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Lennart Minthon - One of the best experts on this subject based on the ideXlab platform.
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Cholinesterase Inhibitor therapy does not affect time spent in nursing homes in patients with alzheimer s disease
Alzheimers & Dementia, 2016Co-Authors: Carina Wattmo, Elisabet Londos, Lennart MinthonAbstract:Background: The time spent in nursing homes (NHs) by patients with Alzheimer’s disease (AD) might be influenced by many factors, e.g., sociodemographic and clinical characteristics, rate of disease progression, and concomitant disorders. Whether different aspects of Cholinesterase Inhibitor (ChEI) therapy (drug agent, dose, and duration) affect time spent in NHs has not been investigated. We studied the relationship between these potential predictors and time spent in NHs. Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for the long-term assessment of ChEI therapy in a routine clinical setting. This presentation includes 220 deceased SATS participants clinically diagnosed with mild-to-moderate AD (Mini-Mental State Examination score, 10–26 at the start of ChEI treatment) who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) capacities were evaluated at the baseline and semiannually over 3 years. The dates of nursing home placement (NHP) and death were recorded. Variables that determined time spent in NHs were analyzed using general linear models. Results: The mean (95% confidence interval) time spent in NHs was 4.06 (3.69–4.43) years: 2.78 (2.19–3.38) years for men vs 4.53 (4.09–4.96) years for women; P < 0.001. When considering the interaction effect of sex and living status, males living with a family member spent a shorter time in NHs (2.15 (1.48–2.83) years) vs the other groups: females living with family, 4.75 (4.00–5.50) years; males living alone, 4.00 (2.96–5.05) years; and females living alone, 4.41 (3.87–4.95) years; P < 0.001. The multivariate model showed that a shorter stay in NHs was independently related to being a man living with family, lower basic ADL at NHP, and more concomitant medications. Age, cognitive or instrumental ADL capacities at NHP, rates of decline in cognition or function, and ChEI type, dose, and treatment duration were not significant predictors. Conclusions: Women cared for their spouses with AD at home longer than did men. The situation of these female informal caregivers needs attention and possibly support. There was no indication that any aspects of ChEI therapy influenced the time spent in NHs.
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Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of Cholinesterase Inhibitor therapy
Alzheimer's Research & Therapy, 2016Co-Authors: Carina Wattmo, Lennart Minthon, Åsa K WallinAbstract:Background There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of Cholinesterase Inhibitor (ChEI) therapy. Methods This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. Results The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. Conclusions More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.
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mild versus moderate stages of alzheimer s disease three year outcomes in a routine clinical setting of Cholinesterase Inhibitor therapy
Alzheimer's Research & Therapy, 2016Co-Authors: Carina Wattmo, Lennart Minthon, Åsa K WallinAbstract:There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of Cholinesterase Inhibitor (ChEI) therapy. This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.
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longitudinal associations between survival in alzheimer s disease and Cholinesterase Inhibitor use progression and community based services
Dementia and Geriatric Cognitive Disorders, 2015Co-Authors: Carina Wattmo, Elisabet Londos, Lennart MinthonAbstract:Background/Aims: Factors including rate of disease progression, different aspects of Cholinesterase Inhibitor (ChEI) treatment, and use of community-based services might affect the longitudinal outcome of Alzheimer's disease (AD). Whether these factors alter life expectancy in AD is unclear. We therefore examined the association between long-term ChEI therapy and survival. Methods: The present study included 1,021 patients with a clinical diagnosis of AD and a Mini-Mental State Examination score of 10-26 at baseline from a 3-year, prospective, multicenter study of ChEI therapy in clinical practice. The relationship of potential predictors with mortality was analyzed using Cox regression models. Results: After up to 16 years of follow-up, 841 (82%) of the participants had died. In the Alzheimer's Disease Assessment Scale-cognitive subscale, a mean decline of ≥4 points/year or ≥2 points/year on the Physical Self-Maintenance Scale was a risk factor for an earlier death. In the multivariate models, longer survival was associated with higher ChEI dose and longer duration of treatment. Users of community-based services at baseline exhibited a 1-year shorter mean life expectancy than nonusers. Conclusion: A longer survival time can be anticipated for AD patients with slower deterioration who receive and tolerate higher ChEI doses and a longer duration of treatment.
