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Initial cognitive response to cholinesterase inhibitors and subsequent long-term course in patients with mild Alzheimer’s disease
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BACKGROUND: Some guidelines recommend to discontinue treatment with cholinesterase inhibitors (ChEIs) in patients with Alzheimer's disease (AD) without an initial response to ChEI treatment. Evidence supporting this recommendation, however, is limited. This study aimed to investigate the relation between the initial cognitive response to ChEI treatment and the subsequent long-term course of cognition of AD patients. METHODS: The Frisian Alzheimer's Disease Cohort study is a retrospective longitudinal study of 576 community-dwelling AD patients treated with ChEIs in a "real-life" setting at a large memory clinic. A repeated measures analysis using a marginal model (population based averaged model) was applied to investigate whether there is a difference in the subsequent long-term course of cognition (Mini-Mental State Examination (MMSE)) between initial non-responders and responders. Absence of an initial response was defined as a lower MMSE score after the first six months of treatment compared to baseline, a positive response as the same or a higher MMSE score. RESULTS: At baseline, median age was 80 years and the median MMSE score 23. Non-responders showed a slower rate of cognitive decline in the three subsequent years than responders, with a mean annual MMSE decline of 0.9 points versus 1.2 points, respectively (p < 0.0001). CONCLUSIONS: Our results suggest that it is not appropriate to discontinue ChEI treatment solely based on the absence of an initial cognitive response.
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The observed rate of decline in MMSE for all non-users when accounting for ChEi use was slower than anticipated, at 0.60 points per year (Table 2), compared to the one-point decline per year observed in longitudinal trials on ChEi use in mild AD.
“the observed rate of decline in MMSE for all non-users when accounting for ChEi use was slower than anticipated, at 0.60 points per year (Table 2), compared to the one-point decline per year observed in longitudinal trials on ChEi use in mild AD [32, 33]”
From Long-Term Trazodone Use and Cognition: A Potential Therapeutic Role for Slow-Wave Sleep Enhancers (2019) · cites this paper as [33]
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Long-Term Trazodone Use and Cognition: A Potential Therapeutic Role for Slow-Wave Sleep Enhancers
La, A. L., Walsh, C. M., Neylan, T. C., Vossel, K. A., Yaffe, K., Krystal, A. D., Miller, B. L., & Karageorgiou, E. (2019) · Journal of Alzheimer's Disease · doi:10.3233/jad-181145 · Cited by 83
TREM2 variants and risk of Alzheimer’s disease: a meta-analysis
Lu, Y., Liu, W., & Wang, X. (2015) · Neurological Sciences · doi:10.1007/s10072-015-2274-2 · Cited by 37
Metadata
- Authors
- Droogsma, E., van Asselt, D., Diekhuis, M., Veeger, N., van der Hooft, C., & De Deyn, P. P.
- Affiliations
- Medisch Centrum Leeuwarden (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Droogsma, Erika
- ORCID
- Veeger, Nic
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 27
- Issue
- 8
- Pages
- 1323-1333
- ISSN
- 1041-6102 (ISSN-L)
- OpenAlex
- W2146539666
- Cited by
- 15
- References
- 2
- Citations by year
- 2026: 1 · 2022: 3 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 1 · 2015: 1
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- Medisch Centrum Leeuwarden
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pharmacology (medical) › Cholinesterase and Neurodegenerative Diseases
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Keywords
- cholinesterase inhibitors, Alzheimer's disease, treatment response, cognitive decline, treatment discontinuation, Mini-Mental State Examination, community-dwelling patients
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Cholinesterase Inhibitors, Cognition, Female, Humans, Longitudinal Studies, Male, Neuropsychological Tests, Retrospective Studies, Treatment Outcome, Nootropic Agents
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