Treatment with galantamine and time to nursing home placement in Alzheimer's disease patients with and without cerebrovascular disease.
OBJECTIVE
This study evaluated patient and treatment (galantamine and other acetylcholinesterase inhibitors (AChEIs)) factors associated with the time until nursing home placement (NHP) in patients with Alzheimer's disease (AD) with and without cerebrovascular disease (CVD).


METHODS
Re-contact follow-up study conducted in 2004 of 548 patients who had previously participated in RCTs with galantamine. Time to NHP was analyzed using Kaplan-Meier estimates and Cox regression analysed factors associated with NHP.


RESULTS
There were 57% of female subjects and the mean age (SE) was 73.6 (+/-0.33) years. Within this cohort 78% of patients had AD, and 22% had AD with CVD. Overall, 59% of subjects had a NHP (median 42.4 months 95%CI: 38.0-48.0). The Cox regression model identified higher baseline Disability Assessment in Dementia (DAD) and Mini Mental State Examination (MMSE) scores, diagnosis (AD with CVD vs AD), living with caregiver, country, and treatment duration with galantamine or other AChEIs as factors associated with a reduced risk of institutionalization (p < 0.05). For each year of treatment with galantamine or other AChEI, the risk of being admitted to a nursing home within a given period was reduced by 31% (galantamine) and 29% (other AChEI).


CONCLUSIONS
Long-term treatment with galantamine or other AChEIs appears to be associated with a significant delay in the time to NHP in patients with AD and AD with CVD. Further prospective studies are needed to confirm these findings.
Feldman
Howard H
HH
Division of Neurology, University British Columbia, Vancouver, British Columbia, Canada. hfeldman@interchange.ubc.ca
Pirttila
Tuula
T
Dartigues
Jean François
JF
Everitt
Brian
B
Van Baelen
Bart
B
Schwalen
Susanne
S
Kavanagh
Shane
S
D000368:Aged; D000544:Alzheimer Disease / Q000150:complications / Q000188:drug therapy*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005702:Galantamine / Q000627:therapeutic use*; D006801:Humans; D007326:Institutionalization; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome
D002800:Cholinesterase Inhibitors; D005702:Galantamine