title: Initial cognitive response to cholinesterase inhibitors and subsequent long-term course in patients with mild Alzheimer's disease.
abstract: BACKGROUND
  Some guidelines recommend to discontinue treatment with cholinesterase inhibitors (ChEIs) in patients with Alzheimer's disease (AD) without an initial response to ChEI treatment. Evidence supporting this recommendation, however, is limited. This study aimed to investigate the relation between the initial cognitive response to ChEI treatment and the subsequent long-term course of cognition of AD patients.
  
  
  METHODS
  The Frisian Alzheimer's Disease Cohort study is a retrospective longitudinal study of 576 community-dwelling AD patients treated with ChEIs in a "real-life" setting at a large memory clinic. A repeated measures analysis using a marginal model (population based averaged model) was applied to investigate whether there is a difference in the subsequent long-term course of cognition (Mini-Mental State Examination (MMSE)) between initial non-responders and responders. Absence of an initial response was defined as a lower MMSE score after the first six months of treatment compared to baseline, a positive response as the same or a higher MMSE score.
  
  
  RESULTS
  At baseline, median age was 80 years and the median MMSE score 23. Non-responders showed a slower rate of cognitive decline in the three subsequent years than responders, with a mean annual MMSE decline of 0.9 points versus 1.2 points, respectively (p < 0.0001).
  
  
  CONCLUSIONS
  Our results suggest that it is not appropriate to discontinue ChEI treatment solely based on the absence of an initial cognitive response.
authors.affiliation: Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands.
authors.forename: Erika
authors.initials: E
authors.lastname: Droogsma
authors.affiliation: Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands.
authors.forename: Dieneke
authors.initials: D
authors.lastname: van Asselt
authors.affiliation: Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Diekhuis
authors.affiliation: Department of Epidemiology,Medical Center Leeuwarden,Leeuwarden,the Netherlands.
authors.forename: Nic
authors.initials: N
authors.lastname: Veeger
authors.affiliation: Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: van der Hooft
authors.affiliation: Department of Neurology and Alzheimer Research Center,University Medical Center Groningen,University of Groningen,Groningen,the Netherlands.
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: De Deyn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D018697:Nootropic Agents / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D018697:Nootropic Agents
keywords: Alzheimer's disease; cholinesterase inhibitors; course of cognition; longitudinal study; treatment response; “real-life” setting