Verbal repetition in patients with Alzheimer's disease who receive donepezil

• Published in: International journal of geriatric psychiatry Vol. 21; no. 5; pp. 426 - 431
• Main Authors: Asp, Elissa, Cloutier, France, Fay, Sherri, Cook, Cheryl, Robertson, Mary Lou, Fisk, John, Dei, Ding-Wai, Rockwood, Kenneth
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.05.2006; Wiley; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Alzheimer Disease - drug therapy; Alzheimer Disease - psychology; Alzheimer's disease; Biological and medical sciences; Cholinesterase Inhibitors - therapeutic use; Clinical outcomes; Cognition Disorders - drug therapy; Cognition Disorders - etiology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Donepezil; Drug therapy; Female; Follow-Up Studies; frontal lobe function; Fundamental and applied biological sciences. Psychology; Geriatric psychiatry; Geriatrics; Goal Attainment Scaling; Humans; Indans - therapeutic use; Male; Medical sciences; Memory, Short-Term; Neurology; Nootropic Agents - therapeutic use; Piperidines - therapeutic use; Psychiatric Status Rating Scales; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; repetition; Treatment Outcome; Verbal Behavior - drug effects; Verbal communication; Frontal lobe; Relapse; Alzheimer disease; Psychotropic; Esterases; Acetylcholinesterase; Goal; Language; Donepezil; Piperidine derivatives; Degenerative disease; Anticholinesterase agent; Alzheimer's disease; Repetition; Human; Nervous system diseases; Enzyme; Enzyme inhibitor; Patient; Antialzheimer agent; Goal Attainment Scaling; frontal lobe function; Carboxylic ester hydrolases; Cerebral disorder; Gerontology; Nootropic agent; Central nervous system disease; Hydrolases; Elderly; Geriatrics
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.1486

Background Current outcome measures for Alzheimer's disease (AD) drugs have been criticized as insufficiently patient‐centred. One commonly unmeasured goal of patients and caregivers is verbal repetition. Objectives We examined how often reducing repetition (of questions, statements or stories) was set as treatment goal, whether and when it responded, and how change in repetition correlated with change in other domains. Methods This is a secondary analysis of the open‐label Atlantic Canada Alzheimer's Disease Investigation of Expectations study of donepezil for mild‐moderate AD in 100 community‐dwelling people. Goal Attainment Scaling, an individualized account of the goals of treatment, was the primary outcome measure. Results Reducing repetition was a treatment goal in 46%, who were not systematically different from others. Of 18 patients in whom repetition improved for 9 months, 83% (15) showed a response at 3 months. Early (3‐month) response correlated best with the overall level of goal attainment (r = 0.74) and changes in leisure activities (r = 0.69) and social interactions (r = 0.68) compared with changes in cognition (r = 0.44) or behaviour (r = 0.11). Correlations with the ADAS‐Cog and MMSE change scores remained only modest (at 12 months = −0.25 and 0.19, respectively). Correlations with the CIBIC‐Plus were higher (−0.47 at 3 months and −0.43 at 12 months). Conclusion Diminution of repetition is common, and appears to mark response to cholinesterase inhibition in some patients. Responders generally also show improved cognition and function, perhaps as an aspect of improved executive function. Copyright © 2006 John Wiley & Sons, Ltd.