Clinical predictors of response to Acetyl Cholinesterase Inhibitors: experience from routine clinical use in Newcastle.
BACKGROUND
Acetyl Cholinesterase Inhibitors (AChEIs) have been in clinical use for the past five years in the UK for the symptomatic treatment of Alzheimer's disease (AD). There are few data on the patterns and predictors of response to AChEI therapy in routine clinical practice. We therefore investigated clinical variables that may distinguish between AChEI responders and non-responders.


METHODS
A retrospective sample of 160 consecutive patients with dementia who were treated on clinical grounds with an AChEI was studied. Treatment response was defined in two ways: (a) A clinical response was achieved when there was no deterioration or there was an improvement on a global clinical assessment (CGI) and (b) a Mini-Mental-State-Examination (MMSE) response when there was an improvement of 2 or more MMSE points.


RESULTS
A total of 62 (45%) patients achieved an MMSE response. A diagnosis of dementia with Lewy Bodies (DLB) and Parkinson's disease+Dementia (PDD) was associated with a MMSE response, as were hallucinations, and lower MMSE scores at baseline. 125 (78%) patients achieved a CGI response for which there were no clinical predictors.


CONCLUSIONS
Severity of illness, a diagnosis of DLB and PDD, and presence of hallucinations at baseline were predictive of a MMSE response. Non-AD dementia and severe dementia responded equally well to AChEI treatment and results of further randomised, placebo-controlled studies are needed to clarify the role of AChEI in the treatment of these disorders.
Pakrasi
S
S
Institute of Ageing and Health, Wolfson Research Centre, Newcastle upon Tyne, UK. sanjeet.pakrasi@ncl.ac.uk
Mukaetova-Ladinska
E B
EB
McKeith
I G
IG
O'Brien
J T
JT
D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy; D003704:Dementia / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D020961:Lewy Body Disease / Q000188:drug therapy / Q000523:psychology; D008297:Male; D011939:Mental Recall / Q000187:drug effects; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors