Heterogeneity of Response to Methylphenidate in Apathetic Patients in the ADMET 2 Trial.
Am J Geriatr Psychiatry
; 31(12): 1077-1087, 2023 12.
Article
em En
| MEDLINE
| ID: mdl-37385898
ABSTRACT
OBJECTIVE:
The Apathy in Dementia Methylphenidate Trial 2 (ADMET 2) found that methylphenidate was effective in treating apathy with a small-to-medium effect size but showed heterogeneity in response. We assessed clinical predictors of response to help determine individual likelihood of treatment benefit from methylphenidate.DESIGN:
Univariate and multivariate analyses of 22 clinical predictors of response chosen a priori.SETTING:
Data from the ADMET 2 randomized, placebo controlled multi-center clinical trial.PARTICIPANTS:
Alzheimer's disease patients with clinically significant apathy. MEASUREMENTS Apathy assessed with the Neuropsychiatric Inventory apathy domain (NPI-A).RESULTS:
In total, 177 participants (67% male, mean [SD] age 76.4 [7.9], mini-mental state examination 19.3 [4.8]) had 6-months follow up data. Six potential predictors met criteria for inclusion in multivariate modeling. Methylphenidate was more efficacious in participants without NPI anxiety (change in NPI-A -2.21, standard error [SE]0.60) or agitation (-2.63, SE0.68), prescribed cholinesterase inhibitors (ChEI) (-2.44, SE0.62), between 52 and 72 years of age (-2.93, SE1.05), had 73-80 mm Hg diastolic blood pressure (-2.43, SE 1.03), and more functional impairment (-2.56, SE1.16) as measured by the Alzheimer's Disease Cooperative Study Activities of Daily Living scale.CONCLUSION:
Individuals who were not anxious or agitated, younger, prescribed a ChEI, with optimal (73-80 mm Hg) diastolic blood pressure, or having more impaired function were more likely to benefit from methylphenidate compared to placebo. Clinicians may preferentially consider methylphenidate for apathetic AD participants already prescribed a ChEI and without baseline anxiety or agitation.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Demência
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Apatia
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Doença de Alzheimer
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Metilfenidato
Tipo de estudo:
Clinical_trials
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Prognostic_studies
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Revista:
Am J Geriatr Psychiatry
Assunto da revista:
GERIATRIA
/
PSIQUIATRIA
Ano de publicação:
2023
Tipo de documento:
Article