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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: erika.droogsma@znb.nl.
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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 

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