[Cholinesterase inhibitor therapy in long term care settings].
OBJECTIVE
Cholinesterase Inhibitors (ChEIs) have proven efficacy in outpatients with mild to moderate Alzheimer's Disease (AD). The benefits of maintaining this treatment once patients are institutionalised remain controversial. The aim of this study was to present current therapeutic strategies regarding ChEIs use in long-term care settings (LTC).


METHODS
A multicentric, retrospective, observational study was conducted on currently available ChEIs (donezepil, rivastigmine, galantamine) prescribed in LTC. Data were obtained from medical records. Judgement was based on three criteria: ChEIs indication, follow-up, and justification for maintenance of treatment.


RESULTS
Among the 1,373 patients evaluated, 6% (N=81) were receiving ChEIs. They represented various stages of the disease, with cognitive and functional decline ranging from severe (18%) to very mild (10%). Among patients receiving ChEIs, 29% met neither the indication for which these drugs were approved, nor professional guidelines. Patient evaluation at entry was of high quality, with 90% of records including cognitive, functional and behavioural evaluation. Follow-up evaluations were weaker, with at least one assessment domain missing in 40% of the medical records. ChEIs treatment was maintained, although almost half of patients experienced a worsening of their clinical state.


CONCLUSIONS
This study shows that follow-up of institutionalised patients receiving ChEIs could be improved. While treatment maintenance seems to be the rule, it should be questioned on ethical, efficacy, and economic grounds. The rationale for use and discontinuation of these therapeutic strategies in institutional settings requires urgent review.
Vantelon
C
C
Service de médecine gériatrique, centre hospitalo-universitaire Bichat-Claude-Bernard, 48, rue Henri-Huchard, 75877 Paris, France.
Gilbert
S
S
Kerneis
S
S
Wolmark
Y
Y
Legrain
S
S
Kergoat
M-J
MJ
D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D000077265:Donepezil; D005500:Follow-Up Studies; D005702:Galantamine / Q000627:therapeutic use*; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008134:Long-Term Care; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D018697:Nootropic Agents / Q000627:therapeutic use*; D018579:Patient Selection; D048448:Phenylcarbamates / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use*; D012189:Retrospective Studies; D000068836:Rivastigmine; D013997:Time Factors
D002800:Cholinesterase Inhibitors; D007189:Indans; D018696:Neuroprotective Agents; D018697:Nootropic Agents; D048448:Phenylcarbamates; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine