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Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study
BACKGROUND: Evidence is lacking for cognitive enhancer therapy in patients with Alzheimer’s disease (AD) and concomitant cerebrovascular disease (mixed AD) as such patients would have been excluded from clinical trials. Earlier studies of mixed AD have focused on large vessel cerebrovascular disease...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153975/ https://www.ncbi.nlm.nih.gov/pubmed/25063270 http://dx.doi.org/10.1007/s40268-014-0057-5 |
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author | Ng, Kok Pin Ng, Aloysius Assam, Pryseley Heng, Esther Kandiah, Nagaendran |
author_facet | Ng, Kok Pin Ng, Aloysius Assam, Pryseley Heng, Esther Kandiah, Nagaendran |
author_sort | Ng, Kok Pin |
collection | PubMed |
description | BACKGROUND: Evidence is lacking for cognitive enhancer therapy in patients with Alzheimer’s disease (AD) and concomitant cerebrovascular disease (mixed AD) as such patients would have been excluded from clinical trials. Earlier studies of mixed AD have focused on large vessel cerebrovascular disease. The influence of small vessel cerebrovascular disease (svCVD) in the form of white matter hyperintensity (WMH) on treatment outcomes in mixed AD has not been addressed. OBJECTIVE: In this long-term naturalistic study, we evaluated the effectiveness of cognitive enhancers in patients with mixed AD with svCVD. METHODS: We conducted a retrospective analysis of a prospective clinical database from a memory clinic of a tertiary hospital. Magnetic resonance imaging WMH was used as a marker of svCVD. Demographic, cognitive, and treatment data were analysed. Linear mixed models with patient-specific random effects were used to evaluate cognitive outcomes over time while adjusting for confounders. RESULTS: Patients with mixed AD (n = 137) or AD without svCVD (pure AD) (n = 28) were studied over a median duration of 28.7 months. Patients with mixed AD had a higher prevalence of hypertension (62.8 vs. 35.7 %, p = 0.011). The majority (75.2 %) of the study sample were managed with monotherapy. Mini Mental State Examination (MMSE) scores decreased over time (−0.04, p = 0.007), and the decrease was similar for both diagnosis groups (−0.03, p = 0.246). Annual estimated mean MMSE decline was 0.84 for pure AD and 0.48 for mixed AD. Similar trends were observed with Montreal Cognitive Assessment (MoCA) scores, with annual estimated mean reduction of 0.72 and 0.48 for pure AD and mixed AD, respectively. CONCLUSION: Cognitive enhancers are effective in slowing the rate of cognitive decline in patients with AD with svCVD. These findings would need to be confirmed in randomized clinical trials. |
format | Online Article Text |
id | pubmed-4153975 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-41539752014-09-04 Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study Ng, Kok Pin Ng, Aloysius Assam, Pryseley Heng, Esther Kandiah, Nagaendran Drugs R D Original Research Article BACKGROUND: Evidence is lacking for cognitive enhancer therapy in patients with Alzheimer’s disease (AD) and concomitant cerebrovascular disease (mixed AD) as such patients would have been excluded from clinical trials. Earlier studies of mixed AD have focused on large vessel cerebrovascular disease. The influence of small vessel cerebrovascular disease (svCVD) in the form of white matter hyperintensity (WMH) on treatment outcomes in mixed AD has not been addressed. OBJECTIVE: In this long-term naturalistic study, we evaluated the effectiveness of cognitive enhancers in patients with mixed AD with svCVD. METHODS: We conducted a retrospective analysis of a prospective clinical database from a memory clinic of a tertiary hospital. Magnetic resonance imaging WMH was used as a marker of svCVD. Demographic, cognitive, and treatment data were analysed. Linear mixed models with patient-specific random effects were used to evaluate cognitive outcomes over time while adjusting for confounders. RESULTS: Patients with mixed AD (n = 137) or AD without svCVD (pure AD) (n = 28) were studied over a median duration of 28.7 months. Patients with mixed AD had a higher prevalence of hypertension (62.8 vs. 35.7 %, p = 0.011). The majority (75.2 %) of the study sample were managed with monotherapy. Mini Mental State Examination (MMSE) scores decreased over time (−0.04, p = 0.007), and the decrease was similar for both diagnosis groups (−0.03, p = 0.246). Annual estimated mean MMSE decline was 0.84 for pure AD and 0.48 for mixed AD. Similar trends were observed with Montreal Cognitive Assessment (MoCA) scores, with annual estimated mean reduction of 0.72 and 0.48 for pure AD and mixed AD, respectively. CONCLUSION: Cognitive enhancers are effective in slowing the rate of cognitive decline in patients with AD with svCVD. These findings would need to be confirmed in randomized clinical trials. Springer International Publishing 2014-07-26 2014-09 /pmc/articles/PMC4153975/ /pubmed/25063270 http://dx.doi.org/10.1007/s40268-014-0057-5 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. |
spellingShingle | Original Research Article Ng, Kok Pin Ng, Aloysius Assam, Pryseley Heng, Esther Kandiah, Nagaendran Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study |
title | Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study |
title_full | Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study |
title_fullStr | Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study |
title_full_unstemmed | Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study |
title_short | Role of Cognitive Enhancer Therapy in Alzheimer’s Disease with Concomitant Cerebral White Matter Disease: Findings from a Long-Term Naturalistic Study |
title_sort | role of cognitive enhancer therapy in alzheimer’s disease with concomitant cerebral white matter disease: findings from a long-term naturalistic study |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153975/ https://www.ncbi.nlm.nih.gov/pubmed/25063270 http://dx.doi.org/10.1007/s40268-014-0057-5 |
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