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Clinical meaningfulness of Alzheimer's Disease Assessment Scale–Cognitive subscale change in relation to goal attainment in patients on cholinesterase inhibitors
Author(s) -
Rockwood Kenneth,
Howlett Susan E.,
Hoffman Deborah,
Schindler Rachel,
Mitnitski Arnold
Publication year - 2017
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.2017.02.005
Subject(s) - psychology , donepezil , cog , confidence interval , cognition , alzheimer's disease , goal attainment scaling , medicine , disease , dementia , psychiatry , computer science , intervention (counseling) , artificial intelligence
The clinical meaningfulness of Alzheimer's Disease Assessment Scale–Cognitive subscale (ADAS‐Cog) subscale change is disputed. We compared 2‐ to 4‐point ADAS‐Cog changes with changes in Goal Attainment Scaling (GAS) and everyday function across initial ADAS‐Cog scores and treatment responses. Methods This exploratory analysis evaluated mild‐moderate Alzheimer's disease patients treated with donepezil (12 months) or galantamine (8 months). Clinical meaningfulness was defined as concomitant ADAS‐Cog and GAS changes of ±3 points and/or functional improvement. Results Patients with ≥3‐point ADAS‐Cog improvement significantly improved on GAS but not on standard tests of everyday function. ADAS‐Cog “no change” (≤±3 points) was seen with mean GAS improvement. Initial ADAS‐Cog improvement made endpoint improvement (ADAS‐Cog 3 points and GAS 1 point) more likely (odds ratio = 6.9; 95% confidence interval = 2.5–19.5). In contrast, initial deterioration made endpoint improvement unlikely (0.33; 0.14–0.64). Discussion ADAS‐Cog improvement and no change were each associated with GAS improvement. Initial ADAS‐Cog worsening was unlikely to result in later improvement. Clinical trial registration number ISRCTN26167328.