Outcome of Alzheimer's disease: Potential impact of cholinesterase inhibitors

Background. Alzheimer's disease is fast becoming a major public health concern with serious economic consequences. The cholinesterase inhibitors (CEIs) offer some benefit in the symptomatic treatment of the disease. This study aims to investigate the effect of CEIs on three clinically relevant domains (rapid cognitive decline, institutionalization, and weight loss) in patients with Alzheimer's disease. Methods. A prospective observational study was performed in which a population of 455 Alzheimer's disease patients were recruited and followed up for at least I year between 1994 and 2002. Patients were reevaluated at 6 monthly intervals using standardized neurocognitive and geriatric evaluations in addition to complete clinical examination, standard paraclinical investigations, and recording of treatment received. Results. The risk of rapid cognitive deterioration was significantly decreased in patients taking CEIs for at least I year compared to untreated patients (odds ratio [OR] = 0.56, 95% confidence interval [01, 0.34-0.93; p =.025). The potential benefit of CEI use was also found on institutionalization (OR = 0.2, 95% Cl, 0.08-0.48; p <.001) and weight loss (OR = 0.56, 95% CI, 0.32-0.97; p =.039) after I year of follow-up. Conclusion. The special interest of this study is that all patients were recruited and followed in the same center with the same management care plan and the same medical team. This follow-up offers us a unique opportunity to compare the I-year evolution of the disease in clinical practice before and after the marketing of CEIs and allows us to demonstrate a clinically significant improvement in patient outcome over time.