Long term use of cholinesterase inhibitors in the old population with Alzheimer disease.

What is it about?

Most of the clinical guidelines recommend discontinuing treatment with cholinesterase inhibitors (ChEIs) in patients with Alzheimer's disease (AD) who do not show an initial response (after three months of treatment) to therapy as evaluated with the MMSE scale. We aimed at investigating the relationship between short-term and long-term response to ChEI therapy in old age subjects with AD in a "real life" setting.In this retrospective longitudinal study we evaluated 628 old age subjects with AD divided into "young-old" (≤75 years) and "old-old" (≥76 years) and treated with ChEIs over three-year follow-up. In the long run, subjects considered as non-responders showed a lower rate of cognitive decline as compared with responders, with a mean annual decline at MMSE of 1.0 point versus 1.6 points (p < 0.0001), respectively. Old-old non-responders had a slower rate of cognitive (p < 0.0001) and functional decline (p < 0.0001) as compared with responders after three years of observation.

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Why is it important?

Discontinuing ChEI treatment solely for the absence of initial response is not appropriate, especially in old-old subjects.