In many of the first treatment trials with tacrine, heterogeneity in treatment response was observed and discussed. One third of the patients were considered to be responders to treatment, one third unchanged and one third non-responders. Factors outlined as possible positive predictors of treatment were among others old age, well preserved frontal lobes, and presence of the APOE e4 allele. Unfortunately, the issue of heterogeneity in treatment response has not been addressed in most of the recent studies with cholinesterase inhibitors. Tools for evaluating treatment response are called for. 435 patients with the clinical diagnosis of Alzheimer’s disease received treatment with donepezil in The Swedish Alzheimer Treatment study. This is an open, prospective, multicenter study in a routine clinical setting. The patients were assessed at baseline, at 2 months and every 6 months after baseline for a total period of three years. MMSE and CIBIC were two of the primary efficacy parameters. The aim of this presentation was to examine the heterogeneity of response and to look for predictors of treatment response. Two methods to evaluate response were tested. Patients were divided into 3 groups: responders, unchanged, and non-responders as defined by the CIBIC rating or the MMSE-change from baseline. Responders had CIBIC 1-3 or MMSE- change of more than +2 points, unchanged had CIBIC 4 or MMSE-change of ±1 or 0 and non-responders had CIBIC 5-7 or MMSE change of −2 or more. Of the patients remaining in the study 34% were responders at 2 months, 28% at 6 months and 20% at 12 months using the CIBIC rating and respectively 34%, 34% and 24% using the MMSE rating. With both methods severity of disease at baseline was a positive predictor of treatment response but age at onset, age at baseline, APOE genotype, duration or gender were not. Patients that were non-responders at 6 and 12 months dropped out significantly earlier than patients that were responders or unchanged. In conclusion: This study clearly demonstrates an existing heterogeneity of treatment response to Donepezil in Alzheimer’s disease and that this has clinical consequences. Simple methods such as CIBIC or MMSE can both be valuable to evaluate response. Severity of disease was a factor influencing the response.
|Published - 2005
|12th Congress of the International Psychogeriatric Association - Stockholm, Sweden
Duration: 2005 Sept 20 → …
|12th Congress of the International Psychogeriatric Association
|2005/09/20 → …
Subject classification (UKÄ)