title: Hippocampal atrophy but not white-matter changes predicts the long-term cognitive response to cholinesterase inhibitors in Alzheimer's disease.
abstract: BACKGROUND
  This study aimed to investigate the feasibility of predicting the long-term effects of cholinesterase inhibitors (ChEI) with common clinical neuroimaging parameters of Alzheimer's disease, including medial temporal lobe atrophy (MTA) and white matter hyperintensity (WMH).
  
  
  METHODS
  A cohort of 353 patients with very mild to moderate Alzheimer's disease received cholinesterase inhibitors and were followed for a median of 46.6 months. Baseline clinical data, including age, educational level, Clinical Dementia Rating (CDR), Taiwanese Mental State Examination (TMSE), and visual scoring for MTA and WMH were tested as possible predictive factors that influence the survival from a TMSE decline of at least 3 points.
  
  
  RESULTS
  During the follow-up period, 162(46%) patients had a significant TMSE decline. Patients with age-adjusted prominent MTA had a significantly shorter TMSE-decline free interval than those without (43.4 ± 4.5 months vs. 68.2 ± 9.5 months, log rank test p-value =0.001). However, the severity of WMH does not significantly influence cognitive outcomes. Cox regression analysis identified that younger age at the time of starting ChEI (p < 0.0005) and higher total MTA scores (p = 0.002) predict a more rapid TMSE decline under ChEI therapy.
  
  
  CONCLUSIONS
  Younger age at the time of starting ChEI and higher visual scoring of MTA may imply a more advanced Alzheimer's pathology. WMH load is not a prognostic indicator of treatment response to ChEI.
authors.affiliation: Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan S Rd., Taipei, 100, Taiwan. yuwencheng610@gmail.com.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Cheng
authors.affiliation: Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan S Rd., Taipei, 100, Taiwan. tfchen@ntu.edu.tw.
authors.forename: Ta-Fu
authors.initials: TF
authors.lastname: Chen
authors.affiliation: Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan S Rd., Taipei, 100, Taiwan. r91227024@ntu.edu.tw.
authors.forename: Ting-Wen
authors.initials: TW
authors.lastname: Cheng
authors.affiliation: Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan S Rd., Taipei, 100, Taiwan. yameilai@ntuh.gov.tw.
authors.forename: Ya-Mei
authors.initials: YM
authors.lastname: Lai
authors.affiliation: Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan. huams@ntu.edu.tw.
authors.forename: Mau-Sun
authors.initials: MS
authors.lastname: Hua
authors.affiliation: Department of Medical Imaging, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan S. Rd., Taipei, 100, Taiwan. joannayfc@gmail.com.
authors.forename: Ya-Fang
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan S Rd., Taipei, 100, Taiwan. mjchiu@ntu.edu.tw.|Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan. mjchiu@ntu.edu.tw.
authors.forename: Ming-Jang
authors.initials: MJ
authors.lastname: Chiu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000473:pathology; D001284:Atrophy / Q000188:drug therapy; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D003071:Cognition / Q000187:drug effects*; D060825:Cognitive Dysfunction / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006624:Hippocampus / Q000187:drug effects* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013702:Temporal Lobe / Q000187:drug effects / Q000473:pathology; D066127:White Matter / Q000187:drug effects / Q000473:pathology
chemical_list: D002800:Cholinesterase Inhibitors