Differential efficacy of treatment with acetylcholinesterase inhibitors in patients with mild and moderate Alzheimer's disease over a 6-month period.

There are various anticholinesterase inhibitors (AChEIs) for the symptomatic treatment of mild to moderate Alzheimer's disease (AD). All AChEIs have shown greater efficacy than placebo in randomized, double-blind, parallel-group clinical trials. No differential studies have yet been made of the efficacy between all AChEIs. The study aims to determine the differential efficacy of the AChEIs with respect to a historical sample of patients with AD that were not treated with AChEIs. An open-label, prospective, observational study with a retrospective control group was undertaken to examine the evolution of the cognitive function over a 6-month period. The patients were assessed with the Mini-Mental State Examination (MMSE) at study entry and at 6 months. A general linear model was applied for repeated measurements with the MMSE score as the dependent variable, treatment type as an independent variable and the severity of the deterioration, age and the MMSE baseline score as covariables. Of the sample of 147 patients, 40 initiated treatment with donepezil, 32 with galantamine, 30 with rivastigmine and 45 were part of a historical sample of the memory clinic patients between 1991 and 1996 that had not been treated with AChEIs. The average age was 73.7 years (SD = 6.9; range = 52-86), 67.3% were women, 78.2% of the cases were mild and the MMSE baseline score was 18.1 points (range = 11-27). No significant intergroup differences were observed in these variables. The average doses of donepezil, galantamine and rivastigmine were 5.87 mg/day (SD = 1.92), 14.81 mg/day (SD = 6.25) and 6.41 mg/day (SD = 1.82), respectively. At 6 months, the difference in the MMSE score with respect to the untreated group was 1.6 points for donepezil (95% CI 0.79-2.37; p < 0.001), 0.99 points for galantamine (95% CI 0.14-1.85; p = 0.01) and 0.90 points for rivastigmine (95% CI 0.05-1.74; p = 0.03). No significant differences were observed in the efficacy among the groups treated with AChEIs (p > 0.05). Treatment with AChEIs significantly delays the global cognitive impairment associated with AD for at least 6 months. Our study found no significant differences in efficacy between donepezil, galantamine and rivastigmine. Further studies in the context of daily clinical practice will determine the clinical significance of the changes observed. An important variability of the response to the treatment was observed in treated patients.

Neuropsychological profile of Alzheimer's disease in women: moderate and moderately severe cognitive decline.

INTRODUCTION: Alzheimer's disease (AD) is characterised by progressive cognitive and functional decline. There is evidence that AD is more prevalent in women. This study aims at identifying the clinical and sociodemographic variables associated with the cognitive functions and the pattern of decline in women with moderate to moderately severe AD. METHODS: Cross-sectional observational study of 165 women with dementia of the AD type according to NINCDS-ADRDA criteria. The cognitive functions were assessed using the Cambridge Cognitive Examination (CAMCOG). The sociodemographic and clinical data were collected from the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) interview, and the Neuropsychiatric Inventory (NPI) was administrated to the caregiver. RESULTS: The number of years of schooling and the score on the CAMDEX depression scale were the variables associated with the CAMCOG score. The effect of these variables was not homogenous for all the CAMCOG subtests. CONCLUSIONS: The number of years of schooling and the presence of depressive symptomatology influence the results of the neuropsychological exploration, but the effect is moderate and not homogenous for all the CAMCOG subtests. The differences in cognitive profile between moderate and moderately severe are characterised by a greater effect on temporal orientation, calculation and perception.

Incidencia clínica de la demencia por cuerpos de Lewy / Clinical incidence of dementia with Lewy bodies

Introducción y objetivos. El reconocimiento de la demencia por cuerpos de Lewy (DCL) como una entidad neurodegenerativa independiente es relativamente reciente. Aún se han realizado pocos estudios epidemiológicos de prevalencia que incluyan la DCL y no existen estudios de incidencia. El objetivo del presente trabajo es de terminar la incidencia clínica anual de la DCL. Pacientes y métodos. Estudio retrospectivo observacional del diagnóstico de todos los sujetos que acudieron a la UVAMID entre los años 1999 y 2001. La valoración clínica se realizó de modo estandarizado según el protocolo de la UVAMID, que incluye la historia clínica realizada a través de una entrevista al paciente y a un informador fiable, un examen médico general y neurológico, una exploración neuropsicológica y un conjunto de pruebas complementarias. Resultados. La incidencia en la práctica clínica de la DCL fue de 26/100.000 casos anuales. Por grupos de edad, se observó un aumento progresivo de la incidencia hasta el intervalo de 80-84 años y el 63 por ciento de los casos de DCL fueron hombres. Conclusiones. Los resultados del presente estudio señalan que los casos de DCL representaron el 2 por ciento del total de casos nuevos anuales. La principal limitación del presente trabajo es que los pacientes, al remitirse a consulta desde los centros de atención primaria, forman una muestra no representativa, clínicamente sesgada, que limita la extrapolación de los resultados (AU)

