Abstract Details

Title Cholinesterase Inhibitor Use and Cognitive Decline in Mild Cognitive Impairment and Mild Dementia due to Alzheimer Disease

Topic Aging and Dementia

Presentation(s) P5 - (-)

Poster/Presentation
Number 410

Background Cholinesterase inhibitors (ChEIs) are approved for the symptomatic treatment of Alzheimer disease (AD) but their efficacy is uncertain in mild cognitive impairment (MCI) despite its frequent use. We investigated whether the use of ChEIs benefits cognitive outcomes in MCI compared with mild AD dementia (ADdem).

Objective

Design/Methods Data from 2,264 individuals clinically diagnosed with ADdem (Clinical Dementia Rating [CDR]=0.5 or 1) or MCI due to AD(MCI-AD) at Alzheimer Disease Centers were available from the National Alzheimer’s Coordinating Center’s Uniform Data Set (UDS). Multivariable linear mixed models were run separately for MCI-AD and ADdem to examine the annual change in the CDR sum of boxes (CDR-SB). We compared slopes before and after ChEI initiation among ChEI users, and then compared change in scores during the entire UDS follow-up in ChEI users versus non-users.

Results 35% of 966 MCI-AD and 72% of 1,298 ADdem participants were ChEI users. In both groups, ChEI users had higher education, were less often African American/other race, and more often had at ?1 APOE e4 allele (p<0.05). Comparing the slopes before and after ChEI initiation, the decline was significantly steeper at ChEI initiation in both groups (e.g., CDR-SB change in MCI-AD: 0.03 points/year before initiation, 0.85 points/year after initiation). Comparing change in scores over the entire UDS follow-up, ChEI users in both the MCI-AD and ADdem groups had a significantly faster cognitive decline compared to the ChEI non-users (e.g., CDR-SB change in MCI-AD: 0.70 points/year among ChEI users, 0.21 points/year among non-users).

Conclusions Preliminary evidence from this study unexpectedly suggests that ChEI prescription and use in individuals with MCI-AD or ADdem may not improve the overall course. This faster decline seen in ChEI users after ChEI initiation may imply the expected decline that resulted in ChEI use.

Authors/Disclosures
Jee-young Han, MD (Washington University in St. Louis)	Dr. Han has nothing to disclose.
Lilah M. Besser (National Alzheimer'S Coordinating Center)	No disclosure on file
Chengjie Xiong, PhD (Washington University School of Medicine)	Chengjie Xiong has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for DIADEM.
Walter A. Kukull, PhD, FAAN (Univ. of Washington)	No disclosure on file
John C. Morris, MD, FAAN (Washington University)	Dr. Morris has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CBR International Advisory Board. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cure Alzheimers Fund. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for LEADS Steering Commitee. The institution of Dr. Morris has received research support from NIH grants. Dr. Morris has received intellectual property interests from a discovery or technology relating to health care. Dr. Morris has received intellectual property interests from a discovery or technology relating to health care.