Short-Term Response to Cholinesterase Inhibitors in Alzheimer’s Disease Delays Time to Nursing Home Placement

Author(s): Carina Wattmo*, Elisabet Londos, Lennart Minthon.

Journal Name: Current Alzheimer Research

Volume 15 , Issue 10 , 2018

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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.

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.

Keywords: Alzheimer`s disease, cholinesterase inhibitors, treatment effect, activities of daily living, cognition, nursing home placement, predictors, statistical models.

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Article Details

VOLUME: 15
ISSUE: 10
Year: 2018
Page: [905 - 916]
Pages: 12
DOI: 10.2174/1567205015666180507105326

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