title: Predictive factors of clinical response to cholinesterase inhibitors in mild and moderate Alzheimer's disease and mixed dementia: a one-year naturalistic study.
abstract: BACKGROUND
  Naturalistic studies evaluate individuals in their usual way of living, presenting more "real-life" data regarding patients and their diseases.
  
  
  OBJECTIVE
  To investigate demographic, clinical, and genetic factors that could be predictive of good response to cholinesterase inhibitors (ChEI) treatment in Alzheimer's disease (AD) and AD + cerebrovascular disease (CVD).
  
  
  METHODS
  A total of 129 patients were diagnosed with AD or AD + CVD and with mild-to-moderate dementia. After a 12-month treatment, 97 patients completed the study. They were evaluated at baseline and after three, six, and 12 months of ChEI (donepezil or rivastigmine or galantamine) use. APOE genotype and CYP2D6 polymorphisms were determined for all of the participants. In each visit, we used cognitive, functional, mood, and behavior scales. We classified patients according to their scores in the Mini-Mental State Examination (MMSE). Good responders were defined as those scoring ≥2 in the MMSE at 12 months.
  
  
  RESULTS
  The rate of good clinical response was 27.8%. In a longitudinal analysis, the patients with mild AD and also good responders at three months were considered to be good responders at 12 months. There was no correlation between ChEI dose, APOE and CYP2D6 polymorphisms, and the pattern of clinical response.
  
  
  CONCLUSIONS
  A higher rate of good response was observed in this study compared to that in previous investigations. The pharmacogenetic aspects do not seem to have an influence in the response.
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Luís F J R
authors.initials: LF
authors.lastname: Miranda
authors.affiliation: Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Karina B
authors.initials: KB
authors.lastname: Gomes
authors.affiliation: Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Josianne N
authors.initials: JN
authors.lastname: Silveira
authors.affiliation: Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Gerson A
authors.initials: GA
authors.lastname: Pianetti
authors.affiliation: Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Ricardo M D
authors.initials: RM
authors.lastname: Byrro
authors.affiliation: Serviço de Neurologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Patrícia R H
authors.initials: PR
authors.lastname: Peles
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Fernando H
authors.initials: FH
authors.lastname: Pereira
authors.affiliation: Instituto de Ciências Exatas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Thiago R
authors.initials: TR
authors.lastname: Santos
authors.affiliation: Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Arthur G
authors.initials: AG
authors.lastname: Assini
authors.affiliation: Faculdade de Farmácia da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Valéria V
authors.initials: VV
authors.lastname: Ribeiro
authors.affiliation: Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Pedro A L
authors.initials: PA
authors.lastname: Tito
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Rafael O
authors.initials: RO
authors.lastname: Matoso
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Thiago O L
authors.initials: TO
authors.lastname: Lima
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil Serviço de Geriatria do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Edgar N
authors.initials: EN
authors.lastname: Moraes
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil Serviço de Neurologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brasil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Caramelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000235:genetics*; D001057:Apolipoproteins E / Q000235:genetics; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D003704:Dementia / Q000188:drug therapy* / Q000235:genetics*; D005260:Female; D005820:Genetic Testing; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010597:Pharmacogenetics; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001057:Apolipoproteins E; D002800:Cholinesterase Inhibitors; D019389:Cytochrome P-450 CYP2D6
keywords: APOE and CYP2D6 polymorphisms; Alzheimer's disease; cholinesterase inhibitors; predictive factors; response