Skip to main content
SpringerLink
Log in

Report of ten years’ activity in an Alzheimer’s disease assessment unit

  • Short Communication
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and aims: After ten years’ treatment with cholinesterase inhibitors (AcheI) in Alzheimer’s disease (AD), we report here the activity of the Alzheimer’s Disease Assessment Unit of IRCCS C. Mondino, Pavia, Italy. Methods: From September 2000 to December 2007, 794 out-patients (of 2236 referred to our Assessment Unit for cognitive disturbances) with AD of mild to moderate degree were treated with cholinesterase inhibitors (M/F: 273/521, mean age 73.6± 8.4 yrs, range 52–85 yrs). Outcome measures were scores on Mini Mental State Examination (MMSE), ADL, IADL and Neuropsychiatric Inventory (NPI). Results: Mean treatment duration was 36.9±16.1 months. After three months’ treatment, MMSE scores remained stable (responders) in 60% of cases and improved (increase of 3 or more points — good responders) in 15%, with good preservation of autonomy. After 15 months, the percentage of “good responders” decreased to 7%, while after 15, 27 and 39 months the percentage of responders progressively decreased to 40%, 30% and 8%, respectively; greater impairment in instrumental with respect to basic everyday activities was noted. No variables capable of predicting the response to treatment were detected. The onset of behavioral disturbances caused significant (p<0.02) worsening of both cognition and function and, in 12% of cases, suspension of treatment. Conclusions: Our results therefore confirm the efficacy of AcheI in AD of mild to moderate degree even in a non-selected population; efficacy also seems to persist in long-term treatment. This report, although brief and mainly descriptive, can make a contribution to better knowledge of the usefulness of these drugs in AD of mild to moderate extent in everyday clinical practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Birks J. Cholinesterase inhibitors for Alzheimer’s disease. Cochraine Database Syst Rev 2006; 1: CD005593.

    Google Scholar 

  2. Birks J, Harvey R. Donepezil for dementia due to Alzheimer’s disease. Cochrane Database Syst Rev 2006; 1: CD001190.

    PubMed  Google Scholar 

  3. Hoklyn J, Mohany S, Yaffe K. Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer’s Disease. A meta-analysis. JAMA 2003; 299: 210–6.

    Google Scholar 

  4. Grimmer T, Kurz A. Effects of cholinesterase inhibitors on behavioural disturbances in Alzheimer’s disease: a systematic review. Drugs Aging 2006; 23: 957–67.

    Article  PubMed  CAS  Google Scholar 

  5. Caltagirone C, Bianchetti A, Di Luca M et al. Guidelines for the treatment of Alzheimer’s Disease from the Italian Association of Psychogeriatrics. Drugs Aging 2005; 22 (Suppl): 1–37.

    Article  PubMed  CAS  Google Scholar 

  6. Waldemar G, Dubois B, Emre M et al. Recommendations for the diagnosis and management of Alzheimer’s disease and other disorders associated with dementia: EFNS guidelines. Eur J Neurol 2007; 14: 1–26.

    Article  Google Scholar 

  7. Wild R, Pettit T, Burns A. Cholinesterase inhibitors for dementia with Lewy bodies. Cochrane Database Syst Rev 2003; 3: CD003672.

    PubMed  Google Scholar 

  8. Emre M, Aarsland D, Albanese A et al. Rivastigmine for dementia associated with Parkinson’s disease N Engl J Med 2004; 35: 2509–18.

    Article  Google Scholar 

  9. Poewe W, Wolters E, Emre M et al. EXPRESS Investigators. Long-term benefits of rivastigmine in dementia associated with Parkinson’s disease: an active treatment extension study. Mov Disord 2006; 21: 456–61.

    Article  PubMed  Google Scholar 

  10. Maidment I, Fox C, Boustani M. Cholinesterase inhibitors for Parkinson’s disease dementia. Cochrane Database Syst Rev 2006; 1: CD004747.

