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Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies

INTRODUCTION: Knowledge of longitudinal progression in mild Alzheimer’s disease (AD) is required for the evaluation of disease-modifying therapies. Our aim was to observe the effects of long-term cholinesterase inhibitor (ChEI) therapy in mild AD patients in a routine clinical setting. METHODS: This...

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Autores principales: Wattmo, Carina, Wallin, Åsa K, Minthon, Lennart
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978889/
https://www.ncbi.nlm.nih.gov/pubmed/24099236
http://dx.doi.org/10.1186/alzrt210
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author Wattmo, Carina
Wallin, Åsa K
Minthon, Lennart
author_facet Wattmo, Carina
Wallin, Åsa K
Minthon, Lennart
author_sort Wattmo, Carina
collection PubMed
description INTRODUCTION: Knowledge of longitudinal progression in mild Alzheimer’s disease (AD) is required for the evaluation of disease-modifying therapies. Our aim was to observe the effects of long-term cholinesterase inhibitor (ChEI) therapy in mild AD patients in a routine clinical setting. METHODS: This was a prospective, open-label, non-randomized, multicenter study of ChEI treatment (donepezil, rivastigmine or galantamine) conducted during clinical practice. The 734 mild AD patients (Mini-Mental State Examination (MMSE) score 20 to 26) were assessed at baseline and then semi-annually over three years. Outcome measures included the MMSE, Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), Clinician’s Interview-Based Impression of Change (CIBIC) and Instrumental Activities of Daily Living (IADL) scale. RESULTS: After three years of ChEI therapy, 31% (MMSE) and 33% (ADAS-cog) of the patients showed improved/unchanged cognitive ability, 33% showed improved/unchanged global performance and 14% showed improved/unchanged IADL capacity. Higher mean dose of ChEI and lower educational level were both predictors of more positive longitudinal cognitive and functional outcomes. Older participants and those with a better IADL score at baseline exhibited a slower rate of cognitive decline, whereas younger participants and those with higher cognitive status showed more preserved IADL ability over time. Gender and apolipoprotein E (APOE) genotype showed inconsistent results. Prediction models using the abovementioned scales are presented. CONCLUSIONS: In naturalistic mild AD patients, a marked deterioration in IADL compared with cognitive and global long-term outcomes was observed, indicating the importance of functional assessments during the early stages of the disease. The participants’ time on ChEI treatment before inclusion in studies of new therapies might affect their rate of decline and thus the comparisons of changes in scores between various studies. An increased understanding of expected disease progression in different domains and potential predictors of disease progression is essential for assessment of future therapies in AD.
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spelling pubmed-39788892014-04-21 Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies Wattmo, Carina Wallin, Åsa K Minthon, Lennart Alzheimers Res Ther Research INTRODUCTION: Knowledge of longitudinal progression in mild Alzheimer’s disease (AD) is required for the evaluation of disease-modifying therapies. Our aim was to observe the effects of long-term cholinesterase inhibitor (ChEI) therapy in mild AD patients in a routine clinical setting. METHODS: This was a prospective, open-label, non-randomized, multicenter study of ChEI treatment (donepezil, rivastigmine or galantamine) conducted during clinical practice. The 734 mild AD patients (Mini-Mental State Examination (MMSE) score 20 to 26) were assessed at baseline and then semi-annually over three years. Outcome measures included the MMSE, Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), Clinician’s Interview-Based Impression of Change (CIBIC) and Instrumental Activities of Daily Living (IADL) scale. RESULTS: After three years of ChEI therapy, 31% (MMSE) and 33% (ADAS-cog) of the patients showed improved/unchanged cognitive ability, 33% showed improved/unchanged global performance and 14% showed improved/unchanged IADL capacity. Higher mean dose of ChEI and lower educational level were both predictors of more positive longitudinal cognitive and functional outcomes. Older participants and those with a better IADL score at baseline exhibited a slower rate of cognitive decline, whereas younger participants and those with higher cognitive status showed more preserved IADL ability over time. Gender and apolipoprotein E (APOE) genotype showed inconsistent results. Prediction models using the abovementioned scales are presented. CONCLUSIONS: In naturalistic mild AD patients, a marked deterioration in IADL compared with cognitive and global long-term outcomes was observed, indicating the importance of functional assessments during the early stages of the disease. The participants’ time on ChEI treatment before inclusion in studies of new therapies might affect their rate of decline and thus the comparisons of changes in scores between various studies. An increased understanding of expected disease progression in different domains and potential predictors of disease progression is essential for assessment of future therapies in AD. BioMed Central 2013-10-07 /pmc/articles/PMC3978889/ /pubmed/24099236 http://dx.doi.org/10.1186/alzrt210 Text en Copyright © 2013 Wattmo et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Wattmo, Carina
Wallin, Åsa K
Minthon, Lennart
Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies
title Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies
title_full Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies
title_fullStr Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies
title_full_unstemmed Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies
title_short Progression of mild Alzheimer’s disease: knowledge and prediction models required for future treatment strategies
title_sort progression of mild alzheimer’s disease: knowledge and prediction models required for future treatment strategies
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978889/
https://www.ncbi.nlm.nih.gov/pubmed/24099236
http://dx.doi.org/10.1186/alzrt210
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