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a longitudinal study of risk factors for community based home help services in alzheimer s disease the influence of Cholinesterase Inhibitor therapy
Clinical Interventions in Aging, 2013Co-Authors: Carina Wattmo, Lennart Minthon, Elisabeth Paulsson, Elisabet LondosAbstract:Background: To investigate the long-term effects of Cholinesterase Inhibitor (ChEI) therapy and the influence of sociodemographic and clinical factors on the use of community-based home help services (HHS) by patients with Alzheimer's disease (AD). Methods: This 3-year, prospective, multicenter study included 880 AD patients treated with donepezil, rivastigmine, or galantamine in a routine clinical setting. At baseline and every 6 months, the patients were assessed with several rating scales, including the Mini-Mental State Examination, Instrumental Activities of Daily Living (IADL), and Physical Self-Maintenance Scale. Doses of ChEI and amounts of HHS per week were recorded. Cox regression models were used to predict the time to HHS, and multiple linear regression was used to predict the volume of HHS used. Results: During the study, 332 patients (38%) used HHS. Factors that both postponed HHS use and predicted lower amounts of HHS were higher doses of ChEIs, better IADL ability, and living with family. Men, younger individuals, and those with a slower IADL decline showed a longer time to HHS, whereas female sex, a lower cognitive status, or more medications at baseline predicted fewer hours of HHS. Conclusions: Higher doses of ChEI might reduce the use of HHS, possibly reducing the costs of community-based care. Female spouses provide more informal care than do male spouses, so the likelihood of using HHS is greater among women with AD. The "silent group" of more cognitively impaired and frail elderly AD patients receives less HHS, which might precipitate institutionalization. (Less)
Carina Wattmo - One of the best experts on this subject based on the ideXlab platform.
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Cholinesterase Inhibitor therapy does not affect time spent in nursing homes in patients with alzheimer s disease
Alzheimers & Dementia, 2016Co-Authors: Carina Wattmo, Elisabet Londos, Lennart MinthonAbstract:Background: The time spent in nursing homes (NHs) by patients with Alzheimer’s disease (AD) might be influenced by many factors, e.g., sociodemographic and clinical characteristics, rate of disease progression, and concomitant disorders. Whether different aspects of Cholinesterase Inhibitor (ChEI) therapy (drug agent, dose, and duration) affect time spent in NHs has not been investigated. We studied the relationship between these potential predictors and time spent in NHs. Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for the long-term assessment of ChEI therapy in a routine clinical setting. This presentation includes 220 deceased SATS participants clinically diagnosed with mild-to-moderate AD (Mini-Mental State Examination score, 10–26 at the start of ChEI treatment) who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) capacities were evaluated at the baseline and semiannually over 3 years. The dates of nursing home placement (NHP) and death were recorded. Variables that determined time spent in NHs were analyzed using general linear models. Results: The mean (95% confidence interval) time spent in NHs was 4.06 (3.69–4.43) years: 2.78 (2.19–3.38) years for men vs 4.53 (4.09–4.96) years for women; P < 0.001. When considering the interaction effect of sex and living status, males living with a family member spent a shorter time in NHs (2.15 (1.48–2.83) years) vs the other groups: females living with family, 4.75 (4.00–5.50) years; males living alone, 4.00 (2.96–5.05) years; and females living alone, 4.41 (3.87–4.95) years; P < 0.001. The multivariate model showed that a shorter stay in NHs was independently related to being a man living with family, lower basic ADL at NHP, and more concomitant medications. Age, cognitive or instrumental ADL capacities at NHP, rates of decline in cognition or function, and ChEI type, dose, and treatment duration were not significant predictors. Conclusions: Women cared for their spouses with AD at home longer than did men. The situation of these female informal caregivers needs attention and possibly support. There was no indication that any aspects of ChEI therapy influenced the time spent in NHs.
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Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of Cholinesterase Inhibitor therapy
Alzheimer's Research & Therapy, 2016Co-Authors: Carina Wattmo, Lennart Minthon, Åsa K WallinAbstract:Background There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of Cholinesterase Inhibitor (ChEI) therapy. Methods This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. Results The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. Conclusions More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.
