Effects of cholinesterase inhibitors on visual attention in drivers with Alzheimer disease.
OBJECTIVE
We conducted a combined observational cohort and case-control study in patients with Alzheimer disease (AD) to assess the effects of acetylcholinesterase inhibitor (ChEI) treatment on cognitive functions important for driving.


METHODS
Performance of 24 outpatients with newly diagnosed (untreated) early-stage AD was compared before beginning ChEI (pre-ChEI) and after 3 months of therapy (post-ChEI) on a set of computerized tests of visual attention and executive function administered under both single-task and dual-task conditions. To address the limitation of a lack of an untreated control group in this observational cohort study, performance of 35 outpatients with newly diagnosed (untreated) early-stage AD (ChEI nonusers) were also compared with a demographically matched group of AD patients treated with stable doses of a ChEI (ChEI users) on these tasks.


RESULTS
Performance was consistently worse under dual-task than single-task conditions regardless of ChEI treatment status. However, ChEI treatment consistently affected specific components of attention within each test across both sets of comparisons: ChEI treatment enhanced simulated driving accuracy and was associated with significantly better visual search target detection accuracy and response time in both pre-ChEI-post-ChEI and users-nonusers treatment comparisons. Cholinesterase inhibitor treatment also improved overall time to complete a set of mazes while not affecting accuracy of completion.


CONCLUSIONS
Cholinesterase inhibitor treatment was associated with improvements in tests of executive function and visual attention. These findings could have important implications for patients who continue to drive in the early stages of AD.
Daiello
Lori A
LA
Department of Clinical Neurosciences, Brown University, Providence, USA. ldaiello@lifespan.org
Ott
Brian R
BR
Festa
Elena K
EK
Friedman
Michael
M
Miller
Lindsay A
LA
Heindel
William C
WC
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology; D001288:Attention / Q000187:drug effects* / Q000502:physiology; D001334:Automobile Driving / Q000523:psychology; D016022:Case-Control Studies; D002800:Cholinesterase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D056344:Executive Function / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010775:Photic Stimulation / Q000379:methods; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology; D011930:Reaction Time / Q000187:drug effects / Q000502:physiology; D014796:Visual Perception / Q000187:drug effects* / Q000502:physiology
D002800:Cholinesterase Inhibitors
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