (2009). Alzheimer's disease. Clinical review. BMJ, 338, 467–471. doi: http://dx.doi.org/10.1136/bmj.b158.CrossRefGoogle Scholar
Caffarra, P.et al. (2007). Comparing treatment effects in a clinical sample of patients with probable Alzheimer's disease treated with two different cholinesterase inhibitors. Acta Bio-medica, 78, 16–21.Google Scholar
Calabria, M., Geroldi, C., Lussignoli, G., Sabbatini, F. and Zanetti, O. (2009). Efficacy of acetyl-cholinesterase-inhibitor (ACHEI) treatment in Alzheimer's disease: a 21-month follow-up “real world” study. Archives of Gerontology and Geriatrics, 49, 6–11. doi: 10.1016/j.archger.2008.07.006.CrossRefGoogle ScholarPubMed
Cummings, J. L. (2003). Use of cholinesterase inhibitors in clinical practice. Evidence based recommendations. The American Journal of Geriatric Psychiatry, 11, 131–145.CrossRefGoogle ScholarPubMed
Cummings, J. L.et al. (2012). Randomized, double-blind, parallel-group, 48-week study of efficacy and safety of a higher-dose rivastigmine patch (15 vs. 10 cm2) in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 33, 341–353. doi: 10.1159/000340056.CrossRefGoogle ScholarPubMed
Hort, J.et al. (2010). EFNS guidelines for the diagnosis and management of Alzheimer's disease. European Journal of Neurology, 17, 1236–1248. doi: 10.1111/j.1468-1331.2010.03040.x.CrossRefGoogle ScholarPubMed
Ferri, C. P.et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fortin, M., Dionne, J., Pinho, G., Gignac, J., Almirall, J. and Lapointe, L. (2006). Randomized controlled trials: do they have external validity for patients with multiple comorbidities? Annals of Family Medicine, 4, 104–108.CrossRefGoogle ScholarPubMed
Gaudig, M., Richarz, U., Han, J., van Baelen, B. and Schäuble, B. (2011). Effects of galantamine in Alzheimer's disease: double-blind withdrawal studies evaluating sustained versus interrupted treatment. Current Alzheimer Research, 8, 771–780.CrossRefGoogle ScholarPubMed
Han, L., Cole, M., Bellavance, F., McCusker, J. and Primau, F. (2000). Tracking cognitive decline in Alzheimer's disease using the Mini-Mental State Examination: a meta-analysis. International Psychogeriatrics, 12, 231–247.CrossRefGoogle ScholarPubMed
Hensel, A., Angermeyer, M. C. and Riedel-Heller, S. G. (2007). Measuring cognitive change in older adults: reliable change indices for the mini-mental state examination. Journal of Neurology, Neurosurgery & Psychiatry, 78, 1298–1303. doi: 10.1136/jnnp.2006.109074.CrossRefGoogle ScholarPubMed
Holthoff, V. A.et al. (2011). Validation of the relevant outcome scale for Alzheimer's disease: a novel multidomain assessment for daily medical practice. Alzheimer's Research & Therapy, 3, 27–37. doi: 10.1186/alzrt89.CrossRefGoogle ScholarPubMed
Kwaliteitsinstituut voor de gezondheidszorg CBO (2005). Richtlijn diagnostiek en medicamenteuze behandeling van dementie. Alphen aan den Rijn: van Zuiden Communications. (Dutch guideline regarding the management of AD). Available at: http://www.artsennet.nl/Richtlijnen/Richtlijn/43407/Diagnostiek-en-medicamenteuze-behandeling-van-dementie.htm; last accessed 30 May 2014.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 189–198.CrossRefGoogle ScholarPubMed
Mendiondo, M. S., Wesson Ashford, J., Kryscio, R. J. and Schmitt, F. A. (2000). Modelling mini mental state examination changes in Alzheimer's disease. Statistics in Medicine, 19, 1607–1616.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Ministry of Health Singapore (2007). Clinical Practice Guideline: dementia. Available at: http://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_medical/current/2007/CPG_Dementia_Booklet.pdf; last accessed 30 May 2014.Google Scholar
Mohs, R., Schmeidler, J. and Aryan, M. (2000). Longitudinal studies of cognitive, functional and behavioural change in patients with Alzheimer's disease. Statistics in Medicine, 19, 1401–1409.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Mossello, E.et al. (2004). Effectiveness and safety of cholinesterase inhibitors in elderly subjects with Alzheimer's disease: a “real world” study. Archives of Gerontology and Geriatrics Supplement, 9, 297–307.CrossRefGoogle Scholar
National Institute for Health and Clinical Excellence (2006). Dementia. Supporting people with dementia and their carers in health and social care. NICE clinical guideline 42. Available at: http://guidance.nice.org.uk/cg42; last accessed 30 May 2014.Google Scholar
National Institute for Health and Clinical Excellence (2011). Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (review of NICE technology appraisal guidance 111). NICE technology appraisal guidance 217. Available at: http://www.nice.org.uk/TA217; last accessed 30 May 2014.Google Scholar
Pakrasi, S., Mukaetova-Ladinska, E. B., McKeith, I. G. and O’Brien, J. T. (2003). Clinical predictors of response to Acetyl Cholinesterase Inhibitors: experience from routine clinical use in Newcastle. International Journal of Geriatric Psychiatry, 18, 879–886.CrossRefGoogle ScholarPubMed
Perry, E. K., Tomlinson, B. E., Blessed, G., Bergmann, K., Gibson, P. H. and Perry, R. H. (1978). Correlation of cholinergic abnormalities with senile plaques and mental test scores in senile dementia. BMJ, 2, 1457–1459.CrossRefGoogle ScholarPubMed
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer's & Dementia, 9, 63–75. doi: 10.1016/j.jalz.2012.11.007.CrossRefGoogle ScholarPubMed
Qaseem, A.et al. (2008). Current pharmacologic treatment of dementia: a clinical practice guideline from the American college of physicians and the American academy of family physicians. Annals of Internal Medicine, 148, 370–378.CrossRefGoogle ScholarPubMed
Rabins, P. V.et al. (2007). American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Second edition. The American Journal of Psychiatry, 164, 5–56.Google ScholarPubMed
Raschetti, R., Maggini, M., Sorrentino, G. C., Martini, N., Caffari, B. and Vanacore, N. (2005). A cohort study of effectiveness of acetylcholinesterase inhibitors in Alzheimer's disease. European Journal of Clinical Pharmacology, 61, 361–368.CrossRefGoogle ScholarPubMed
Reitz, C., Brayne, C. and Mayeux, R. (2011). Epidemiology of Alzheimer disease. Nature Reviews. Neurology, 7, 137–152. doi: 10.1038/nrneurol.2011.2.CrossRefGoogle ScholarPubMed
Rota, E., Ferrero, P., Ursone, R. and Migliaretti, G. (2007). Short term response is predictive of long term response to acetylcholinesterase inhibitors in Alzheimer's disease: a starting point to explore Bayesian approximation in clinical practice. Bioinformation, 2, 39–42.CrossRefGoogle ScholarPubMed
Rothwell, P. M. (2005). External validity of randomised controlled trials: “to whom do the results of this trial apply?” Lancet, 365, 82–93.CrossRefGoogle Scholar
Salvi, F.et al. (2008). A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients. Journal of the American Geriatrics Society, 56, 1926–1931. doi: 10.1111/j.1532-5415.2008.01935.x.CrossRefGoogle ScholarPubMed
Schölzel-Dorenbos, C. J. M., Draskovic, I., Vernooij-Dassen, M. J. and Olde Rikkert, M. G. (2009). Quality of life and burden of spouses of Alzheimer disease patients. Alzheimer Disease and Associated Disorders, 23, 171–177.CrossRefGoogle ScholarPubMed
Scottish Intercollegiate Guidelines Network (2006). Management of Patients with Dementia. A National Clinical Guideline. Edinburgh. Available at: http://www.sign.ac.uk/pdf/sign86.pdf; last accessed 30 May 2014.Google Scholar
Shulman, K. I., Gold, D. P., Cohen, C. A. and Zucchero, C. A. (1993). Clock-drawing and dementia in the community: a longitudinal study. International Journal of Geriatric Psychiatry, 8, 487–496.CrossRefGoogle Scholar
Van der Putt, R., Dineen, C., Janes, D., Series, H. and McShane, R. (2006). Effectiveness of acetylcholinesterase inhibitors: diagnosis and severity as predictors of response in routine practice. International Journal of Geriatric Psychiatry, 21, 755–760.CrossRefGoogle ScholarPubMed
Wallin, A. K., Hansson, O., Blennow, K., Londos, E. and Minthon, L. (2009). Can CSF biomarkers or pre-treatment progression rate predict response to cholinesterase inhibitor treatment in Alzheimer's disease? International Journal of Geriatric Psychiatry, 24, 638–647. doi: 10.1002/gps.2195.CrossRefGoogle ScholarPubMed