ABSTRACT
BACKGROUND: Cerebral white matter changes (WMC) represent cerebrovascular disease (CVD) and are common in dementia. Cholinesterase inhibitors (ChEIs) are effective in Alzheimer's Disease (AD) with or without CVD, and in Dementia with Lewy Bodies (DLB). Predictors of treatment response are controversial. OBJECTIVE: To investigate the effect of WMC severity on rate of progression of dementia during treatment with ChEIs. METHODS: CT or MRI brain scans were rated for WMC severity in 243 patients taking ChEIs for dementia. Raters were blind to patients' clinical risk factors, dementia subtype and course of illness. Effects of WMC severity on rates of decline in cognition, function and behaviour were analysed for 140 patients treated for 9 months or longer. Analysis was performed for this group as a whole and within diagnostic subgroups AD and DLB. The main outcome measure was rate of change in Mini Mental State Examination (MMSE) score. Secondary measures were rates of change in scores on the Cambridge Cognitive Examination (CAMCOG), Instrumental Activities of Daily Living (IADL) and Clifton Assessment Procedures for the Elderly - Behaviour Rating Scale (CAPE-BRS). RESULTS: There was no significant association between severity of WMC and any specified outcome variable for the cohort as a whole or for patients with AD. In patients with DLB, higher WMC scores were associated with more rapid cognitive decline. CONCLUSIONS: Increased WMC severity does not influence clinical response to ChEI treatment in AD, but may hasten deterioration in ChEI-treated patients with DLB.
Subject(s)
Brain/pathology , Cholinesterase Inhibitors/therapeutic use , Dementia/drug therapy , Dementia/pathology , Aged , Aged, 80 and over , Cognition Disorders/etiology , Cognition Disorders/pathology , Cognition Disorders/prevention & control , Dementia/psychology , Disease Progression , Female , Follow-Up Studies , Geriatric Assessment/methods , Humans , Magnetic Resonance Imaging , Male , Psychiatric Status Rating Scales , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Ischaemic vascular dementia shares risk factors with stroke. There is evidence that control of these risk factors may prevent or alter the course of vascular dementia. OBJECTIVE: To assess the effect of regular low-dose aspirin on outcomes for patients with vascular dementia. DESIGN: Retrospective analysis of hospital case-notes with further outcome information from telephone calls to general practitioners, social services and institutions. Comparison of outcomes for aspirin-treated and untreated patients. SETTING: One North London NHS Trust. PATIENTS: Seventy-eight patients with clinician's diagnosis of ischaemic vascular dementia, discharged from acute inpatient units between 1 January 1995 and 31 December 1997; 38 on aspirin. MAIN OUTCOME MEASURES: Survival times from dementia onset to institutionalization and death. RESULTS: Median survival time to institutionalization was 28 months and to death was 52 months. There was no overall difference between aspirin and non-aspirin groups for these outcomes. When data were stratified for social status, i.e. living alone or with carer when last at home, differences emerged for those living with carer. Aspirin was associated with a trend towards increased time to institutionalization (39 vs 22 months, p < 0.09) and a significant advantage in time to death (71 vs 27 months, p = 0.02). These effects were non-significant after statistical adjustment for confounding variables. CONCLUSIONS: The results support but do not prove a role for regular, low-dose aspirin in improving both life expectancy and survival at home for patients with vascular dementia. Compliance may be better in those living with a carer. Larger, prospective studies should be performed to confirm these findings. Cognitive and behavioural outcomes should also be studied.
