Title:Short-Term Response to Cholinesterase Inhibitors in Alzheimer’s Disease Delays Time to Nursing Home Placement
Volume: 15
Issue: 10
Author(s): Carina Wattmo*, Elisabet Londos and Lennart Minthon
Affiliation:
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmo, Lund University, SE-205 02 Malmo,Sweden
Keywords:
Alzheimer`s disease, cholinesterase inhibitors, treatment effect, activities of daily living, cognition, nursing home
placement, predictors, statistical models.
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.