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mild versus moderate stages of alzheimer s disease three year outcomes in a routine clinical setting of Cholinesterase Inhibitor therapy
Alzheimer's Research & Therapy, 2016Co-Authors: Carina Wattmo, Lennart Minthon, Åsa K WallinAbstract:There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of Cholinesterase Inhibitor (ChEI) therapy. This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.
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longitudinal associations between survival in alzheimer s disease and Cholinesterase Inhibitor use progression and community based services
Dementia and Geriatric Cognitive Disorders, 2015Co-Authors: Carina Wattmo, Elisabet Londos, Lennart MinthonAbstract:Background/Aims: Factors including rate of disease progression, different aspects of Cholinesterase Inhibitor (ChEI) treatment, and use of community-based services might affect the longitudinal outcome of Alzheimer's disease (AD). Whether these factors alter life expectancy in AD is unclear. We therefore examined the association between long-term ChEI therapy and survival. Methods: The present study included 1,021 patients with a clinical diagnosis of AD and a Mini-Mental State Examination score of 10-26 at baseline from a 3-year, prospective, multicenter study of ChEI therapy in clinical practice. The relationship of potential predictors with mortality was analyzed using Cox regression models. Results: After up to 16 years of follow-up, 841 (82%) of the participants had died. In the Alzheimer's Disease Assessment Scale-cognitive subscale, a mean decline of ≥4 points/year or ≥2 points/year on the Physical Self-Maintenance Scale was a risk factor for an earlier death. In the multivariate models, longer survival was associated with higher ChEI dose and longer duration of treatment. Users of community-based services at baseline exhibited a 1-year shorter mean life expectancy than nonusers. Conclusion: A longer survival time can be anticipated for AD patients with slower deterioration who receive and tolerate higher ChEI doses and a longer duration of treatment.
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a longitudinal study of risk factors for community based home help services in alzheimer s disease the influence of Cholinesterase Inhibitor therapy
Clinical Interventions in Aging, 2013Co-Authors: Carina Wattmo, Lennart Minthon, Elisabeth Paulsson, Elisabet LondosAbstract:Background: To investigate the long-term effects of Cholinesterase Inhibitor (ChEI) therapy and the influence of sociodemographic and clinical factors on the use of community-based home help services (HHS) by patients with Alzheimer's disease (AD). Methods: This 3-year, prospective, multicenter study included 880 AD patients treated with donepezil, rivastigmine, or galantamine in a routine clinical setting. At baseline and every 6 months, the patients were assessed with several rating scales, including the Mini-Mental State Examination, Instrumental Activities of Daily Living (IADL), and Physical Self-Maintenance Scale. Doses of ChEI and amounts of HHS per week were recorded. Cox regression models were used to predict the time to HHS, and multiple linear regression was used to predict the volume of HHS used. Results: During the study, 332 patients (38%) used HHS. Factors that both postponed HHS use and predicted lower amounts of HHS were higher doses of ChEIs, better IADL ability, and living with family. Men, younger individuals, and those with a slower IADL decline showed a longer time to HHS, whereas female sex, a lower cognitive status, or more medications at baseline predicted fewer hours of HHS. Conclusions: Higher doses of ChEI might reduce the use of HHS, possibly reducing the costs of community-based care. Female spouses provide more informal care than do male spouses, so the likelihood of using HHS is greater among women with AD. The "silent group" of more cognitively impaired and frail elderly AD patients receives less HHS, which might precipitate institutionalization. (Less)
Åsa K Wallin - One of the best experts on this subject based on the ideXlab platform.
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mild versus moderate stages of alzheimer s disease three year outcomes in a routine clinical setting of Cholinesterase Inhibitor therapy
Alzheimer's Research & Therapy, 2016Co-Authors: Carina Wattmo, Lennart Minthon, Åsa K WallinAbstract:There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of Cholinesterase Inhibitor (ChEI) therapy. This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.
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Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of Cholinesterase Inhibitor therapy
Alzheimer's Research & Therapy, 2016Co-Authors: Carina Wattmo, Lennart Minthon, Åsa K WallinAbstract:Background There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer’s disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of Cholinesterase Inhibitor (ChEI) therapy. Methods This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20–26) and 287 had moderate AD (MMSE score, 10–19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. Results The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. Conclusions More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.
