Cholinesterase inhibitors slow decline in function in Alzheimer's disease (AD): A 2-year observational study in the Sunnybrook dementia cohort: p02.197
Neurology
OBJECTIVE: To assess change in ADL functioning over two years in AD patients treated with CHEIs matched to untreated patients in the same longitudinal cohort study BACKGROUND: Despite widespread use of second-generation cholinesterase inhibitors (CHEIs) for the symptomatic treatment of Alzheimer's Disease (AD), surprisingly little is known about possible long-term effects in different functional domains. DESIGN/METHODS: Patients (Untreated=40, Treated=58) meeting NINCDS-ADRDA criteria for mild or moderate probable AD seen at a university memory clinic underwent standardized neuropsychological, functional, and behavioral assessments including the Disability Assessment for Dementia Scale (DAD), at baseline and two year follow-up (Mean 30.5 months). Groups received a careful evaluation of co morbid illnesses, concomitant medication use, and vascular risk factors. RESULTS: There were no significant differences between the two groups in the detailed medical evaluations and baseline demographics including age, education, duration, Mini Mental State Examination (MMSE), Dementia Rating Scale (DRS) total score, and Disability Assessment for Dementia Scale (DAD) total score. Repeated measures MANOVA (Bonferroni correction) on the total DAD scores, scores for instrumental (I) and basic (B) ADLs, and subscores for initiation, planning, and performance showed a significant group by time interaction (p = 0.015) with treated patients showing less decline in overall function and in IADLs and BADLs. Furthermore, less decline was seen in the overall scores for initiation, and planning (effect sizes 0.6-1.1). CONCLUSIONS/RELEVANCE: Treated patients declined more slowly across the domains of IADLs and BADLs, as well as initiation, and planning of these activities after two years of follow-up. Results suggest that chronic treatment slowed the loss of both IADLs and BADLs. These findings have important clinical implications since measurement of function has been increasingly recognized as a key outcome variable in AD treatment. It is also important to note that these subscores reflect executive functioning and were selectively responsive to cholinesterase inhibitors over two years.
OBJECTIVE: To assess change in ADL functioning over two years in AD patients treated with CHEIs matched to untreated patients in the same longitudinal cohort study BACKGROUND: Despite widespread use of second-generation cholinesterase inhibitors (CHEIs) for the symptomatic treatment of Alzheimer's Disease (AD), surprisingly little is known about possible long-term effects in different functional domains. DESIGN/METHODS: Patients (Untreated=40, Treated=58) meeting NINCDS-ADRDA criteria for mild or moderate probable AD seen at a university memory clinic underwent standardized neuropsychological, functional, and behavioral assessments including the Disability Assessment for Dementia Scale (DAD), at baseline and two year follow-up (Mean 30.5 months). Groups received a careful evaluation of co morbid illnesses, concomitant medication use, and vascular risk factors. RESULTS: There were no significant differences between the two groups in the detailed medical evaluations and baseline demographics including age, education, duration, Mini Mental State Examination (MMSE), Dementia Rating Scale (DRS) total score, and Disability Assessment for Dementia Scale (DAD) total score. Repeated measures MANOVA (Bonferroni correction) on the total DAD scores, scores for instrumental (I) and basic (B) ADLs, and subscores for initiation, planning, and performance showed a significant group by time interaction (p = 0.015) with treated patients showing less decline in overall function and in IADLs and BADLs. Furthermore, less decline was seen in the overall scores for initiation, and planning (effect sizes 0.6-1.1). CONCLUSIONS/RELEVANCE: Treated patients declined more slowly across the domains of IADLs and BADLs, as well as initiation, and planning of these activities after two years of follow-up. Results suggest that chronic treatment slowed the loss of both IADLs and BADLs. These findings have important clinical implications since measurement of function has been increasingly recognized as a key outcome variable in AD treatment. It is also important to note that these subscores reflect executive functioning and were selectively responsive to cholinesterase inhibitors over two years.
66 (5)
2005
A121
Behl P., Lanctot K., Streiner D. & Black S.
Supplement: Suppl. 2 Conference Information: 58th Annual Meeting of the American-Academy-of-Neurology San Diego, CA, APR 01-08, 2006 Amer Acad Neruol Meeting Abstract Publisher: LIPPINCOTT WILLIAMS & WILKINS, 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA Subject Category: Clinical Neurology IDS Number: 022PM ISSN: 0028-3878
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