P3‐108: Gait and cognitive function among elderly individuals with Alzheimer's disease, mild cognitive impairment (MCI) and no Alzheimer's or MCI

Abstract

Background: Verbal repetition (repetitive stories, questions) is a common, troubling, but comparatively under-studied problem in people with Alzheimer’s disease (AD). Clinically meaningful change in verbal repetition following cholinesterase inhibitor treatment can track the overall treatment effect. When such an effect might be discerned is less clear. Here, we evaluated how soon after treatment a change in verbal repetition might be identified, and whether the effect was sustained. Methods: Patients attending a Canadian tertiary care memory clinic and their care partners were asked to target 4-6 symptoms for treatment. Diagnoses were made using standardized criteria. Symptoms were defined using the 60-item SymptomGuide , which includes verbal repetition. At each visit, symptoms were tracked using a 7 point scale anchored at 0 (no change) to +/3 (very much better/very much worse). Time-to-event (improvement/worsening) was defined as the time from entry to the first non-zero score. We tracked both change in symptoms and the Mini-Mental State Examination (MMSE) score. The time-to-event distribution was calculated using the Kaplan-Meyer estimator. Between group (better/worse) differences were calculated using the log rank test, significant at P<0.05.Results:Of 243 patients with AD in whom a verbal repetition tracking goal was set, 107 (44%) had clinically meaningful change in symptoms, of whom 69 also had corresponding MMSE score changes. Of the 37 patients who improved, the median time to improvement was 43 days range (1-594). By two years, 88% of those with initial improvement also showed final visit improvement in bothMMSE and symptoms. Of the 32 patients whoworsened, the median time to both symptom andMMSE worsening was 164 days range (1-720). By two years, 85%who initially had shown worsening were also worse at their final visit. Conclusions: In evaluating the impact of a cholinesterase inhibitor on verbal repetition, half the cases of clear improvement were detected by 6 weeks, and half those with clear worsening by six months; both corresponded to two year effects. Simple clinical inquiries can help track the impact of AD treatment.