Efficacy of Acetylcholinesterase Inhibitors in the Logopenic Variant of Primary Progressive Aphasia

Abstract

Introduction: For over twenty-five years, cholinesterase inhibitors (ChEIs) have been the main symptomatic treatment for Alzheimer's disease (AD). Several meta-analyses have supported their efficacy in various neurocognitive, functional, and behavioral aspects of amnestic AD. Over 86% of cases of the language variant AD are caused by a similar pathologic process than AD, yet no study has examined the efficacy of ChEIs in this AD variant. We aimed to explore the efficacy of ChEIs in the treatment of language AD by comparing their evolution on the MMSE to that of treated amnestic AD patients. Methods: A retrospective chart review was performed in forty-five patients with language AD and fifty-two patients with amnestic AD. Both groups were similar regarding age, level of education, and onset of symptoms. Drug history, MMSE scores, functional and neuropsychiatric symptoms were collected on several time points before and after the introduction of ChEIs. Data was analysed using ANOVA and a generalized linear mixed model. Results: Patients with language AD showed a similar trajectory of decline than amnestic AD patients on serial MMSEs up to twenty-four months after the introduction of ChEIs. In language AD patients, ChEIs had a significant impact on activities of daily life (ADLs), but not instrumental activities of daily living (IADLs), and neuropsychiatric symptoms remained stable over time. Conclusion: This study provides preliminary evidence for efficacy of ChEIs in patients with language AD and suggests similar benefits to those seen in amnestic AD patients, hence reassuring patients and their physicians.