2012 issue 3

Back

Volume 21, issue 3

Original article

Clinical predictors of response to cholinesterase inhibitors: results of an observational program concerning the use of cholinesterase inhibitors in the treatment of dementias

Tomasz Sobów1
1. Zakład Psychologii Lekarskiej, Katedra Nauk Humanistycznych, Uniwersytet Medyczny, Łódź
Postępy Psychiatrii i Neurologii 2012; 21(3): 191–198
Keywords: dementia, cholinesterase inhibitors, cognitive dysfunction, behavioral symptoms, treatment response, predictors

Abstract

Objectives. To evaluate the effectiveness of cholinesterase inhibitors (ChEI) in the treatment of dementias in routine clinical practice and to identify clinical predictors of treatment outcome in terms of cognition and neuropsychiatric symptoms.
Method. The total of 3080 patients treated by 220 medical specialists in routine clinical practice participated in the open, observational, non-interventional clinical trial. The data recorded on uniform observation sheets were prospectively collected during 6 months. Treatment outcomes of 900 randomly selected patients were analyzed.
Results. A clinically meaningful response (defined as an increase in the MMSE scores by at least 3 points or a change in dementia severity as measured by the FAST scores) was observed in 12% of patients, while in 73‒82% of the sample (depending on the measure used) no change was found in the clinical status. The prevalence of a majority of behavioral symptoms was reduced during the trial, so was the use of some psychotropic drugs. The best treatment outcomes (measured by the ratios of arbitrarily defined improvement or deterioration) were noticed in the vascular dementia group, while the poorest response was attained in patients diagnosed with dementia with parkinsonism. Multiple logistic regression analysis showed that positive predictors of clinical response to treatment included, besides dementia type, also lower baseline MMSE scores (i.e. higher dementia severity), longer duration of cognitive impairments, and the presence of depression/tearfulness and anxiety, while the presence of apathy at baseline was a significant predictor of poor prognosis. Neither the type of ChEI administered (rivastigmine or donepezil) nor the patient's age had a significant effect on the treatment outcome and drug tolerance.
Conclusions. Cholinesterase inhibitors are moderately effective in the treatment of dementias, in terms of both cognitive dysfunction and behavioral symptoms. Comorbid vascular pathology not only should not be considered a contraindication to ChEI therapy, but even proved to be a predictor of positive clinical response. No clinically relevant variation in the treatment response depending on the type of ChEI used (rivastigmine or donepezil) was noted in the study.

Address for correspondence:
dr hab., prof. nadzw. Tomasz Sobów
Centralny Szpital Kliniczny Uniwersytetu Medycznego w Łodzi
ul. Czechosłowacka 8/10, 92-216 Łódź
e-mail: tomasz.sobow@umed.lodz.pl