The effect of cholinesterase inhibitors on decline in multiple functional domains in Alzheimer's disease: a two-year observational study in the Sunnybrook dementia cohort

Behl, Pearl; Lanctôt, Krista L.; Streiner, David L.; Black, Sandra E.

doi:10.1017/s1041610208007540

Cited by 21 publications

(14 citation statements)

References 27 publications

(66 reference statements)

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“…These drugs may improve or stabilize some of the symptoms of AD for a limited period of 6-12 months on average [5]. Moreover, long-term observational studies of AD have described the benefits of ChEI on cognition [6,7] and function [8,9] over several years. We observed slower disease progression in patients with a higher cognitive or ADL ability at the start of therapy [9,10], which suggests advantages of early initiation of ChEIs.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Associations between Survival in Alzheimer's Disease and Cholinesterase Inhibitor Use, Progression, and Community-Based Services

Wattmo¹,

Londos²,

Minthon³

2015

Dement Geriatr Cogn Disord

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Background/Aims: Factors including rate of disease progression, different aspects of cholinesterase inhibitor (ChEI) treatment, and use of community-based services might affect the longitudinal outcome of Alzheimer's disease (AD). Whether these factors alter life expectancy in AD is unclear. We therefore examined the association between long-term ChEI therapy and survival. Methods: The present study included 1,021 patients with a clinical diagnosis of AD and a Mini-Mental State Examination score of 10-26 at baseline from a 3-year, prospective, multicenter study of ChEI therapy in clinical practice. The relationship of potential predictors with mortality was analyzed using Cox regression models. Results: After up to 16 years of follow-up, 841 (82%) of the participants had died. In the Alzheimer's Disease Assessment Scale-cognitive subscale, a mean decline of ≥4 points/year or ≥2 points/year on the Physical Self-Maintenance Scale was a risk factor for an earlier death. In the multivariate models, longer survival was associated with higher ChEI dose and longer duration of treatment. Users of community-based services at baseline exhibited a 1-year shorter mean life expectancy than nonusers. Conclusion: A longer survival time can be anticipated for AD patients with slower deterioration who receive and tolerate higher ChEI doses and a longer duration of treatment.

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Section: Introductionmentioning

confidence: 99%

Longitudinal Associations between Survival in Alzheimer's Disease and Cholinesterase Inhibitor Use, Progression, and Community-Based Services

Wattmo¹,

Londos²,

Minthon³

2015

Dement Geriatr Cogn Disord

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“…This enhances cholinergic transmission and improves the communication between neurons [6]. Randomized AD trials have demonstrated that ChEIs are effective in slowing functional decline compared with placebo-treated controls [7-9], and “real world” studies have reported positive long-term effects of ChEI on ADL [10,11]. The expected effect of ChEI on function may slow or delay the deterioration rather than promote the regaining of lost abilities [12].…”

Section: Introductionmentioning

confidence: 99%

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

2012

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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.

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“…Longitudinal studies of the interrelationship between cognition and everyday life have shown a linear relationship in the decline of DAD and various measures of cognition, including the MMSE [15,17] and the Dementia Rating Scale [18] , as well as between the MMSE and other ADL scales [19] .…”

Section: Introductionmentioning

confidence: 99%

Rate of Change of Functional Abilities in Frontotemporal Dementia

Mioshi

Hodges²

2009

Dement Geriatr Cogn Disord

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Background: Frontotemporal dementia (FTD) causes progressive change in activities of daily living (ADLs) and little is known about their rate of decline. This study aimed to examine changes in ADLs, including subcomponents of initiation, planning or execution. Methods: A total of 72 ADL and general cognitive assessments were analysed. The patients were subdivided into behavioural variant FTD (bvFTD) pathological and phenocopy subgroups, semantic dementia (SemDem) and progressive non-fluent aphasia (PNFA). Results: Pathological bvFTD, SemDem and PNFA groups showed significant decline on ADLs after 12 months, while the phenocopy subgroup did not. In terms of subcomponents of ADLs, each variant showed different profiles of decline. The decline in ADL and cognitive scores were significantly correlated. Conclusions: FTD variants show differential annual rates of functional decline. The rate of decline should be taken into consideration when discussing prognosis.

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The effect of cholinesterase inhibitors on decline in multiple functional domains in Alzheimer's disease: a two-year observational study in the Sunnybrook dementia cohort

Abstract: These findings have clinical relevance since functional ability has been increasingly recognized as a key outcome variable in AD treatment. It is also of note that the subscores reflecting executive functioning appear to drive these beneficial differences.

Cited by 21 publications

References 27 publications

Longitudinal Associations between Survival in Alzheimer's Disease and Cholinesterase Inhibitor Use, Progression, and Community-Based Services

Longitudinal Associations between Survival in Alzheimer's Disease and Cholinesterase Inhibitor Use, Progression, and Community-Based Services

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

Rate of Change of Functional Abilities in Frontotemporal Dementia

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