IngentaConnect A Naturalistic Study of Galantamine for Alzheimers Disease

Abstract:

Objective: To collect descriptive data on the treatment of Alzheimer's disease with galantamine under naturalistic conditions.

Study design: This was a prospective, open-label, observational study.

Patients: Subjects (n = 345) with mild to moderately severe dementia of the Alzheimer's type were recruited from 48 hospitals in Australia.

Methods: Subjects were enrolled and received treatment with galantamine for 6 months in a clinical practice setting. Subjects were assessed at baseline and 3 and 6 months after starting treatment using the Mini-Mental State Examination (MMSE), the Clinician's Interview-Based Impression of Change plus Caregiver Input (CIBIC-plus) and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) [the latter only if the baseline MMSE score was at least 25]. Subjects were also assessed using an abridged Instrumental Activities of Daily Living (IADL) questionnaire that included questions on using the telephone, ability to travel more than 1km outside the home, taking medications and managing money, and an 11-item behaviour assessment scale that measured aggression, sleep disturbance, disinhibition, personality changes, irritability, depression, agitation, apathy, inertia, hallucinations and aberrant motor behaviour.

Results: Of the 345 subjects who were enrolled in the study (intent-to-treat [ITT] population), 229 completed the baseline, 3- and 6-month visits (per-protocol [PP] population). The mean age of the PP population was 78.0 ± 6.8 years.

At 6 months, most PP subjects (70%) showed an increase in MMSE score compared with baseline, with a mean increase in score of 2.0 ± 3.1 points from a baseline of 20.8 ± 4.2 points. In the ITT population, 44% of subjects (151/345) showed an increase in MMSE after 6 months. If data were unavailable the patient was classified as a nonresponder. Of the 21 PP patients who were assessed using ADAS-cog, 18 (86%) demonstrated a decrease in the ADAS-cog score, reflecting an improvement in cognition. Of the ITT population, 33% (19/57) had a decreased ADAS-cog score after 6 months.

Most PP subjects (86%) were considered responders according to the CIBIC-plus score, with 65% showing some improvement over 6 months of treatment. Of the ITT population, 54% (187/345) showed no deterioration in CIBIC-plus score after 6 months.

No deterioration in IADL or behaviour assessments occurred in the majority of PP subjects over 6 months.

Conclusions: In a clinical practice setting, the majority of subjects receiving galantamine who completed the study maintained their ratings of cognition, function, behaviour or global assessment over the 6-month period.

Keywords: Alzheimer's disease; Antidementias; Cholinesterase inhibitors; Galantamine

Document Type: Research article

Affiliations: 1: 1 Academic Department for Old Age Psychiatry, School of Psychiatry, University of New South Wales and Prince of Wales Hospital, Randwick, New South Wales, Australia 2: 2 Austin Health, Heidelberg Repatriation Hospital, Heidelberg West, Victoria, Australia 3: 3 Neurology Department, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia 4: 4 Medical Research Department, Janssen-Cilag Pty Ltd, North Ryde, New South Wales, Australia

A Naturalistic Study of Galantamine for Alzheimer's Disease