BACKGROUND: Cholinesterase inhibitors are modestly effective in treating patients with Alzheimer's disease. However, there may be important inter-individual variations ranging from no improvement at all to significant improvement and long periods of stabilization. Carotid atherosclerosis is associated with cognitive decline in elderly people. OBJECTIVE: The objective of this study was to investigate whether carotid intima-media thickness (IMT) predicts response to cholinesterase inhibitors in Alzheimer's disease. PATIENTS AND METHODS: A series of 54 patients with mild to moderate Alzheimer's disease were enrolled consecutively in an open-label trial. At baseline, all patients were assessed on the following clinical scales: Mini-Mental State Examination, Clinical Dementia Rating, the Hachinski Ischemic Scale, Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), Neuropsychiatric Inventory (NPI) and a daily-living activities scale (Disability Assessment for Dementia [DAD]). Investigations included magnetic resonance imaging of the brain and a colour echo-Doppler scan of the carotid arteries to measure the maximum IMT. Patients were then commenced on galantamine treatment for 6 months, after which scores on the ADAS-cog, NPI and DAD scales were reassessed. RESULTS: A total of 50 patients completed the study. Their mean age was 77.78 years (SD 6.51 years); 34 patients were female. Galantamine treatment decreased the mean NPI score from 17.68 to 13.86 points, but this difference was not statistically significant (p=0.07). On the ADAS-cog scale, a modest and nonsignificant mean difference of -0.4 points (p=0.7) was observed. A weak (correlation coefficient r=0.4) but significant correlation between IMT and changes in clinical scale score was found, with low carotid IMT being shown to be a predictor of response on both the ADAS-cog (p=0.003) and NPI (p=0.006) scales; these findings were corroborated in multivariate analysis. For men, the correlation was stronger (r=0.7 and 0.8 for the ADAS-cog and NPI scales, respectively). CONCLUSION: Although the magnitude of effect was moderate, carotid IMT could be a significant predictor of clinical response to cholinesterase inhibitors in patients with Alzheimer's disease.
BACKGROUND:Cholinesterase inhibitors are modestly effective in treating patients with Alzheimer's disease. However, there may be important inter-individual variations ranging from no improvement at all to significant improvement and long periods of stabilization. Carotid atherosclerosis is associated with cognitive decline in elderly people. OBJECTIVE: The objective of this study was to investigate whether carotid intima-media thickness (IMT) predicts response to cholinesterase inhibitors in Alzheimer's disease. PATIENTS AND METHODS: A series of 54 patients with mild to moderate Alzheimer's disease were enrolled consecutively in an open-label trial. At baseline, all patients were assessed on the following clinical scales: Mini-Mental State Examination, Clinical Dementia Rating, the Hachinski Ischemic Scale, Blessed Dementia Rating Scale, Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), Neuropsychiatric Inventory (NPI) and a daily-living activities scale (Disability Assessment for Dementia [DAD]). Investigations included magnetic resonance imaging of the brain and a colour echo-Doppler scan of the carotid arteries to measure the maximum IMT. Patients were then commenced on galantamine treatment for 6 months, after which scores on the ADAS-cog, NPI and DAD scales were reassessed. RESULTS: A total of 50 patients completed the study. Their mean age was 77.78 years (SD 6.51 years); 34 patients were female. Galantamine treatment decreased the mean NPI score from 17.68 to 13.86 points, but this difference was not statistically significant (p=0.07). On the ADAS-cog scale, a modest and nonsignificant mean difference of -0.4 points (p=0.7) was observed. A weak (correlation coefficient r=0.4) but significant correlation between IMT and changes in clinical scale score was found, with low carotid IMT being shown to be a predictor of response on both the ADAS-cog (p=0.003) and NPI (p=0.006) scales; these findings were corroborated in multivariate analysis. For men, the correlation was stronger (r=0.7 and 0.8 for the ADAS-cog and NPI scales, respectively). CONCLUSION: Although the magnitude of effect was moderate, carotid IMT could be a significant predictor of clinical response to cholinesterase inhibitors in patients with Alzheimer's disease.
Authors: L O Wahlund; F Barkhof; F Fazekas; L Bronge; M Augustin; M Sjögren; A Wallin; H Ader; D Leys; L Pantoni; F Pasquier; T Erkinjuntti; P Scheltens Journal: Stroke Date: 2001-06 Impact factor: 7.914
Authors: G C Román; T K Tatemichi; T Erkinjuntti; J L Cummings; J C Masdeu; J H Garcia; L Amaducci; J M Orgogozo; A Brun; A Hofman Journal: Neurology Date: 1993-02 Impact factor: 9.910
Authors: Anne Catrien Baakman; Carmen Gavan; Lotte van Doeselaar; Marieke de Kam; Karen Broekhuizen; Ovidiu Bajenaru; Laura Camps; Eleonora L Swart; Kees Kalisvaart; Niki Schoonenboom; Evelien Lemstra; Philip Scheltens; Adam Cohen; Joop van Gerven; Geert Jan Groeneveld Journal: Br J Clin Pharmacol Date: 2022-01-26 Impact factor: 3.716
Authors: Barbora Urbanova; Ales Tomek; Robert Mikulik; Hana Magerova; Daniel Horinek; Jakub Hort Journal: Front Behav Neurosci Date: 2014-01-21 Impact factor: 3.558