Good rate of clinical response to cholinesterase inhibitors in mild and moderate Alzheimer's disease after three months of treatment: An open-label study

Abstract

Life expectancy in Brazil has increased markedly over the last 30 years. Hence, age-related disorders, such as Alzheimer's disease (AD), warrant special attention due to their high prevalence in the elderly. Pharmacologic treatment of AD is based on cholinesterase inhibitors (ChEI) and memantine, leading to modest clinical benefits both in the short and long-term. However, clinical response is heterogeneous and needs further investigation.OBJECTIVETo investigate the rate of response to ChEI in AD after three months of treatment.METHODSPatients with mild or moderate dementia due to probable AD or to AD associated with cerebrovascular disease were included in the study. The subjects were assessed at baseline and again after three months of ChEI treatment. Subjects were submitted to the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale, Katz Basic Activities of Daily Living, Pfeffer Functional Activities Questionnaire, Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Good response was defined by a gain of ≥2 points on the MMSE after three months of treatment in relation to baseline.RESULTSSeventy-one patients, 66 (93%) with probable AD and five (7%) with AD associated with cerebrovascular disease, were evaluated. The good response rate at three months was 31.0%, being 37.2% and 21.4% in mild and moderate dementia, respectively. There were no significant differences on most tests, except for improvement in hallucinations, agitation and dysphoria in moderate dementia patients.CONCLUSIONThe rate of good clinical response to ChEI was higher than usually reported. Specific behavioral features significantly improved in the subgroup of moderate dementia.

Effects of Acetylcholinesterase Inhibitors on Balance and Gait Functions and Orthostatic Hypotension in Elderly Patients With Alzheimer Disease

“…The patients were divided into 3 groups according to the cognitive test scores on the sixth month: improvement (increase in MMSE score was ≥2), no change (change in MMSE score ≤1), and worsening (decrease in MMSE score was ≥2). 23…”

O Questionário De Atividades Funcionais De Pfeffer: Revisão Integrativa Da Literatura Brasileira

“…No Brasil, o Departamento Científi co de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia recomenda, como norma, a aplicação do FAQ por parte de informantes, sendo o questionário combinado a uma escala cognitiva para melhorar a detecção de demência (NI T R I N I et al, 2005). Esse tipo de utilização do instrumento pode ser observado nesta revisão, bem como para classifi car idosos com diferentes graus de comprometimento cognitivo (TEDRUS et al, 2009;APRAHAMIAN et al, 2011;ALENCAR et al, 2012) ou para diagnosticar CCL e demências (HERRERA et al, 2002;NITRINI et al, 2004;LAKS et al, 2007LAKS et al, , 2010JACINTO, 2008;JACINTO et al, 2012JACINTO et al, , 2014PASSOS;BARRETO, 2012;MIRANDA et al, 2013;REZENDE;CECATO;MARTINELLI, 2013;VIEIRA et al, 2013;MARTINELLI et al, 2014).…”

Real-world effectiveness, its predictors and onset of action of cholinesterase inhibitors and memantine in dementia: retrospective health record study

“…The evidence for cholinergic loss in dementia 1,2 that correlates with severity of disease informed the development of a class of drugs that inhibit the enzyme acetylcholinesterase thus increasing the neuronal availability of acetylcholine. Three acetylcholinesterase inhibitor (AChEI) agents have been approved (donepezil, rivastigmine and galantamine) for the treatment of mild to moderate forms of Alzheimer's disease (AD) [3][4][5] . Memantine is the fourth available option which is thought to counteract some of the neurotoxicity in AD through antagonism of the glutamate NMDA receptor 6 .…”

“…Memantine is the fourth available option which is thought to counteract some of the neurotoxicity in AD through antagonism of the glutamate NMDA receptor 6 . In contrast to AChEIs, memantine is approved for the treatment of the more advanced forms of AD 4,7,8 .…”

“…Response rates reportedly vary between 20% and 60%, depending on medication dosage, socio-demographical factors (e.g. education and lifestyle) as well as presumed dementia etiology 4,7,8 .…”