Background: Alzheimer’s disease (AD) patients experiencing more rapid symptom progression are likely to have a poorer prognosis than those experiencing slow symptom progression. In a recent retrospective analysis, treatment effects of rivastigmine were more pronounced in AD patients with rapid cognitive decline than in those with slow cognitive decline. This warranted further investigation. Methods: Rapidly and slowly progressing patients were identified by rates of cognitive decline [≧4 points and <4 points, respectively, on the Alzheimer’s Disease Assessment Scale – cognitive subscale (ADAS-cog)] during 26 weeks of placebo treatment in four randomized controlled trials (weeks 0–26). This meta-analysis evaluated rates of cognitive decline in both subgroups during subsequent open-label rivastigmine 26-week extension studies (weeks 26–52). A longitudinal mixed effects model compared cognitive decline in rapidly and slowly progressing patients, including correction for possible regression to the mean. Results: 180 (75%) rapidly and 337 (78%) slowly progressing patients provided ADAS-cog data after 26 weeks of open-label rivastigmine treatment. Improvements in cognitive symptoms were observed during the first 12 weeks, which were more pronounced in patients with rapid progression than in those with slow progression. Rapidly progressing patients experienced significantly greater cognitive benefits than slowly progressing patients (p = 0.029), who experienced a modest decline in cognitive symptoms at the end of the study. Comment: Patients experiencing rapid symptom progression may receive greater benefit from rivastigmine than those with slow progression. In this study, cholinesterase inhibition appeared to be of particular utility in the management of AD patients whose symptoms were rapidly worsening.
© 2005 S. Karger AG, Basel
- Cholinesterase inhibitor
- Alzheimer’s disease
- Rapid progression
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Dr. Martin R. Farlow
Department of Neurology, Clinical Building, Room 299
541 Clinical Drive, Indiana University School of Medicine
Indianapolis, IN 46202-5111 (USA)
Tel. +1 317 274 2893, Fax +1 317 278 3930, E-Mail firstname.lastname@example.org
Disclosures: Dr. Martin Farlow receives grants from Novartis, Pfizer, Forest Laboratories, Eunoe Inc., Janssen, Eli Lilly and Co., Elan and Pharmanet LLC. Dr. Farlow has acted as a paid consultant for Novartis, Janssen, Eli Lilly and Co., Best Practice, Memory, and Accera Inc., and is on speaker bureaus for Novartis, Forest Research, and Eisai/Pfizer. Dr. Gary Small reports having been a consultant for, having served on advisory boards for, and having received honoraria for lectures from Pfizer, Eisai, Novartis, Lilly, Organon, Forest, Janssen, Abbott, Memory Fitness Institute, Amersham, and CTI. Dr. Peter Quarg and Andreas Krause are employees of Novartis Pharma AG, Basel, Switzerland.
Accepted: March 7, 2005
Published online: August 3, 2005
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 2, Number of References : 24
Dementia and Geriatric Cognitive Disorders
Vol. 20, No. 2-3, Year 2005 (Cover Date: Released August 2005)
Journal Editor: Chan-Palay, V. (New York, N.Y.)
ISSN: 1420–8008 (print), 1421–9824 (Online)
For additional information: http://www.karger.com/dem
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