Introduction and aims. Dementia with Lewy bodies (DLB) has only relatively recently been acknowledged as an independent neurodegenerative entity. Until now few epidemiological prevalence studies have been carried out that include DLB and there are no studies about its incidence. The aim of this study is to determine the annual clinical incidence of DLB. Patients and methods. We performed an observational retrospective study of the diagnosis of all the individuals who were attended at the UVAMID (Memory and Dementia Assessment Unit) between 1999 and 2001. The clinical assessment was performed in a standardised manner following the UVAMID protocol, which includes the medical history, obtained by interviewing the patient and a reliable informant, a general medical and neurological check-up, neuropsychological exploration and a set of complementary tests. Results. The incidence of DLB in clinical practice was found to be 26/100,000 cases per year. By age groups, a progressive increase in incidence was seen until the 80-84 year old bracket and 63% of the cases of DLB were males. Conclusions. The results of this study show that cases of DLB made up 2% of the total number of new annual cases. The main limitation of this study lies in the fact that, because patients were referred to clinic from primary health care centres, they do not constitute a representative sample that is clinically unbiased, and this imposes restraints on the extrapolation of results (AU)

[Tolerance and adverse events of treatment with acetylcholinesterase inhibitors in a clinical sample of patients with very slight and mild Alzheimer s disease over a six-month period]. / Tolerancia y acontecimientos adversos del tratamiento con inhibidores de la acetilcolinesterasa en una muestra clínica de pacientes con enfermedad de Alzheimer de gravedad mínima y leve durante un período de seis meses.

INTRODUCTION: At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose. PATIENTS AND METHODS: We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6 month period. RESULTS: The sample was made up of 175 patients, of which 134 began therapy with 5 10 mg/day of donepezil and 41 with 6 12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil. CONCLUSIONS: The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine.

Tolerancia y acontecimientos adversos del tratamiento con inhibidores de la acetilcolinesterasa en una muestra clínica de pacientes con enfermedad de Alzheimer de gravedad mínima y leve durante un período de seis meses / Tolerance and adverse events of treatment with acetylcholinesterase inhibitors in a clinical sample of patients with very slight and mild alzheimer's disease over a six-month period

Introducción. Actualmente, en el tratamiento del deterioro cognitivo asociado a la enfermedad de Alzheimer (EA) se utilizan los inhibidores de la acetilcolinesterasa (iACh). Los efectos secundariosde estos fármacos se asocian al aumento de acetilcolina, lo que limita su efectividad, y se debe ajustar al paciente hasta la dosis máxima tolerada . Pacientes y métodos. Se realiza un estudio comparativoretrospectivo de la tolerancia y de los acontecimientos adversos (AA) de dos iACh en un grupo de pacientes con EA probable de gravedad mínima y leve durante un período de 6 meses. Resultados. La muestra la formaban 175 pacientes, de los cuales 134 iniciaron tratamiento con donepecilo en 5-10 mg/día y 41 con rivastigmina en 6-12 mg/día. El 20 por ciento de los pacientes presentaron AA y el 8 por ciento abandonó el tratamiento. Los trastornos gastrointestinales (TGI) fueron el principal AA observado (57,1 por ciento). El 6 por ciento de los pacientes tratados con donepecilo abandonaron el tratamiento a causa de los AA frente al 14,6 por ciento de los pacientes tratados con rivastigmina. Los pacientes tratados con rivastigmina presentaron una mayor incidencia de TGI y el riesgo relativo de presentar TGI fue 4,4 veces superior que en los pacientestratados con donepecilo. Conclusiones. Los TGI asociados al tratamiento con iACh son el principal motivo de abandono del tratamiento y se producen con mayor frecuencia en pacientes tratados con rivastigmina (AU)

Introduction. At present acetylcholinesterase inhibitors (AChEI) are used in the treatment of the cognitive deterioration associated with Alzheimer’s disease (AD). The side effects of these drugs are linked with the increase in acetylcholine, which limits their effectiveness, and must be adjusted to the patient close to the maximum tolerated dose. Patients and methods. We conducted a comparative retrospective study of the tolerance and the adverse events (AE) of two AChEI in a group of patients with very slight and mild probable AD over a 6-month period. Results. The sample was made up of 175 patients, of which 134 began therapy with 5-10 mg/day of donepezil and 41 with 6-12 mg/day of rivastigmine. 20% of the patients presented AE and 8% abandoned the treatment. Gastrointestinal disorders (GID) were the main AE observed (57.1%). Only 6% of the patients treated with donepezil abandoned the therapy because of the AE as opposed to 14.6% of the patients treated with rivastigmine. Patients treated with rivastigmine displayed a higher incidence of GID and the relative risk of presenting GID was 4.4 times higher than in the patients treated with donepezil. Conclusions. The GID associated to therapy with AChEI are the main reason for abandoning treatment and occur more frequently in patients treated with rivastigmine (AU)