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Activities of Daily Living – Outcome During Three Years in Donepezil Treated Alzheimer Patients.

Wattmo, Carina LU ; Wallin, Åsa LU and Minthon, Lennart LU (2007) IPA (International Psychogeriatric Association) 2007 Osaka Silver Congress
Abstract
Objectives: To analyse and present the outcome of longitudinal change and possible subgroups with respect to Activities of daily living (ADL) function measured by different scales (PSMS, FAST and IADL) in patients treated with donepezil for three years (n=435). Methods: The Swedish Alzheimer Treatment Study (SATS) is an open, 3-year, multicentre study in a routine clinical setting. The patients were assessed with several rating scales including ADL at baseline and every 6 months for a total period of three years. IADL scores were compared to the expected change in untreated patients based on a mathematical model by Green et al. A two-step cluster analysis was performed to reveal any natural groupings (clusters) of the patients based on the... (More)
Objectives: To analyse and present the outcome of longitudinal change and possible subgroups with respect to Activities of daily living (ADL) function measured by different scales (PSMS, FAST and IADL) in patients treated with donepezil for three years (n=435). Methods: The Swedish Alzheimer Treatment Study (SATS) is an open, 3-year, multicentre study in a routine clinical setting. The patients were assessed with several rating scales including ADL at baseline and every 6 months for a total period of three years. IADL scores were compared to the expected change in untreated patients based on a mathematical model by Green et al. A two-step cluster analysis was performed to reveal any natural groupings (clusters) of the patients based on the ADL scores at baseline. Results: After three years of donepezil treatment the total mean change in PSMS score was 3,2 ± 3,6 and in FAST 1,8 ± 2,1 points. The three-year change in IADL-score was 6,1 ± 5,4 points whereas the expected change using the mathematical model was 15,8 ± 5,6 points. The different ADL scales were linearly correlated with each other and with cognition measured by MMSE and ADAS-cog at all assessment points. However, the strength of the relationship increased over time with p-values < 0,000 from 18 months and onwards. The three scales showed no significant difference between gender at baseline but after three years the IADL mean decline from baseline was significantly worse among women. A cluster analysis showed two subgroups that significantly differed in age (p<0,000), duration (p<0,05) and cognition (p<0,000) at baseline. No significant difference in gender, APOE e4-carriers or mean dose of donepezil was observed. The two subgroups also deviated significantly in the long-term outcome of ADL score particularly measured by the PSMS scale (0,000<p<0,05). Conclusions: Increasing strength in the linear correlation between the three ADL scales as well as cognition was observed during the three years of the study. The IADL scale showed a decline of function less than expected compared with untreated patients in a mathematic model. Long term IADL scores deteriorated significantly more in the female gender than in the male. Cluster analysis based on ADL scores at baseline, identified two subgroups: with different mean age and cognitive ability and dissimilar rate of change in functional decline predominantly shown by the PSMS scale. (Less)
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IPA (International Psychogeriatric Association) 2007 Osaka Silver Congress
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English
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yes
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57a16fe7-5784-45c0-88b1-7e3d50a94de2 (old id 2064174)
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2011-11-16 13:48:29
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@misc{57a16fe7-5784-45c0-88b1-7e3d50a94de2,
  abstract     = {Objectives: To analyse and present the outcome of longitudinal change and possible subgroups with respect to Activities of daily living (ADL) function measured by different scales (PSMS, FAST and IADL) in patients treated with donepezil for three years (n=435). Methods: The Swedish Alzheimer Treatment Study (SATS) is an open, 3-year, multicentre study in a routine clinical setting. The patients were assessed with several rating scales including ADL at baseline and every 6 months for a total period of three years. IADL scores were compared to the expected change in untreated patients based on a mathematical model by Green et al. A two-step cluster analysis was performed to reveal any natural groupings (clusters) of the patients based on the ADL scores at baseline. Results: After three years of donepezil treatment the total mean change in PSMS score was 3,2 ± 3,6 and in FAST 1,8 ± 2,1 points. The three-year change in IADL-score was 6,1 ± 5,4 points whereas the expected change using the mathematical model was 15,8 ± 5,6 points. The different ADL scales were linearly correlated with each other and with cognition measured by MMSE and ADAS-cog at all assessment points. However, the strength of the relationship increased over time with p-values &lt; 0,000 from 18 months and onwards. The three scales showed no significant difference between gender at baseline but after three years the IADL mean decline from baseline was significantly worse among women. A cluster analysis showed two subgroups that significantly differed in age (p&lt;0,000), duration (p&lt;0,05) and cognition (p&lt;0,000) at baseline. No significant difference in gender, APOE e4-carriers or mean dose of donepezil was observed. The two subgroups also deviated significantly in the long-term outcome of ADL score particularly measured by the PSMS scale (0,000&lt;p&lt;0,05). Conclusions: Increasing strength in the linear correlation between the three ADL scales as well as cognition was observed during the three years of the study. The IADL scale showed a decline of function less than expected compared with untreated patients in a mathematic model. Long term IADL scores deteriorated significantly more in the female gender than in the male. Cluster analysis based on ADL scores at baseline, identified two subgroups: with different mean age and cognitive ability and dissimilar rate of change in functional decline predominantly shown by the PSMS scale.},
  author       = {Wattmo, Carina and Wallin, Åsa and Minthon, Lennart},
  language     = {eng},
  title        = {Activities of Daily Living – Outcome During Three Years in Donepezil Treated Alzheimer Patients.},
  year         = {2007},
}