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Functional response to Cholinesterase Inhibitor therapy in a naturalistic Alzheimer’s disease cohort
BMC Neurology, 2012Co-Authors: Carina Wattmo, Åsa K Wallin, Lennart MinthonAbstract:Background Activities of daily living (ADL) are an essential part of the diagnostic criteria for Alzheimer’s disease (AD). A decline in ADL affects independent living and has a strong negative impact on caregiver burden. Functional response to Cholinesterase Inhibitor (ChEI) treatment and factors that might influence this response in naturalistic AD patients need investigating. The aim of this study was to identify the socio-demographic and clinical factors that affect the functional response after 6 months of ChEI therapy. Methods This prospective, non-randomised, multicentre study in a routine clinical setting included 784 AD patients treated with donepezil, rivastigmine or galantamine. At baseline and after 6 months of treatment, patients were assessed using several rating scales, including the Instrumental Activities of Daily Living (IADL) scale, Physical Self-Maintenance Scale (PSMS) and Mini-Mental State Examination (MMSE). Demographic and clinical characteristics were investigated at baseline. The functional response and the relationships of potential predictors were analysed using general linear models. Results After 6 months of ChEI treatment, 49% and 74% of patients showed improvement/no change in IADL and in PSMS score, respectively. The improved/unchanged patients exhibited better cognitive status at baseline; regarding improved/unchanged PSMS, patients were younger and used fewer anti-depressants. A more positive functional response to ChEI was observed in younger individuals or among those having the interaction effect of better preserved cognition and lower ADL ability. Patients with fewer concomitant medications or those using NSAIDs/acetylsalicylic acid showed a better PSMS response. Conclusions Critical characteristics that may influence the functional response to ChEI in AD were identified. Some predictors differed from those previously shown to affect cognitive response, e.g., lower cognitive ability and older age predicted better cognitive but worse functional response.
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functional response to Cholinesterase Inhibitor therapy in a naturalistic alzheimer s disease cohort
BMC Neurology, 2012Co-Authors: Carina Wattmo, Åsa K Wallin, Lennart MinthonAbstract:Activities of daily living (ADL) are an essential part of the diagnostic criteria for Alzheimer’s disease (AD). A decline in ADL affects independent living and has a strong negative impact on caregiver burden. Functional response to Cholinesterase Inhibitor (ChEI) treatment and factors that might influence this response in naturalistic AD patients need investigating. The aim of this study was to identify the socio-demographic and clinical factors that affect the functional response after 6 months of ChEI therapy. This prospective, non-randomised, multicentre study in a routine clinical setting included 784 AD patients treated with donepezil, rivastigmine or galantamine. At baseline and after 6 months of treatment, patients were assessed using several rating scales, including the Instrumental Activities of Daily Living (IADL) scale, Physical Self-Maintenance Scale (PSMS) and Mini-Mental State Examination (MMSE). Demographic and clinical characteristics were investigated at baseline. The functional response and the relationships of potential predictors were analysed using general linear models. After 6 months of ChEI treatment, 49% and 74% of patients showed improvement/no change in IADL and in PSMS score, respectively. The improved/unchanged patients exhibited better cognitive status at baseline; regarding improved/unchanged PSMS, patients were younger and used fewer anti-depressants. A more positive functional response to ChEI was observed in younger individuals or among those having the interaction effect of better preserved cognition and lower ADL ability. Patients with fewer concomitant medications or those using NSAIDs/acetylsalicylic acid showed a better PSMS response. Critical characteristics that may influence the functional response to ChEI in AD were identified. Some predictors differed from those previously shown to affect cognitive response, e.g., lower cognitive ability and older age predicted better cognitive but worse functional response.
