Long-term use of cholinesterase inhibitors -- 2008 paper - Cholinesterase Inhibitors for Treating Alzheimer's

The effect of cholinesterase inhibitors on decline in multiple functional domains in Alzheimer's disease: a two-year observational study in the Sunnybrook dementia cohort

Pearl Behl, Krista L. Lanctôt, David L. Streiner and Sandra E. Black

International Psychogeriatrics (2008), 20:1141-1159

ABSTRACT

Background: Despite widespread use of second-generation cholinesterase inhibitors (CHEIs) for the symptomatic treatment of Alzheimer's disease (AD), little is known about possible long-term effects in different functional domains. This study seeks to assess change in activities of daily living (ADLs) over two years in AD patients treated with CHEIs matched to untreated patients in the same longitudinal cohort study.

Methods: This study is based on the two-year prospective cohort study at the Memory Clinic in Sunnybrook Health Sciences Centre, University of Toronto. Probable AD patients (N = 130: untreated = 65, treated = 65) underwent standardized neuropsychological assessments including the Disability Assessment for Dementia Scale (DAD), at baseline, one-year and two-year follow-up. Groups received a careful evaluation of comorbid illnesses, concomitant medication use, and vascular risk factors.

Results: At baseline, there were no significant differences in demographics and characteristics. Treated patients showed less decline in overall function and in instrumental and basic ADLs. Furthermore, less decline was seen in the overall scores for initiation and planning over two years with moderate to large effect sizes.

Conclusion: These findings have clinical relevance since functional ability has been increasingly recognized as a key outcome variable in AD treatment. It is also of note that the subscores reflecting executive functioning appear to drive these beneficial differences.

Key words:functional decline; instrumental ADL; basic ADL; Disability Assessment for Dementia Scale (DAD); executive function; Alzheimer's disease

Correspondence:

Correspondence should be addressed to: Dr. Sandra E. Black, Brill Chair of Neurology (Medicine), Sunnybrook Health Sciences Centre, Room A421, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, Canada, Tel: +1 416 480 4551, Fax: +1 416 480 4552. Email: sandra.black@sunnybrook.ca.

Copies of the full paper may be obtained from the publisher, a university library, or the corresponding author.