Association of acetylcholinesterase inhibitor and memantine treatment with cognitive function in patients with clinical dementia syndrome with and without post‐mortem Alzheimer pathology

Abstract

AbstractBackgroundAcetylcholinesterase inhibitors (AchE‐I) and memantine are licensed and recommended for the treatment of dementia of Alzheimer type (DAT). Between 10 and 20 % of patients with DAT, however, do not have Alzheimer’s disease (AD) pathology. It remains unclear, if these patients also benefit from treatment. This project aims to examine the association of AchE‐I and memantine use with cognitive function in patients with DAT with and without evidence of AD pathology at autopsy.MethodThis study is based on The National Alzheimer‘s Coordinating Center‐Uniform Data Set (NACC‐UDS). Inclusion of participants for this analysis was based on the following criteria: 1) Diagnosis of DAT, 2) information on the extent of AD‐neuropathological change at autopsy (ABC score high/intermediate/low/not), 3) follow‐up time ≥ 6 months, 4) ≥ 2 Mini‐Mental State Examinations (MMSE) during follow‐up.Result1483 participants with 3.8 ± 1.7 visits met inclusion criteria. Of these, 1009 participants showed an ABC score of “high”, 265 of “intermediate” and 209 of “low/not”. Use of AD‐medication was more common in participants with pronounced AD pathology (ABC score “high”: 89 %, “intermediate”: 66 %, “low/not”: 53 %). Follow‐up time was 41 ± 23 months in participants with medication compared to 36 ± 24 months in participants without medication. In the group of participants with an ABC score of “high” and “intermediate”, those with treatment showed a baseline MMSE score of 23 ± 5 and a decline of 8 ± 6 points, while those without treatment scored 26 ± 4 at baseline with a decline of 4 ± 6 points. In the cohort of participants with an ABC score of “low” and “not”, both groups with and without medication showed a baseline MMSE score of 26 ± 4 points with a decline in those with medication of 6 ± 6 points and of 3 ± 4 points in those without medication.ConclusionThe present descriptive analysis does not provide evidence for a clear association of treatment with AD medication and the presence of AD pathology in patients with DAT. Modelling analyses including covariates will be presented.