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risk factors for nursing home placement in alzheimer s disease a longitudinal study of cognition adl service utilization and Cholinesterase Inhibitor treatment
Gerontologist, 2011Co-Authors: Carina Wattmo, Åsa K Wallin, Elisabet Londos, Lennart MinthonAbstract:Purpose of the Study: To identify risk factors for early nursing home placement (NHP) in Alzheimer's disease (AD), focusing on the impact of longitudinal change in cognition, activities of daily living (ADL), service utilization, and Cholinesterase Inhibitor treatment (ChEI). DESIGN AND METHODS: In an open, 3-year, prospective, multicenter study in a routine clinical setting, 880 AD patients were treated with either donepezil, rivastigmine, or galantamine. At baseline and every 6 months, they were assessed with several rating scales including Mini-Mental State Examination, Instrumental Activities of Daily Living scale (IADL), and Physical Self-Maintenance scale. Moreover, the dose of ChEI, the amount of weekly assistance (home help service and adult day care), and the date of NHP were recorded. Cox regression models were constructed to predict the risk of NHP. RESULTS: During the study, 206 patients (23%) were admitted to nursing homes. Factors that precipitated institutionalization were lower cognitive and functional abilities at baseline, faster rate of decline in IADLs, female gender, solitary living, and a lower mean dose of ChEI. The men living alone and patients with a substantial increase in adult day care also demonstrated shorter time to NHP. IMPLICATIONS: The rate of functional but not cognitive decline was a strong risk factor for NHP. The results could be used to identify the care recipients that might risk early NHP to ensure that these individuals receive a sufficient level of assistance. Furthermore, higher doses of ChEI might postpone institutionalization in AD.
Elisabet Londos - One of the best experts on this subject based on the ideXlab platform.
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Cholinesterase Inhibitor therapy does not affect time spent in nursing homes in patients with alzheimer s disease
Alzheimers & Dementia, 2016Co-Authors: Carina Wattmo, Elisabet Londos, Lennart MinthonAbstract:Background: The time spent in nursing homes (NHs) by patients with Alzheimer’s disease (AD) might be influenced by many factors, e.g., sociodemographic and clinical characteristics, rate of disease progression, and concomitant disorders. Whether different aspects of Cholinesterase Inhibitor (ChEI) therapy (drug agent, dose, and duration) affect time spent in NHs has not been investigated. We studied the relationship between these potential predictors and time spent in NHs. Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for the long-term assessment of ChEI therapy in a routine clinical setting. This presentation includes 220 deceased SATS participants clinically diagnosed with mild-to-moderate AD (Mini-Mental State Examination score, 10–26 at the start of ChEI treatment) who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) capacities were evaluated at the baseline and semiannually over 3 years. The dates of nursing home placement (NHP) and death were recorded. Variables that determined time spent in NHs were analyzed using general linear models. Results: The mean (95% confidence interval) time spent in NHs was 4.06 (3.69–4.43) years: 2.78 (2.19–3.38) years for men vs 4.53 (4.09–4.96) years for women; P < 0.001. When considering the interaction effect of sex and living status, males living with a family member spent a shorter time in NHs (2.15 (1.48–2.83) years) vs the other groups: females living with family, 4.75 (4.00–5.50) years; males living alone, 4.00 (2.96–5.05) years; and females living alone, 4.41 (3.87–4.95) years; P < 0.001. The multivariate model showed that a shorter stay in NHs was independently related to being a man living with family, lower basic ADL at NHP, and more concomitant medications. Age, cognitive or instrumental ADL capacities at NHP, rates of decline in cognition or function, and ChEI type, dose, and treatment duration were not significant predictors. Conclusions: Women cared for their spouses with AD at home longer than did men. The situation of these female informal caregivers needs attention and possibly support. There was no indication that any aspects of ChEI therapy influenced the time spent in NHs.
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longitudinal associations between survival in alzheimer s disease and Cholinesterase Inhibitor use progression and community based services
Dementia and Geriatric Cognitive Disorders, 2015Co-Authors: Carina Wattmo, Elisabet Londos, Lennart MinthonAbstract:Background/Aims: Factors including rate of disease progression, different aspects of Cholinesterase Inhibitor (ChEI) treatment, and use of community-based services might affect the longitudinal outcome of Alzheimer's disease (AD). Whether these factors alter life expectancy in AD is unclear. We therefore examined the association between long-term ChEI therapy and survival. Methods: The present study included 1,021 patients with a clinical diagnosis of AD and a Mini-Mental State Examination score of 10-26 at baseline from a 3-year, prospective, multicenter study of ChEI therapy in clinical practice. The relationship of potential predictors with mortality was analyzed using Cox regression models. Results: After up to 16 years of follow-up, 841 (82%) of the participants had died. In the Alzheimer's Disease Assessment Scale-cognitive subscale, a mean decline of ≥4 points/year or ≥2 points/year on the Physical Self-Maintenance Scale was a risk factor for an earlier death. In the multivariate models, longer survival was associated with higher ChEI dose and longer duration of treatment. Users of community-based services at baseline exhibited a 1-year shorter mean life expectancy than nonusers. Conclusion: A longer survival time can be anticipated for AD patients with slower deterioration who receive and tolerate higher ChEI doses and a longer duration of treatment.