    PubMed  Google Scholar 

  11. Courtney C, Farrell D, Gray R et al. AD 2000 Collaborative Group. Long-term donepezil treatment in 565 patients with Alzheimer’s disease. Lancet 2004; 383: 2105–15.

    Google Scholar 

  12. National Council of Clinical Excellence. Alzheimer’s disease — donepezil, galantamine, rivastigmine (review) and memantine guidance. November 17; 2006.

  13. Getsios D, Migliaccio-Walle K, Caro J. NICE cost-effectiveness appraisal of cholinesterase inihibitors: was the right question posed? Were the best tools used? Pharmacoeconomics 2007; 25: 997–1006.

    Article  PubMed  Google Scholar 

  14. Lyle S, Grizzell M, Willmost S, Benbow S, Clark M, Jolley D. Treatment of a whole population sample of Alzheimer’s disease with donepezil over a 4-year period: lessons learned. Dementia Geriatr Cogn Disord 2008; 25: 225–31.

    Article  Google Scholar 

  15. Raschetti R., Maggini M, Sorrentino GC, Martini N, Caffari B, Vanacore N. A cohort study of effectiveness of acetylcholinesterase inhibitors in Alzheimer’s disease. Eur J Clin Pharmacol 2005; 61: 361–8.

    Article  PubMed  CAS  Google Scholar 

  16. Bellelli G, Lucchi E, Minicuci N et al. Results of a multi-level therapeutic approach for Alzheimer’s disease subjects in the “real world” (CRONOS project): a 36-week follow-up study. Aging Clin Exp Res 2005; 17: 54–61.

    PubMed  Google Scholar 

  17. Sinforiani E, Banchieri LM, Zucchella C, Bernasconi L, Nappi G. Cholinesterase inhibitors in Alzheimer’s disease: efficacy in a non-selected population. Funct Neurol 2003; 18: 233–7.

    PubMed  Google Scholar 

  18. Folstein MF, Folstein SE, McHugh PR. Mini Mental State; a practical method grading the cognitive status of patients for the clinician. J Psychiatry Res 1975; 12: 189–98.

    Article  CAS  Google Scholar 

  19. Mckhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34: 939–44.

    Article  PubMed  CAS  Google Scholar 

  20. Lawton MP. Scales to measure competence in everyday activities. Psychopharmacol Bull 1988; 24: 695–97.

    Google Scholar 

  21. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179–86.

    Article  PubMed  CAS  Google Scholar 

  22. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994; 44: 2308–14.

    Article  PubMed  CAS  Google Scholar 

  23. Seltzer B. Is long-term treatment of Alzheimer’s disease with cholinesterase inhibitor therapy justified? Drugs Aging 2007; 24: 881–90.

    Article  PubMed  CAS  Google Scholar 

  24. Raina P, Santaguida P, Ismaila A et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med 2008; 148: 379–87.

    Article  PubMed  Google Scholar 

  25. Qaseem A, Snow V, Cross T et al. Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med 2008; 148: 370–8.

    Article  PubMed  Google Scholar 

  26. Pariente A, Helmer C, Merliere Y, Moore N, Fourrier-Réglat A, Dartigues JF. Prevalence of cholinesterase inhibitors in subjects with dementia in Europe. Pharmacoepidemiol Drug Saf 2008; 17: 655–60.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Alzheimer’s Disease Assessment Unit/Laboratory of Neuropsychology, IRCCS C. Mondino, Institute of Neurology, Via Mondino 2, 27100, Pavia, Italy

    Elena Sinforiani MD, Chiara Zucchella, Chiara Pasotti, Michelangelo Bartolo & Giuseppe Nappi

Authors
  1. Elena Sinforiani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiara Zucchella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chiara Pasotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michelangelo Bartolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giuseppe Nappi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elena Sinforiani MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sinforiani, E., Zucchella, C., Pasotti, C. et al. Report of ten years’ activity in an Alzheimer’s disease assessment unit. Aging Clin Exp Res 21, 365–368 (2009). https://doi.org/10.1007/BF03324930

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324930

Keywords

Search

Navigation