G Lombardi1, N Lombardi2, A Bettiol2, G Crescioli2, C Ferrari2, G Lucidi3, C Polito4, V Berti5, V Bessi6, S Bagnoli2, B Nacmias4,2, A Vannacci2, S Sorbi4,2. 1. IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, 50143, Florence, Italy. gemmalomb@gmail.com. 2. Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, viale Pieraccini 6, 50139, Florence, Italy. 3. Neurology Unit, S. Giovanni Di Dio Hospital, Via Torregalli, 3, 50143, Florence, Italy. 4. IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, 50143, Florence, Italy. 5. Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", Nuclear Medicine Unit, University of Florence, Largo Brambilla 3, 50134, Florence, Italy. 6. Neurology Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Largo Brambilla 3, 50134, Florence, Italy.
Abstract
PURPOSE: To assess the impact of long-term use of different drugs commonly prescribed in Alzheimer's disease (AD) on its clinical course and to identify clinical and therapeutic factors associated with a delay in AD progression. METHODS: We retrospectively enrolled 50 patients visited at the Neurology Unit, Careggi University Hospital (Florence), followed for at least 24 months. AD diagnosis was made according to clinical diagnostic criteria for probable/possible AD dementia, always supported at least by one biomarker. Clinical features, MMSE scores evaluated at diagnosis and every 6 months, and AD drugs used for at least 6 months, were recorded. Cox regression analysis was performed to estimate the hazard ratio (HR) for AD progression, assuming as the "final event," the progression to a more severe disease stage, defined as the achievement of an MMSE score less than 10. RESULTS: At baseline, the median MMSE score was 22. During follow-up (median of 41 months), 56% of patients progressed to a more severe disease stage. The use of memantine, either alone (HR 0.24; 95% CI 0.09-0.60) or combined with acetylcholinesterase inhibitors (HR 0.35; 95% CI 0.14-0.88) and a higher MMSE score at baseline (HR 0.82; 95% CI 0.70-0.96) were associated with a significantly lower risk of AD progression. CONCLUSION: Nowadays, effective disease-modifying therapy for AD is missing. Nevertheless, when the diagnosis is established, our results support the advantage of long-term use of available pharmacological treatments, especially in combination, in delaying AD progression to its more severe disease stage.
PURPOSE: To assess the impact of long-term use of different drugs commonly prescribed in Alzheimer's disease (AD) on its clinical course and to identify clinical and therapeutic factors associated with a delay in AD progression. METHODS: We retrospectively enrolled 50 patients visited at the Neurology Unit, Careggi University Hospital (Florence), followed for at least 24 months. AD diagnosis was made according to clinical diagnostic criteria for probable/possible AD dementia, always supported at least by one biomarker. Clinical features, MMSE scores evaluated at diagnosis and every 6 months, and AD drugs used for at least 6 months, were recorded. Cox regression analysis was performed to estimate the hazard ratio (HR) for AD progression, assuming as the "final event," the progression to a more severe disease stage, defined as the achievement of an MMSE score less than 10. RESULTS: At baseline, the median MMSE score was 22. During follow-up (median of 41 months), 56% of patients progressed to a more severe disease stage. The use of memantine, either alone (HR 0.24; 95% CI 0.09-0.60) or combined with acetylcholinesterase inhibitors (HR 0.35; 95% CI 0.14-0.88) and a higher MMSE score at baseline (HR 0.82; 95% CI 0.70-0.96) were associated with a significantly lower risk of AD progression. CONCLUSION: Nowadays, effective disease-modifying therapy for AD is missing. Nevertheless, when the diagnosis is established, our results support the advantage of long-term use of available pharmacological treatments, especially in combination, in delaying AD progression to its more severe disease stage.
Authors: Andrea C Tricco; Huda M Ashoor; Charlene Soobiah; Patricia Rios; Areti Angeliki Veroniki; Jemila S Hamid; John D Ivory; Paul A Khan; Fatemeh Yazdi; Marco Ghassemi; Erik Blondal; Joanne M Ho; Carmen H Ng; Brenda Hemmelgarn; Sumit R Majumdar; Laure Perrier; Sharon E Straus Journal: J Am Geriatr Soc Date: 2017-09-29 Impact factor: 5.562
Authors: R Schmidt; E Hofer; F H Bouwman; K Buerger; C Cordonnier; T Fladby; D Galimberti; J Georges; M T Heneka; J Hort; J Laczó; J L Molinuevo; J T O'Brien; D Religa; P Scheltens; J M Schott; S Sorbi Journal: Eur J Neurol Date: 2015-03-25 Impact factor: 6.089