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a longitudinal study of risk factors for community based home help services in alzheimer s disease the influence of Cholinesterase Inhibitor therapy
Clinical Interventions in Aging, 2013Co-Authors: Carina Wattmo, Lennart Minthon, Elisabeth Paulsson, Elisabet LondosAbstract:Background: To investigate the long-term effects of Cholinesterase Inhibitor (ChEI) therapy and the influence of sociodemographic and clinical factors on the use of community-based home help services (HHS) by patients with Alzheimer's disease (AD). Methods: This 3-year, prospective, multicenter study included 880 AD patients treated with donepezil, rivastigmine, or galantamine in a routine clinical setting. At baseline and every 6 months, the patients were assessed with several rating scales, including the Mini-Mental State Examination, Instrumental Activities of Daily Living (IADL), and Physical Self-Maintenance Scale. Doses of ChEI and amounts of HHS per week were recorded. Cox regression models were used to predict the time to HHS, and multiple linear regression was used to predict the volume of HHS used. Results: During the study, 332 patients (38%) used HHS. Factors that both postponed HHS use and predicted lower amounts of HHS were higher doses of ChEIs, better IADL ability, and living with family. Men, younger individuals, and those with a slower IADL decline showed a longer time to HHS, whereas female sex, a lower cognitive status, or more medications at baseline predicted fewer hours of HHS. Conclusions: Higher doses of ChEI might reduce the use of HHS, possibly reducing the costs of community-based care. Female spouses provide more informal care than do male spouses, so the likelihood of using HHS is greater among women with AD. The "silent group" of more cognitively impaired and frail elderly AD patients receives less HHS, which might precipitate institutionalization. (Less)
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risk factors for nursing home placement in alzheimer s disease a longitudinal study of cognition adl service utilization and Cholinesterase Inhibitor treatment
Gerontologist, 2011Co-Authors: Carina Wattmo, Åsa K Wallin, Elisabet Londos, Lennart MinthonAbstract:Purpose of the Study: To identify risk factors for early nursing home placement (NHP) in Alzheimer's disease (AD), focusing on the impact of longitudinal change in cognition, activities of daily living (ADL), service utilization, and Cholinesterase Inhibitor treatment (ChEI). DESIGN AND METHODS: In an open, 3-year, prospective, multicenter study in a routine clinical setting, 880 AD patients were treated with either donepezil, rivastigmine, or galantamine. At baseline and every 6 months, they were assessed with several rating scales including Mini-Mental State Examination, Instrumental Activities of Daily Living scale (IADL), and Physical Self-Maintenance scale. Moreover, the dose of ChEI, the amount of weekly assistance (home help service and adult day care), and the date of NHP were recorded. Cox regression models were constructed to predict the risk of NHP. RESULTS: During the study, 206 patients (23%) were admitted to nursing homes. Factors that precipitated institutionalization were lower cognitive and functional abilities at baseline, faster rate of decline in IADLs, female gender, solitary living, and a lower mean dose of ChEI. The men living alone and patients with a substantial increase in adult day care also demonstrated shorter time to NHP. IMPLICATIONS: The rate of functional but not cognitive decline was a strong risk factor for NHP. The results could be used to identify the care recipients that might risk early NHP to ensure that these individuals receive a sufficient level of assistance. Furthermore, higher doses of ChEI might postpone institutionalization in AD.
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long term outcome and prediction models of activities of daily living in alzheimer disease with Cholinesterase Inhibitor treatment
Alzheimer Disease & Associated Disorders, 2011Co-Authors: Carina Wattmo, Åsa K Wallin, Elisabet Londos, Lennart MinthonAbstract:In untreated patients with Alzheimer disease (AD) the functional ability is gradually lost. What happens to the patients after continuous long-term Cholinesterase Inhibitor (ChEI) treatment is less investigated. The objective of this study was to describe the longitudinal functional outcome and analyze factors affecting the outcome in ChEI-treated patients. In an open, 3-year, nonrandomized, prospective, multicenter study in a routine clinical setting, 790 patients were treated with either donepezil, rivastigmine, or galantamine. At baseline and every 6 months, they were assessed with several rating scales including Instrumental Activities of Daily Living (IADL), Physical Self-Maintenance Scale (PSMS), and Mini-Mental State Examination (MMSE). A faster functional decline was associated with lower cognitive ability at baseline, older age, and the interaction of higher education and longer time in the study. The patients residing with a spouse or relative showed slower deterioration in IADL score. A higher mean dose of ChEI, regardless of drug agent, was also related to slower instrumental ADL decline. Prediction models for longitudinal functional outcome were provided. AD severity at baseline is a key factor in obtaining reliable clinical prognoses of the long-term ADL ability. The dosage of ChEI treatment could possibly lead to a different functional outcome.
