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

Wattmo, Carina LU ; Wallin, Åsa LU and Minthon, Lennart LU (2012) In BMC Neurology 12.
Abstract
Background: Activities 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. Methods: This 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,... (More)
Background: Activities 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. Methods: This 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. Results: After 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. Conclusions: Critical 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alzheimer's disease, Activities of daily living, Cholinesterase, inhibitors, Treatment effect, Predictors, Statistical models
in
BMC Neurology
volume
12
publisher
BioMed Central
external identifiers
  • wos:000313070100001
  • scopus:84868247504
ISSN
1471-2377
DOI
10.1186/1471-2377-12-134
language
English
LU publication?
yes
id
b7350a12-3f6e-4144-b981-d4791553beb3 (old id 3508195)
date added to LUP
2013-03-01 07:52:06
date last changed
2017-05-21 04:09:27
@article{b7350a12-3f6e-4144-b981-d4791553beb3,
  abstract     = {Background: Activities 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. Methods: This 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. Results: After 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. Conclusions: Critical 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.},
  articleno    = {134},
  author       = {Wattmo, Carina and Wallin, Åsa and Minthon, Lennart},
  issn         = {1471-2377},
  keyword      = {Alzheimer's disease,Activities of daily living,Cholinesterase,inhibitors,Treatment effect,Predictors,Statistical models},
  language     = {eng},
  publisher    = {BioMed Central},
  series       = {BMC Neurology},
  title        = {Functional response to cholinesterase inhibitor therapy in a naturalistic Alzheimer's disease cohort},
  url          = {http://dx.doi.org/10.1186/1471-2377-12-134},
  volume       = {12},
  year         = {2012},
}