Effects of 21 months of acetylcholinesterase inhibitors on cognitive and functional decline in demented patients

Objectives: The aim of this study was to assess, in a natural setting, the development of cognitive, behavioral and functional performance of elderly dementia patients treated with acetylcholinesterase inhibitors (ChEIs) during a 21-month follow-up,. Another aim was to compare patterns of clinical changes in relation to the patients’ level of cognitive impairment at the beginning of the therapy. Method: Of the 1987 elderly demented patients seen at our unit, 143 met the inclusion/exclusion criteria, were followed for at least 21 months, and were thus included in the study. At the baseline and each control point (up to 21 months), patients were scored for Mini Mental State Examination (MMSE), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and the Neuropsychiatric Inventory. Results: After 21 months’ treatment with ChEIs, patients showed a significant reduction in MMSE, ADL and IADL values. The MMSE score decreased by -1.7 points/year (95%CI -2.1 ; -1.3), irrespective of initial cognitive level, and was lower that expected in non-treated patients (-3/-4 points/year). Conclusion: ChEI therapy is effective in slowing the progression of dementia, even in the long-term, irrespective of baseline cognitive level.