SPECT-identified neuroanatomical predictor of the cognitive effects of donepezil treatment in patients with Alzheimer's disease.
OBJECTIVE
We attempted to determine whether the pretreatment regional cerebral blood flow (rCBF) might predict cognitive changes in response to donepezil treatment, as assessed in terms of the Alzheimer Disease Assessment Scale cognitive subscale (ADAS-cog), and in relation to the severity of subcortical hyperintensities (SH).


METHODS
Forty-one patients with Alzheimer's disease (AD) were treated with donepezil at baseline. All the patients underwent a single photon emission computed tomography examination before donepezil therapy. They also completed the ADAS-cog at baseline and after 24 weeks of donepezil therapy. SH were assessed semiquantitatively using a recently developed visual rating scale. We analyzed the correlation between the baseline rCBF and changes in the ADAS-cog score using statistical parametric mapping, including the severity of the SH as a covariate.


RESULTS
Lower pretreatment rCBF levels in the right orbitofrontal cortex (OFC) predicted a better improvement in the ADAS-cog score in response to donepezil therapy. The severity of SH did not appear to influence this correlation.


CONCLUSIONS
This effect may reflect the choline acetyltransferase activity associated with the OFC. The presence of SH did not appear to influence the effect of donepezil therapy on the cognitive function as assessed by ADAS-cog.
Hongo
Jin
J
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Nakaaki
Shutaro
S
Shinagawa
Yoshihiro
Y
Murata
Yoshie
Y
Sato
Junko
J
Tatsumi
Hiroshi
H
Tohyama
Junko
J
Soma
Tsutomu
T
Iidaka
Tetsuya
T
Fukui
Toshiya
T
Mimura
Masaru
M
Furukawa
Toshiaki A
TA
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000523:psychology; D001921:Brain / Q000473:pathology; D003071:Cognition / Q000187:drug effects*; D000077265:Donepezil; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007189:Indans / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D015899:Tomography, Emission-Computed, Single-Photon
D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil