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Changes in cognitive domains during three years in patients with Alzheimer's disease treated with donepezil.

Persson CM, Wallin AK, Levander S, Minthon L - BMC Neurol (2009)

Bottom Line: The early dropouts showed no improvement at six months and many dropped out due to side effects.Before dropping out, deterioration accelerated, particularly in the Spatial domain.As an aid we constructed three algorithms corresponding to the cognitive domains, which can be used to characterize patients initially, identify rapid decliners and follow the course of the disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Sciences in Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden. cecilia.persson@med.lu.se

ABSTRACT

Background: The objective was to identify separate cognitive domains in the standard assessment tools (MMSE, ADAS-Cog) and analyze the process of decline within domains during three years in Alzheimer's disease (AD) patients with donepezil treatment.

Method: AD patients (n = 421) were recruited from a clinical multi-centre study program in Sweden. Patients were assessed every six months during three years. All patients received donepezil starting directly after study entry. After dropouts, 158 patients remained for analyses over three years. Data for the other patients were analysed until they dropped out (4 groups based on length in study).

Results: Factor analyses of all items suggested that there were three intercorrelated factors: a General, a Memory and a Spatial factor for which we constructed corresponding domains. Overall there was a cognitive improvement at six months followed by a linear drop over time for the three domains. Some group and domain differences were identified. Patients who remained longer in the study had better initial performance and a slower deterioration rate. The early dropouts showed no improvement at six months and many dropped out due to side effects. The other groups displayed a performance improvement at six months that was less pronounced in the Memory domain. Before dropping out, deterioration accelerated, particularly in the Spatial domain.

Conclusion: The course of illness in the three domains was heterogeneous among the patients. We were not able to identify any clinically relevant correlates of this heterogeneity. As an aid we constructed three algorithms corresponding to the cognitive domains, which can be used to characterize patients initially, identify rapid decliners and follow the course of the disease.

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Related in: MedlinePlus

Domain scores over time for AD groups based on time in study. Scores are shown for patients only participating at study entry (N = 38) and 6-month completers (N = 39) (Subfigure A), for 12-month completers (N = 93) (B), for 24-month completers (N = 93) (C) and for 36-month completers (N = 158) (D). Domain scores represent z-scores based on the study entry session for all patients. In subfigure A, study entry patients are shown to the left with no lines.
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Figure 2: Domain scores over time for AD groups based on time in study. Scores are shown for patients only participating at study entry (N = 38) and 6-month completers (N = 39) (Subfigure A), for 12-month completers (N = 93) (B), for 24-month completers (N = 93) (C) and for 36-month completers (N = 158) (D). Domain scores represent z-scores based on the study entry session for all patients. In subfigure A, study entry patients are shown to the left with no lines.

Mentions: The development over time measured by the three cognitive domains, for the subgroups defined according to time in study is shown in Figure 2. Inspection of the diagrams suggests the following conclusions. The shorter a subject remains in the study, the more poor appears the domain scores at study entry to be, particularly the General and the Memory domain scores. The Memory domain seems to differ from the others by displaying no clear inverted U-shape (quadratic effect) during the first year. The downward slope of the lines appears to be less steep for the 3-year completers. The other groups seem to accelerate in deterioration before dropout.


Changes in cognitive domains during three years in patients with Alzheimer's disease treated with donepezil.

Persson CM, Wallin AK, Levander S, Minthon L - BMC Neurol (2009)

Domain scores over time for AD groups based on time in study. Scores are shown for patients only participating at study entry (N = 38) and 6-month completers (N = 39) (Subfigure A), for 12-month completers (N = 93) (B), for 24-month completers (N = 93) (C) and for 36-month completers (N = 158) (D). Domain scores represent z-scores based on the study entry session for all patients. In subfigure A, study entry patients are shown to the left with no lines.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2666627&req=5

Figure 2: Domain scores over time for AD groups based on time in study. Scores are shown for patients only participating at study entry (N = 38) and 6-month completers (N = 39) (Subfigure A), for 12-month completers (N = 93) (B), for 24-month completers (N = 93) (C) and for 36-month completers (N = 158) (D). Domain scores represent z-scores based on the study entry session for all patients. In subfigure A, study entry patients are shown to the left with no lines.
Mentions: The development over time measured by the three cognitive domains, for the subgroups defined according to time in study is shown in Figure 2. Inspection of the diagrams suggests the following conclusions. The shorter a subject remains in the study, the more poor appears the domain scores at study entry to be, particularly the General and the Memory domain scores. The Memory domain seems to differ from the others by displaying no clear inverted U-shape (quadratic effect) during the first year. The downward slope of the lines appears to be less steep for the 3-year completers. The other groups seem to accelerate in deterioration before dropout.

Bottom Line: The early dropouts showed no improvement at six months and many dropped out due to side effects.Before dropping out, deterioration accelerated, particularly in the Spatial domain.As an aid we constructed three algorithms corresponding to the cognitive domains, which can be used to characterize patients initially, identify rapid decliners and follow the course of the disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Sciences in Malmö, Clinical Memory Research Unit, Lund University, Lund, Sweden. cecilia.persson@med.lu.se

ABSTRACT

Background: The objective was to identify separate cognitive domains in the standard assessment tools (MMSE, ADAS-Cog) and analyze the process of decline within domains during three years in Alzheimer's disease (AD) patients with donepezil treatment.

Method: AD patients (n = 421) were recruited from a clinical multi-centre study program in Sweden. Patients were assessed every six months during three years. All patients received donepezil starting directly after study entry. After dropouts, 158 patients remained for analyses over three years. Data for the other patients were analysed until they dropped out (4 groups based on length in study).

Results: Factor analyses of all items suggested that there were three intercorrelated factors: a General, a Memory and a Spatial factor for which we constructed corresponding domains. Overall there was a cognitive improvement at six months followed by a linear drop over time for the three domains. Some group and domain differences were identified. Patients who remained longer in the study had better initial performance and a slower deterioration rate. The early dropouts showed no improvement at six months and many dropped out due to side effects. The other groups displayed a performance improvement at six months that was less pronounced in the Memory domain. Before dropping out, deterioration accelerated, particularly in the Spatial domain.

Conclusion: The course of illness in the three domains was heterogeneous among the patients. We were not able to identify any clinically relevant correlates of this heterogeneity. As an aid we constructed three algorithms corresponding to the cognitive domains, which can be used to characterize patients initially, identify rapid decliners and follow the course of the disease.

Show MeSH
Related in: MedlinePlus