Functional response to cholinesterase inhibitor therapy in a naturalistic Alzheimer’s disease cohort

Abstract

BackgroundActivities of daily living (ADL) are an essential part of the diagnostic criteria for Alzheimer’s disease (AD). A decline in ADL affects independent living and has a strong negative impact on caregiver burden. Functional response to cholinesterase inhibitor (ChEI) treatment and factors that might influence this response in naturalistic AD patients need investigating. The aim of this study was to identify the socio-demographic and clinical factors that affect the functional response after 6 months of ChEI therapy.MethodsThis prospective, non-randomised, multicentre study in a routine clinical setting included 784 AD patients treated with donepezil, rivastigmine or galantamine. At baseline and after 6 months of treatment, patients were assessed using several rating scales, including the Instrumental Activities of Daily Living (IADL) scale, Physical Self-Maintenance Scale (PSMS) and Mini-Mental State Examination (MMSE). Demographic and clinical characteristics were investigated at baseline. The functional response and the relationships of potential predictors were analysed using general linear models.ResultsAfter 6 months of ChEI treatment, 49% and 74% of patients showed improvement/no change in IADL and in PSMS score, respectively. The improved/unchanged patients exhibited better cognitive status at baseline; regarding improved/unchanged PSMS, patients were younger and used fewer anti-depressants. A more positive functional response to ChEI was observed in younger individuals or among those having the interaction effect of better preserved cognition and lower ADL ability. Patients with fewer concomitant medications or those using NSAIDs/acetylsalicylic acid showed a better PSMS response.ConclusionsCritical characteristics that may influence the functional response to ChEI in AD were identified. Some predictors differed from those previously shown to affect cognitive response, e.g., lower cognitive ability and older age predicted better cognitive but worse functional response.

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

“…In randomized clinical trials, ChEIs have exhibited short-term response in both cognitive abilities and activities of daily living (ADL) [ 13 ]; however, the response differed between the AD patients [ 14 ]. After 6 months of therapy, 49%-63% of the individuals had improved or were unchanged as measured by cognitive scales [ 15 ], while the corresponding percentages were 49% for instrumental ADL and 74% for basic ADL [ 16 ]. Studies from our group and others have described that the protective factors for better cognitive response to ChEI were lower cognitive status [ 14 , 17 ], male sex [ 17 , 18 ], older age [ 17 , 19 ], and absence of the apolipoprotein E (APOE) ε4 allele [ 17 , 20 ].…”

“…Studies from our group and others have described that the protective factors for better cognitive response to ChEI were lower cognitive status [ 14 , 17 ], male sex [ 17 , 18 ], older age [ 17 , 19 ], and absence of the apolipoprotein E (APOE) ε4 allele [ 17 , 20 ]. In contrast, better cognitive performance and younger age at the initiation of ChEI treatment predicted a more positive ADL response after 6 months [ 16 ]. No study has shown whether different levels of short-term response to ChEI directly affect the time to NHP.…”

Early- versus Late-Onset Alzheimer Disease: Long-Term Functional Outcomes, Nursing Home Placement, and Risk Factors for Rate of Progression

“…The SATS has been reported at length and various findings were published in a number of articles [4, 5, 12, 14, 21]. In total, 1,258 participants with AD were enrolled from 14 memory clinics located across Sweden.…”

Cognitive Results of CANTAB Tests and Their Change Due to the First Dose of Donepezil May Predict Treatment Efficacy in Alzheimer Disease

“…It has been demonstrated that demographic and clinical factors, such as dementia severity and age of the AD patients, significantly influence the response to donepezil [ 24 , 25 ]. Some results indicated that lower cognitive ability and older age predicted better cognitive response but worse functional response [ 26 ]. Comorbidity also has been found to influence the response to ChEI treatment: improvement is more likely to occur only in AD patients without concomitant diseases and only for those who had demonstrated a positive response at 3 months of treatment [ 27 ].…”