Relationship between Eating Disturbance and Dementia Severity in Patients with Alzheimer’s Disease

Abstract Background Prolonged exposure to anticholinergic medication, particularly in midlife, is associated with increased risk of cognitive impairment/dementia. Less well explored is the ongoing use of drugs with anticholinergic properties in patients with Alzheimer’s Disease (AD), where the potential to accelerate cognitive decline may be greatest. Methods We analysed medication data from the NILVAD trial, a clinical trial examining the efficacy of Nilvadapine in mild-moderate Alzheimer’s Disease (AD). Drgs were coded based on their Anatomical Therapeutic Chemical (ATC) classification and Anticholinergic Burden Scale (ABS) applied to each participant’s medication list. Logistic and linear regression were used to model predictors of potential anticholinergic medication use/total ABS score. Results Of 510 participants with AD (mean age 72.8 +/-8.3 years; 62% female), just over one-quarter (N = 134, 26.27%) were prescribed a drug with potential/definite anticholinergic properties. Half of these had an anticholinergic burden score of 3 or greater (N = 67, 13.4%). The most frequent definite anticholinergics prescribed included quetiapine (N=27) oxybutynin (N = 22), paroxetine (N=14) and amitriptyline (N=8). Usage did not significantly differ by country or study arm. Overall, 88.43% of patients were prescribed a cholinesterase inhibitor. On multivariate analysis of potential/definite anticholinergic usage, age (p=0.044; OR 1.03, 1.01-1.06), total number of medications (p=0.001, OR 1.3, 1.18-1.41) as well as a greater dementia severity rated using the Alzheimer’s Disease Assessment Scale (ADAS-Cog) (p=0.008; 1.04 1.01-1.07) were associated with likelihood of anticholinergic use. Conclusion Over one-quarter of community-dwelling older patients with AD are prescribed a drug with potential or definite anticholinergic properties. Use of drugs with potential/definite anticholinergic properties were associated with total medication burden in addition to greater dementia severity at baseline. This is particularly pertinent given the deleterious cognitive effects of anticholinergic medication. Further attention to reducing total anticholinergic burden in patients with dementia is warranted.

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Is Ongoing Anticholinergic Burden Associated With Greater Cognitive Decline and Dementia Severity in Mild to Moderate Alzheimer’s Disease?

The Journals of Gerontology Series A ◽

10.1093/gerona/glz244 ◽

2019 ◽

Vol 75 (5) ◽

pp. 987-994 ◽

Cited By ~ 4

Author(s):

Adam H Dyer ◽

Claire Murphy ◽

Ricardo Segurado ◽

Brian Lawlor ◽

Sean P Kennelly ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Controlled Trial ◽

Anticholinergic Medication ◽

Clinical Dementia Rating ◽

Dementia Severity ◽

Increased Risk ◽

Clinical Covariates ◽

The Impact ◽

Anticholinergic Burden

Abstract Background Use of anticholinergic medication is associated with an increased risk of cognitive impairment and/or dementia. Despite this, the impact of continuing medication with anticholinergic properties in those diagnosed with Alzheimer’s Disease (AD) is not clear. Methods Analysis of data from NILVAD, an 18-month randomized controlled trial of Nilvadipine in AD. Effects of ongoing Anticholinergic Cognitive Burden (ACB) on cognition (ADAS-Cog: Alzheimer’s Disease Cog Subsection) and dementia severity (CDR-sb: Clinical Dementia Rating – Sum of Boxes/DAD: Disability Assessment for Dementia) over 18 months was evaluated adjusting for important clinical covariates. Results Just over one-quarter (27.90%, n = 142/510) of patients with mild to moderate AD were prescribed a potential/definite anticholinergic. While ACB score was not associated with greater progression on the ADAS-Cog/CDR-sb over time, a higher total ACB predicted greater dementia severity on the DAD, which persisted after robust covariate adjustment (β Coef: −1.53, 95% CI: −2.83 to −0.23, p = .021). There was a significant interaction between APOE ε4 status and ACB score, with carriers experiencing greater progression on both the CDR-Sb (β Coef: 0.36, 95% CI: 0.05–0.67, p = .021) and DAD (β Coef: −3.84, 95% CI: −7.65 to 0.03, p = .049). Conclusions Ongoing use of anticholinergic medication was associated with greater dementia progression on the DAD, but not the CDR-sb. APOE ε 4 carriers may be particularly vulnerable to the effect of ongoing anticholinergic medication on dementia severity, with significant APOE ε 4 x ACB score interactions demonstrated on both the DAD and CDR-sb.

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Increase in direct social care costs of Alzheimer's disease in Japan depending on dementia severity

Geriatrics and Gerontology International ◽

10.1111/ggi.13764 ◽

2019 ◽

Vol 19 (10) ◽

pp. 1023-1029 ◽

Cited By ~ 2

Author(s):

Hajime Takechi ◽

Atsuko Kokuryu ◽

Akira Kuzuya ◽

Shinji Matsunaga

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Social Care ◽

Dementia Severity ◽

Care Costs

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Premorbid intelligence estimation and level of dementia in Alzheimer's disease

Journal of the International Neuropsychological Society ◽

10.1017/s1355617700001727 ◽

1996 ◽

Vol 2 (6) ◽

pp. 551-555 ◽

Cited By ~ 20

Author(s):

A. Matt Maddrey ◽

C.M. Cullum ◽

M.F. Weiner ◽

C.M. Filley

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Word Reading ◽

Progressive Dementia ◽

Sight Word Reading ◽

Dementia Severity ◽

Premorbid Intelligence ◽

Adult Reading ◽

Iq Scores ◽

National Adult Reading Test

AbstractSimple sight-word reading tasks have demonstrated utility in the estimation of premorbid intelligence, although the effects of progressive dementia on such tasks has not been thoroughly examined. The present investigation sought to examine estimated IQ scores from the National Adult Reading Test-Revised (NART-R; Blair & Spreen, 1989) in relation to a WAlS-R-bascd (Wechsler, 1981) estimate of IQ in a series of patients with probable Alzheimer's disease across varying levels of dementia. Results suggest that while NART-R scores do show a decrement with dementia severity, this decline is mild, in contrast to traditionally based IQ scores and other measures of cognitive function, which show more marked declines. Similarly, compared with other tasks, the NART-R showed the strongest correlation with education across the sample as a whole, while the other indices were more related to level of dementia. These findings support the use of measures such as the NART-R in estimating premorbid intellectual functioning in patients at various levels of dementia severity, including those with more advanced cognitive deterioration. (JINS, 1996, 2, 551–555.)

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