title: Long-term outcome and prediction models of activities of daily living in Alzheimer disease with cholinesterase inhibitor treatment.
abstract: In untreated patients with Alzheimer disease (AD) the functional ability is gradually lost. What happens to the patients after continuous long-term cholinesterase inhibitor (ChEI) treatment is less investigated. The objective of this study was to describe the longitudinal functional outcome and analyze factors affecting the outcome in ChEI-treated patients. In an open, 3-year, nonrandomized, prospective, multicenter study in a routine clinical setting, 790 patients were treated with either donepezil, rivastigmine, or galantamine. At baseline and every 6 months, they were assessed with several rating scales including Instrumental Activities of Daily Living (IADL), Physical Self-Maintenance Scale (PSMS), and Mini-Mental State Examination (MMSE). A faster functional decline was associated with lower cognitive ability at baseline, older age, and the interaction of higher education and longer time in the study. The patients residing with a spouse or relative showed slower deterioration in IADL score. A higher mean dose of ChEI, regardless of drug agent, was also related to slower instrumental ADL decline. Prediction models for longitudinal functional outcome were provided. AD severity at baseline is a key factor in obtaining reliable clinical prognoses of the long-term ADL ability. The dosage of ChEI treatment could possibly lead to a different functional outcome.
authors.affiliation: Department of Clinical Sciences, Clinical Memory Research Unit, Malmö, Lund University, Sweden. carina.wattmo@skane.se
authors.forename: Carina
authors.initials: C
authors.lastname: Wattmo
authors.forename: Åsa K
authors.initials: ÅK
authors.lastname: Wallin
authors.forename: Elisabet
authors.initials: E
authors.lastname: Londos
authors.forename: Lennart
authors.initials: L
authors.lastname: Minthon
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000544:Alzheimer Disease / Q000150:complications* / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D018450:Disease Progression; D000077265:Donepezil; D004305:Dose-Response Relationship, Drug; D005260:Female; D005702:Galantamine / Q000008:administration & dosage; D006801:Humans; D007189:Indans / Q000008:administration & dosage; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D048448:Phenylcarbamates / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage; D000068836:Rivastigmine; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine