Persistent treatment with cholinesterase inhibitors and/or memantine slows clinical progression of Alzheimer's disease (AD)
Abstract (provisional)
Introduction
There are no empiric data to support guidelines for duration of therapy with antidementia drugs. This study examined if persistent use of antidementia drugs slows clinical progression of Alzheimer's Disease (AD) assessed by repeated measures on serial tests of cognition and function.
Methods
641 probable AD patients followed prospectively at an academic center over 20 years. Cumulative drug exposure was expressed as a persistency index (PI) reflecting total years of drug use divided by total years of disease symptoms. Baseline and annual testing included Mini-Mental State exam (MMSE), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS), Baylor Profound Mental State Exam (BPMSE), Clinical Dementia Rating Scale-Sum of Boxes (CDR-SB), Physical Self-Maintenance Scale (PSMS), Independent Activities of Daily Living (IADL). Annual change in slope of neuropsychological and functional tests as predicted by follow-up time, PI, and the interaction of these two variables was evaluated.
Results
PI was associated with significantly slower rate of decline (with, without adjustment for covariates) on MMSE (p<.001, p<.01), ADAS (p<.01, p<.05), BPMSE (p<.01, p<.01), PSMS (p<.001, p<.01). Treatment did not influence rate of decline on IADL or CDR-SB. Each 10% increment in PI was associated with slowed MMSE decline 0.09 points/year; slowed decline ADAS 0.2 points/year; slowed decline BPMSE 0.2 points/year; slowed PSMS decline 0.09 points/year (with adjustment).
Conclusions
Persistent drug treatment had a positive impact on AD progression by multiple cognitive and functional outcome measures. The magnitude of the treatment effect was clinically significant. Positive treatment effects were even found in those with advanced disease.
Rountree SD, Chan W, Pavlik VN, Darby EJ, Siddiqui S, Doody RS. Persistent treatment with cholinesterase inhibitors and/or memantine slows clinical progression of Alzheimer's disease (AD). Alzheimer's Research & Therapy 2009, 1:7
The full paper is available as a .pdf at: http://alzres.com/content/1/2/7
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Susan
rountree@bcm.edu
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