Differential long-term cognitive, functional, and behavioral effects of cholinesterase inhibitors in Alzheimer's disease.
Published: 2006
Language: eng
Number of pages: 251
ISBN-13: 9780494219713
Description: Despite widespread use of second-generation cholinesterase inhibitors for the symptomatic treatment of Alzheimer's disease (AD), surprisingly little is known about possible long-term effects in different cognitive, functional and behavioral domains. This observational cohort study assessed detailed cognitive, functional and behavioral performance in 65 treated mild to moderate AD patients well-matched to 65 untreated AD patients within the same longitudinal study over one and two years. Results add to the body of evidence from double blind, placebo-controlled and open label trials in mild to moderate AD, suggesting that treatment with cholinesterase inhibitors may continue to show beneficial effects in overall cognition and selective cognitive functions and activities of daily living for up to two years. Specifically, functions mediated by the frontal regions may be particularly responsive to treatment benefits with cholinergic therapy. It is important to note that selective cognitive benefits were paralleled with functional benefits, which are more likely to be considered clinically relevant. The concept of strategic location of cerebrovascular disease was extended to cholinergic pathways in the treated subjects. Possible modulatory effects on responsivity to cholinergic therapy of cholinergic pathway subcortical hyperintensities were investigated in comparison to total white matter lesion burden. Patients with more subcortical hyperintensities in the cholinergic projections, but no greater overall white matter disease burden, showed less decline in some executive tasks compared to those with little involvement, suggesting that cerebrovascular compromise of the cholinergic pathways may contribute additively to the cognitive deficit in AD and be more amenable to cholinergic enhancement of frontal/executive tasks. The overall study results illustrate the importance of including executive function tasks as well as ADL inventories as outcome measures in evaluating pharmacotherapies in AD.
Notes: Source: Dissertation Abstracts International, Volume: 68-01, Section: B, page: 0109.

Thesis (Ph.D.)--University of Toronto, 2006.

Electronic version licensed for access by U. of T. users.