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Long-Term Cholinesterase Inhibitor Treatment of Alzheimer’s Disease
CNS Drugs, 2004Co-Authors: Peter JohannsenAbstract:The most prevalent cause of dementia — Alzheimer’s disease — is characterised by an early cholinergic deficit that is in part responsible for the cognitive deficits, especially memory and attention defects, seen with this condition. Three Cholinesterase Inhibitors (ChEIs), namely donepezil, rivastigmine and galantamine, are widely used for the symptomatic treatment of patients with Alzheimer’s disease. Placebo-controlled, randomised clinical trials have shown significant effects of these drugs on global function, cognition, activities of daily living (ADL) and behavioural symptoms in patients with this disorder. These trials have been conducted for up to 12 months and were followed by open-label extension studies. One placebo-controlled, randomised clinical trial followed patients for up to 4 years. Both retrospective and prospective follow-up studies suggest a treatment effect for ChEIs that lasts for up to 5 years. Studies have shown comparable effects for ChEIs in patients with moderate-to-severe Alzheimer’s disease or mild Alzheimer’s disease. Clinically relevant responses consist not only of improvement over 3–6 months but also stabilisation and possibly slower than expected decline. Lack of overt clinical improvement in one domain (e.g. global function, cognition, ADL or behaviour) does not preclude clinically relevant benefit(s) in other domains. If it is judged that the patient has experienced a treatment effect from ChEI therapy during the first 6 months, it is recommended that treatment be continued for at least 1 year before discontinuation is considered again. On average, patients will return to their pre-treatment status between 9 and 12 months of initiation of treatment. However, this return to pre-treatment level does not mean that the treatment effect has disappeared. At this point in time, the patient may still function better than he or she would have without treatment. Setting a fixed measurement, e.g. a Mini-Mental State Examination score, as a ‘when to stop treatment limit’ is not clinically rational. The length of treatment should depend on several individual patient factors. The earlier the diagnosis is made and the slower the rate of disease progression, the longer the treatment period will tend to be. Treatment duration must therefore be evaluated on an individual basis, and the patient’s status compared with what would have been expected without treatment. If a clinical evaluation is conducted with a view to stopping or switching treatment, it is crucial that all domains are evaluated and that the patient is evaluated at more than one point in time before the decision is made.
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long term Cholinesterase Inhibitor treatment of alzheimer s disease
CNS Drugs, 2004Co-Authors: Peter JohannsenAbstract:The most prevalent cause of dementia — Alzheimer’s disease — is characterised by an early cholinergic deficit that is in part responsible for the cognitive deficits, especially memory and attention defects, seen with this condition. Three Cholinesterase Inhibitors (ChEIs), namely donepezil, rivastigmine and galantamine, are widely used for the symptomatic treatment of patients with Alzheimer’s disease. Placebo-controlled, randomised clinical trials have shown significant effects of these drugs on global function, cognition, activities of daily living (ADL) and behavioural symptoms in patients with this disorder. These trials have been conducted for up to 12 months and were followed by open-label extension studies. One placebo-controlled, randomised clinical trial followed patients for up to 4 years. Both retrospective and prospective follow-up studies suggest a treatment effect for ChEIs that lasts for up to 5 years. Studies have shown comparable effects for ChEIs in patients with moderate-to-severe Alzheimer’s disease or mild Alzheimer’s disease. Clinically relevant responses consist not only of improvement over 3–6 months but also stabilisation and possibly slower than expected decline. Lack of overt clinical improvement in one domain (e.g. global function, cognition, ADL or behaviour) does not preclude clinically relevant benefit(s) in other domains.