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Short-term response to cholinesterase inhibitors in Alzheimer’s disease delays time to nursing home placement

Wattmo, Carina LU ; Londos, Elisabet LU and Minthon, Lennart LU (2018) In Current Alzheimer Research 15(10). p.905-916
Abstract

Background: A varying response to cholinesterase inhibitor (ChEI) treatment has been reported among patients with Alzheimer’s disease (AD). Whether the individual-specific response directly affects time to nursing home placement (NHP) was not investigated. Objective: We examined the relationship between the 6-month response to ChEI and institutionalization. Methods: In a prospective, observational, multicenter study, 881 outpatients with a clinical AD diagnosis and a Mini-Mental State Examination score of 10-26 at the start of ChEI therapy (baseline) were included. The participants were evaluated using cognitive, global, and activities of daily living (ADL) scales at baseline and semiannually over 3 years. The date of NHP was recorded.... (More)

Background: A varying response to cholinesterase inhibitor (ChEI) treatment has been reported among patients with Alzheimer’s disease (AD). Whether the individual-specific response directly affects time to nursing home placement (NHP) was not investigated. Objective: We examined the relationship between the 6-month response to ChEI and institutionalization. Methods: In a prospective, observational, multicenter study, 881 outpatients with a clinical AD diagnosis and a Mini-Mental State Examination score of 10-26 at the start of ChEI therapy (baseline) were included. The participants were evaluated using cognitive, global, and activities of daily living (ADL) scales at baseline and semiannually over 3 years. The date of NHP was recorded. Results: During the study, 213 patients (24%) were admitted to nursing homes. The mean ± standard deviation time from baseline (AD diagnosis) to NHP was 20.8 ± 9.3 months. After 6 months of ChEI treatment, the improved/unchanged individuals had longer time to NHP than those who worsened. The prolonged time to NHP was 3 months for cognitive response (P=0.022), 4 months for global response (P=0.004), 6 months for basic ADL response (P<0.001), and 8 months for response in all three scales (P<0.001). No differences were detected between the improved and unchanged groups in any scales. Conclusion: Patients who exhibit a positive short-term response to ChEI can expect to stay in their own home for 3-8 months longer. These findings underline the importance of a comprehensive clinical examination including various assessment scales to evaluate treatment response and provide a more accurate prognosis.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Activities of daily living, Alzheimer’s disease, Cholinesterase inhibitors, Cognition, Nursing home placement, Predictors, Statistical models, Treatment effect
in
Current Alzheimer Research
volume
15
issue
10
pages
12 pages
publisher
Bentham Science Publishers
external identifiers
  • scopus:85051843996
  • pmid:29732972
ISSN
1567-2050
DOI
10.2174/1567205015666180507105326
language
English
LU publication?
yes
id
17692ad3-555a-468c-89e1-5900a00f2ae8
date added to LUP
2018-09-12 09:00:22
date last changed
2020-03-24 06:21:45
@article{17692ad3-555a-468c-89e1-5900a00f2ae8,
  abstract     = {<p>Background: A varying response to cholinesterase inhibitor (ChEI) treatment has been reported among patients with Alzheimer’s disease (AD). Whether the individual-specific response directly affects time to nursing home placement (NHP) was not investigated. Objective: We examined the relationship between the 6-month response to ChEI and institutionalization. Methods: In a prospective, observational, multicenter study, 881 outpatients with a clinical AD diagnosis and a Mini-Mental State Examination score of 10-26 at the start of ChEI therapy (baseline) were included. The participants were evaluated using cognitive, global, and activities of daily living (ADL) scales at baseline and semiannually over 3 years. The date of NHP was recorded. Results: During the study, 213 patients (24%) were admitted to nursing homes. The mean ± standard deviation time from baseline (AD diagnosis) to NHP was 20.8 ± 9.3 months. After 6 months of ChEI treatment, the improved/unchanged individuals had longer time to NHP than those who worsened. The prolonged time to NHP was 3 months for cognitive response (P=0.022), 4 months for global response (P=0.004), 6 months for basic ADL response (P&lt;0.001), and 8 months for response in all three scales (P&lt;0.001). No differences were detected between the improved and unchanged groups in any scales. Conclusion: Patients who exhibit a positive short-term response to ChEI can expect to stay in their own home for 3-8 months longer. These findings underline the importance of a comprehensive clinical examination including various assessment scales to evaluate treatment response and provide a more accurate prognosis.</p>},
  author       = {Wattmo, Carina and Londos, Elisabet and Minthon, Lennart},
  issn         = {1567-2050},
  language     = {eng},
  month        = {01},
  number       = {10},
  pages        = {905--916},
  publisher    = {Bentham Science Publishers},
  series       = {Current Alzheimer Research},
  title        = {Short-term response to cholinesterase inhibitors in Alzheimer’s disease delays time to nursing home placement},
  url          = {http://dx.doi.org/10.2174/1567205015666180507105326},
  doi          = {10.2174/1567205015666180507105326},
  volume       = {15},
  year         = {2018},
}