Abstract
BackgroundGalantamine has been approved for the treatment of Alzheimer’s disease (AD). However, there are few studies which have reported the association between cognitive responses and galantamine plasma concentration. The aim of this study was to determine the correlation between galantamine plasma concentration and the subsequent cognitive response following treatment in AD patients.MethodsAD sufferers who continuously took 8 mg/d galantamine for at least 6 months without previous exposure to other kinds of AChEI such as donepezil, rivastigmine, or memantine were included in this cohort study. The assessments included the Mini Mental Status Examination (MMSE), Clinical Dementia Rating Scale (CDR) and the Cognitive Assessment Screening Instrument (CASI). Each subdomain of the CASI assessment was conducted at baseline and after 6 months of galantamine. The plasma concentrations of galantamine were measured by capillary electrophoresis after 6 months of the treatment. Logistic regression was performed to adjust for age, gender, apolipoprotein E ε4 genotype status, and baseline score to investigate the association between galantamine plasma concentrations and the cognitive response.ResultsThe total sample consisted of 33 clinically diagnosed AD patients taking galantamine 8 mg/d for 6 months. There was no linear correlation between galantamine concentration and cognitive response in patients. However, 22 patients were responsive to the treatment in the long-term memory domain. In CASI subset domain, concentration improved during the 6 months follow up.ConclusionsIn the limited samples study, galantamine mostly benefitted the cognitive domain of long-term memory. The benefits were not related to the galantamine plasma concentration. Objective intra-individual evaluation of therapeutic response should be encouraged.
Highlights
Galantamine is one of the acetylcholinesterase inhibitors (AChEIs) that have been approved as the main treatment for mild to moderate Alzheimer’s disease (AD) (Lanctot et al, 2003; Pirttila et al, 2004; Wilcock, Lilienfeld & Gaens, 2000), which can inhibit enzymes from degrading acetylcholine
It is still to be determined whether higher galantamine plasma concentration is related to better therapeutic response—especially in Asia where, to our knowledge, no study has investigated the relationship between cognitive response and the plasma concentration of galantamine in AD patients
The cognitive responses, measured by the Cognitive Assessment Screening Instrument (CASI) assessment with its nine cognitive domains, were not significantly associated with the concentration of galantamine after adjusting for age, gender, apolipoprotein E (ApoE) ε4, education and baseline cognitive performance in the logistic regression model with Bonferroni corrections (Fig. 2)
Summary
Galantamine is one of the acetylcholinesterase inhibitors (AChEIs) that have been approved as the main treatment for mild to moderate Alzheimer’s disease (AD) (Lanctot et al, 2003; Pirttila et al, 2004; Wilcock, Lilienfeld & Gaens, 2000), which can inhibit enzymes from degrading acetylcholine. Previous studies have stated that several factors influence the treatment outcome, including sex, body weight, neuroanatomical characteristics, baseline cognitive function, gene polymorphism, cytochrome P450 and apolipoprotein E (ApoE) (Cacabelos et al, 2007; Chen & Hu, 2006; Geerts et al, 2005; MacGowan, Wilcock & Scott, 1998). It is still to be determined whether higher galantamine plasma concentration is related to better therapeutic response—especially in Asia where, to our knowledge, no study has investigated the relationship between cognitive response and the plasma concentration of galantamine in AD patients. The aim of this study was to determine the correlation between galantamine plasma concentration and the subsequent cognitive response following treatment in AD patients. Objective intra-individual evaluation of therapeutic response should be encouraged
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