Premium
P3‐283: REM SLEEP DISORDERS IN LEWY BODY DISEASE—OR MAY THERE BE ANOTHER REASON?
Author(s) -
Hager Klaus,
Kenklies Magdalene
Publication year - 2018
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.2018.06.1643
Subject(s) - citalopram , rem sleep behavior disorder , medicine , psychology , pediatrics , psychiatry , anesthesia , parkinson's disease , disease , anxiety , antidepressant
Background: Neuropsychiatric syndromes have been associated with risk and earlier onset of dementia, but it is unclear whether neuropsychiatric treatment may affect clinical changes in Alzheimer’s disease dementia (AD). This study aimed to investigate whether psychotropics may affect cognitive or functional changes in AD. Methods: Consecutive outpatients with late-onset AD according to National Institute on Aging – Alzheimer’s Association criteria were screened for demographic data and prospectively assessed for psychotropic therapy, the Mini-Mental State Examination (MMSE) and a 15-item Clock Drawing Test (CDT), while caregivers were queried for the Index of Independence in Activities of Daily Living (ADL) and Lawton’s Scale for Instrumental Activities of Daily Living (IADL), and followed for one year. Genotyping for rs7412&rs429358 (APOE gene) was undertaken with TaqMan Real-Time Polymerase Chain Reactions. Baseline behavioral symptoms were assessed according to the Neuropsychiatric Inventory, whereas anti-depressants, anti-psychotics and antiepileptic drugs entered the statistical model, significance at p<0.05. Results:Overall, 193 patients were included (mean age at AD onset 73.2966.4 years-old): 130 were female (67.36%), 103 were APOEε4 carriers (53.37%), 181 used a cholinesterase inhibitor (93.78%), 143 used Memantine (74.09%), 93 used anti-depressants (48.19%), 56 used anti-psychotics (29.02%) and 25 used anti-epileptic drugs (12.95%). Baseline neuropsychiatric burden was not significantly different according to APOE-ε4 carrier status (p1⁄40.9732). Scores in the MMSE, ADL and IADL were significantly lower after one year (p<0.0001), whereas scores in the CDT were marginally significantly lower (p1⁄40.0655). For APOE-ε4 carriers: use of anti-psychotics marginally slowed the decline in IADL (p1⁄40.0611), while use of anti-depressants and anti-epileptic drugs in combination slowed the decline in the MMSE (p1⁄40.0429). For APOE-ε4 non-carriers: use of anti-epileptic drugs accelerated the decline in ADL (p1⁄40.0114), while use of anti-psychotics marginally accelerated the decline in ADL (p1⁄40.0652) and in the MMSE (p1⁄40.0557). Conclusions:The results of this study support the prospective effects of psychotropic drugs over cognitive and functional changes in AD according to APOE-ε4 carrier status, considering a sample in which almost all patients regularly used a cholinesterase inhibitor. Psychotropics differentially affect clinical changes in AD according to APOE-ε4 carrier status, possibly due to genetically-mediated variable efficiency of neural repair mechanisms. (FAPESP grant #2015/10109-5.)