Response to cholinesterase inhibitors affects lifespan in Alzheimer's disease.
(2014) In BMC Neurology 14(1).- 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, specific ChEI agent or dose affects mortality is unclear. We aimed to examine the relationship between the 6-month response to ChEI and lifespan. Methods: Six hundred and eighty-one deceased patients with a clinical AD diagnosis and a Mini-Mental State Examination (MMSE) score of 10-26 at the start of ChEI therapy (baseline) were included in a prospective, observational, multicentre study in clinical practice. At baseline and after 6 months of treatment, the participants were assessed using the MMSE, the Alzheimer's Disease Assessment Scale-cognitive subscale... (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, specific ChEI agent or dose affects mortality is unclear. We aimed to examine the relationship between the 6-month response to ChEI and lifespan. Methods: Six hundred and eighty-one deceased patients with a clinical AD diagnosis and a Mini-Mental State Examination (MMSE) score of 10-26 at the start of ChEI therapy (baseline) were included in a prospective, observational, multicentre study in clinical practice. At baseline and after 6 months of treatment, the participants were assessed using the MMSE, the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), the Clinician's Interview-Based Impression of Change (CIBIC), the Instrumental Activities of Daily Living (IADL) scale, and the Physical Self-Maintenance Scale (PSMS). The individuals' socio-demographic characteristics, ChEI dose, and date of death were recorded. Responses to ChEI and the association of possible risk factors with survival were analysed using general linear models.
Results: A longer lifespan (mean of 0.5 years) was observed among the improved/unchanged patients, as measured by MMSE or CIBIC score, but not by ADAS-cog score, after 6 months of ChEI therapy. In the multivariate models, increased survival time was independently related to a better 6-month response in MMSE, CIBIC, IADL, and PSMS scores, female sex, no antihypertensive/cardiac or antidiabetic therapy, younger age, lower education, milder disease stage at baseline, and higher ChEI dose. Apolipoprotein E genotype did not affect mortality significantly. The patients who received a higher ChEI dose during the first 6 months had a mean lifespan after baseline that was 15 months longer than that of those who received a lower dose.
Conclusions: A better short-term response to ChEI might prolong survival in naturalistic AD patients. In individuals who received and tolerated higher ChEI doses, a longer lifespan can be expected. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4809632
- author
- Wattmo, Carina LU ; Londos, Elisabet LU and Minthon, Lennart LU
- organization
- publishing date
- 2014
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Alzheimer's disease, Cholinesterase inhibitors, Treatment effect, Life, expectancy, Survival, Cognition, Activities of daily living, Predictors, Statistical models
- in
- BMC Neurology
- volume
- 14
- issue
- 1
- article number
- 173
- publisher
- BioMed Central (BMC)
- external identifiers
-
- wos:000342373000001
- scopus:84908134453
- pmid:25213579
- ISSN
- 1471-2377
- DOI
- 10.1186/s12883-014-0173-4
- language
- English
- LU publication?
- yes
- id
- d87ca519-84dc-42cd-9f87-57b6e2679ee6 (old id 4809632)
- alternative location
- http://www.biomedcentral.com/1471-2377/14/173
- date added to LUP
- 2016-04-01 14:13:48
- date last changed
- 2022-02-27 01:33:07
@article{d87ca519-84dc-42cd-9f87-57b6e2679ee6,
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, specific ChEI agent or dose affects mortality is unclear. We aimed to examine the relationship between the 6-month response to ChEI and lifespan. Methods: Six hundred and eighty-one deceased patients with a clinical AD diagnosis and a Mini-Mental State Examination (MMSE) score of 10-26 at the start of ChEI therapy (baseline) were included in a prospective, observational, multicentre study in clinical practice. At baseline and after 6 months of treatment, the participants were assessed using the MMSE, the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), the Clinician's Interview-Based Impression of Change (CIBIC), the Instrumental Activities of Daily Living (IADL) scale, and the Physical Self-Maintenance Scale (PSMS). The individuals' socio-demographic characteristics, ChEI dose, and date of death were recorded. Responses to ChEI and the association of possible risk factors with survival were analysed using general linear models.<br/><br>
Results: A longer lifespan (mean of 0.5 years) was observed among the improved/unchanged patients, as measured by MMSE or CIBIC score, but not by ADAS-cog score, after 6 months of ChEI therapy. In the multivariate models, increased survival time was independently related to a better 6-month response in MMSE, CIBIC, IADL, and PSMS scores, female sex, no antihypertensive/cardiac or antidiabetic therapy, younger age, lower education, milder disease stage at baseline, and higher ChEI dose. Apolipoprotein E genotype did not affect mortality significantly. The patients who received a higher ChEI dose during the first 6 months had a mean lifespan after baseline that was 15 months longer than that of those who received a lower dose.<br/><br>
Conclusions: A better short-term response to ChEI might prolong survival in naturalistic AD patients. In individuals who received and tolerated higher ChEI doses, a longer lifespan can be expected.}},
author = {{Wattmo, Carina and Londos, Elisabet and Minthon, Lennart}},
issn = {{1471-2377}},
keywords = {{Alzheimer's disease; Cholinesterase inhibitors; Treatment effect; Life; expectancy; Survival; Cognition; Activities of daily living; Predictors; Statistical models}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Neurology}},
title = {{Response to cholinesterase inhibitors affects lifespan in Alzheimer's disease.}},
url = {{https://lup.lub.lu.se/search/files/3855601/5464221}},
doi = {{10.1186/s12883-014-0173-4}},
volume = {{14}},
year = {{2014}},
}