Short-Term Response to Cholinesterase Inhibitors in Alzheimer’s Disease Delays Time to Nursing Home Placement

BACKGROUND: A varying response to cholinesterase inhibitor (ChEI) treatment has been report-ed among patients with Alzheimer’s disease (AD). Whether the individual-specific response directly af-fects 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 base-line 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 de-viation time from baseline (AD diagnosis) to NHP was 20.8 ± 9.3 months. After 6 months of ChEI treat-ment, the improved/unchanged individuals had longer time to NHP than those who worsened. The pro-longed 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 exami-nation including various assessment scales to evaluate treatment response and provide a more accurate prognosis.