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Response to cholinesterase inhibitors affects lifespan in Alzheimer's disease.

Wattmo, Carina LU ; Londos, Elisabet LU and Minthon, Lennart LU (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)
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author
organization
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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
publisher
BioMed Central
external identifiers
  • wos:000342373000001
  • scopus:84908134453
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
2014-12-01 07:38:31
date last changed
2017-07-30 04:13:59
@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.},
  articleno    = {173},
  author       = {Wattmo, Carina and Londos, Elisabet and Minthon, Lennart},
  issn         = {1471-2377},
  keyword      = {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},
  series       = {BMC Neurology},
  title        = {Response to cholinesterase inhibitors affects lifespan in Alzheimer's disease.},
  url          = {http://dx.doi.org/10.1186/s12883-014-0173-4},
  volume       = {14},
  year         = {2014},
}