Cholinesterase inhibitors do not alter the length of stay in nursing homes among patients with Alzheimer’s disease: a prospective, observational study of factors affecting survival time from admission to death

Abstract

BackgroundThe survival time in nursing homes (NHs) in Alzheimer’s disease (AD) might be affected by sociodemographic/clinical characteristics, rate of disease progression, and use of specific medications and community-based services. Whether different aspects of cholinesterase inhibitor (ChEI) therapy modify time spent in NHs is unclear. Therefore, we examined the relationship between these potential predictors and survival time in NHs.MethodsThis prospective, multicenter study of ChEI treatment in clinical practice included 220 deceased patients clinically diagnosed with mild-to-moderate AD who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) performance, ChEI dose, and amount of services used/week were evaluated every 6 months over 3 years. Dates of nursing-home placement (NHP) and death were recorded. Variables that determined survival time in NHs were analyzed using general linear models.ResultsThe mean survival time in NHs was 4.06 years (men, 2.78 years; women, 4.53 years; P < 0.001). The multivariate model showed that a shorter stay in NHs was associated with the interaction term male living with a family member, use of antihypertensive/cardiac therapy or anxiolytics/sedatives/hypnotics, and worse basic ADL at NHP, but not with age or cognitive and instrumental ADL capacities.ConclusionsIncreased community-based care did not reduce the survival time in NHs among individuals with AD. Men living with family spent significantly less time in NHs compared with the corresponding women, which suggests that the situation of female spouses of AD patients may need attention and possibly support. There was no indication that different aspects of ChEI therapy, e.g., drug type, dose, or duration, alter survival time in NHs.

Dealing with severe dementia in clinical practice: A validity and reliability study of Severe Mini‐Mental State Examination in Greek population

“…Our findings reflect an inherent limitation of the MMSE to detect longitudinal changes in short‐term intervals in patients with severe dementia, which has been also reported even in long‐term intervals when functional decline is examined . The absence of significantly detected changes for group 3 (neither in SMMSE nor in MMSE) could not be attributed to specific demographic characteristics of the sample (absence of age, gender, and educational differences among the 3 groups) and could be explained under the view of slow decline in milder dementia stages when treatment with cholinesterase inhibitors can be more effective . The fact that cognitive deterioration has been found to be slow during the early and very late stages of dementia and follow a more rapid decline during the middle stages further highlights the clinical usefulness of the SMMSE and renders it as a valuable candidate instrument to evaluate the effect of pharmacological and nonpharmacological interventions in future studies, since it was only with the use of the SMMSE that we were able to detect significant changes over a period of 6 months in patients initially scored on the 0 to 6 range of MMSE.…”

“…First, the SMMSE was shown to have good internal consistency, as well as high and educational differences among the 3 groups) and could be explained under the view of slow decline in milder dementia stages 40 when treatment with cholinesterase inhibitors can be more effective. [41][42][43] The fact that cognitive deterioration has been found to be slow during the early and very late stages of dementia and follow a more rapid decline during the middle stages 40 Overall, by first confirming the psychometric properties of the…”

Determinants of Progression and Mortality in Alzheimers disease: A Systematic Review

“…The effect of ChEI use on survival has not been clearly elucidated, but the trend is for increased survival time. The treatment with cholinesterase inhibitors (higher doses and longer duration of treatment) was associated with longer survival and slower cognitive deterioration in a prospective multi-centre study of ChEI in the clinical practice comprising 1021 communitybased AD patients followed-up for up to 16 years [76]. Conversely, in a sub-cohort of 220 nursing home-based patients from the same multi-centre study, the use of ChEI did not alter survival time [77].…”

Short-Term Response to Cholinesterase Inhibitors in Alzheimer’s Disease Delays Time to Nursing Home Placement

“…The costs of NHs are predominantly funded by the social security system; the annual cost in 2016 was SEK 655,000 (USD ~80,800, EUR ~68,200) per care recipient [ 3 ]. Our group reported that on average, 72% (4.1 years) of the period from AD diagnosis to death was spent in NHs [ 4 ].…”