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P4‐277: Adverse drug effects in patients with Alzheimer's disease or another dementia: PEIMA study
Author(s) -
Laroche MarieLaure,
PéraultPochat MarieChristine,
KreftJais Carmen,
Castot Anne,
Ingrand Isabelle,
Merle Louis
Publication year - 2011
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2011.05.2313
Subject(s) - dementia , medicine , adverse effect , memantine , rivastigmine , pharmacovigilance , disease , alzheimer's disease , drug , pediatrics , donepezil , psychiatry
was predictive of acetylcholinesterase inhibitors (AChEI) response in patients with Alzheimer’s disease (AD), but few examined the effect of education level. This study was aimed to identify whether the effect of baseline cognition on AChEI response was modified by education level. Methods: A total of 257 mild to moderate AD patients, who received AChEI, were recruited from the neurology clinics of three teaching hospitals in northern Taiwan from 2007 to 2010. Mini-mental status examination (MMSE) was performed at baseline and at months 6 and 12 after the initiation of AChEI. The education level was classified as lower education ( 6 years) or higher education (> 6 years). Responders to AChEI treatment were defined as the improvement of MMSE score equaled to two points or greater between baseline and 6 months. Logistic regression was used to explore the association between baseline MMSE and AChEI response by education level (higher and lower). Results: About 90% patients completed 6 months while 72% completed 12 months of AChEI treatment. A significant improvement was observed at the 6 months in both AD patients with low and high education (mean MMSE change 1⁄4 0.9 6 2.6, 0.5 6 2.6, respectively). At the 12 months, a sustained improvement in MMSE score was observed among those with low education (12 month MMSE-baseline MMSE 1⁄4 0.99 6 3.12, p 1⁄4 0.0014). In contrast, among those with higher education, MMSE increased at 6 month and then decreased to slightly lower than baseline at 12 month (12 month MMSE-baseline MMSE 1⁄4 0.35 6 3.8, p 1⁄4 0.415). A lower baseline MMSE score was associated with better response to AChEI in those with higher education, after adjustment for age, gender, and apolipoprotein E (APOE) e4 status [odds ratio (OR) 1⁄4 0.82, 95% confidence interval (CI) 1⁄4 0.72-0.92]. Patients with the lowest quartile of baseline MMSE were 7 times more likely to be responders as compared with those in the highest quartile (95% CI 1⁄4 2.36-20.5). Education level alone was not predictive of AChEI response. Conclusions: AD patients with low education level have more sustained response to AChEI. Baseline MMSE is a useful predictor of AChEI treatment, especially in those with high education.