No abstract

Background: Prescribed drugs in patients with Alzheimer's disease may affect the symptomatic progression of their disease, both positively and negatively. Aim: To examine the effects of drugs on the progression of disease in a representative group of patients with Alzheimer's disease. Methods: Patients with the diagnosis of probable Alzheimer's disease were recruited from the community. The prescribed drugs taken by 224 patients (mean age 82.3 years) were recorded at initial assessment and then correlated in logistic regression analysis with progression of the disease, defined as an increase of one point or more in the Global Deterioration Scale over the next 12-month period. Results: Patients who were taking antipsychotic drugs and sedatives had a significantly higher risk of deterioration than those who were taking none (odds ratios (ORs) 2.74 (95% confidence interval (CI) 1.17 to 6.41) and 2.77 (95% CI 1.14 to 6.73), respectively). Higher risk of deterioration was observed in those who were taking both antipsychotic and sedative drugs together (OR 3.86 (95% CI 1.28 to 11.7). Patients taking drugs licensed for dementia, drugs affecting the renin-angiotensin system and statins had a significantly lower risk of deterioration than those who were not taking any of these drugs (ORs 0.49 (95% CI 0.25 to 0.97), 0.31 (95% CI 0.11 to 0.85) and 0.12 (95% CI 0.03 to 0.52), respectively). Conclusion: Our findings have implications for both clinicians and trialists. Most importantly, clinicians should carefully weigh any potential benefits of antipsychotics and benzodiazepines, especially in combination, against the risk of increased decline. Researchers need to be aware of the potential of not only licensed drugs for dementia but also drugs affecting the renin-angiotensin system and statins in reducing progression in clinical trials.

The NEO-FFI can be used reliably to measure premorbid personality in patients with probable AD. It may be useful to maximise reliability by using a mean domain score based on questionnaires completed by two or more informants who knew the patient well earlier in life.

SynopsisThe Standardized Assessment of Personality (SAP) is a short, semi-structured interview designed to be used with an informant of the patient. The informants of 52 patients were interviewed separately by two raters for an inter-rater reliability study. The overall level of agreement was excellent, kappa = 0·76, with a range between 0·60 and 0·82 for the individual categories of personality disorder. For a temporal reliability study, the relatives of 77 patients were interviewed. The overall level of agreement was good, kappa = 0·65, with a range between 0·54 and 0·79 for individual categories. Characteristics of informants whose reports were rated with greater levels of reliability were female gender and greater length of acquaintance with the patient.

SUMMARYGlobal ratings of change were obtained from 17 clinicians on eight patients, as though participating in an antidementia drug trial. Simultaneous rating was made possible by the use of videotaped semi-standardized interviews, and clinical change was simulated by providing raters with adjusted initial assessment documentation representing the situation 6 months earlier. In a second study, seven more ratings were obtained on the two patients who had commanded best and worst agreement in order to clarify important variables for levels of agreement. The main finding was that levels of interrater agreement on a global rating of change (which included carer information) varied widely from patient to patient. An important contributor to this variation was carer information. The order in which information for rating had been presented was found to be of overriding importance; if carer information was presented before patient information, considerably higher levels of agreement were achieved on the global rating than if the reverse order was used. KEY w o m d e m e n t i a ; global change; CIBIC; interrater agreement