Carina Wattmo | Lund University (original) (raw)

Papers by Carina Wattmo

Research paper thumbnail of Cholinesterase inhibitors do not alter the length of stay in nursing homes among patients with Alzheimer's disease: a prospective, observational study of factors affecting survival time from admission to death

BMC neurology, Jan 31, 2016

The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by soc... more The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by sociodemographic/clinical characteristics, rate of disease progression, and use of specific medications and community-based services. Whether different aspects of cholinesterase inhibitor (ChEI) therapy modify time spent in NHs is unclear. Therefore, we examined the relationship between these potential predictors and survival time in NHs. This prospective, multicenter study of ChEI treatment in clinical practice included 220 deceased patients clinically diagnosed with mild-to-moderate AD who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) performance, ChEI dose, and amount of services used/week were evaluated every 6 months over 3 years. Dates of nursing-home placement (NHP) and death were recorded. Variables that determined survival time in NHs were analyzed using general linear models. The mean survival time in NHs was 4.06 years (men, 2.78 years; wom...

Research paper thumbnail of Response to the Letter From Abid Iraqi, MD, CMD and Terry Hughes, RN, CS

Journal of the American Medical Directors Association, 2017

Research paper thumbnail of Prevalence of Dementia With Lewy Body Symptoms: A Cross-Sectional Study in 40 Swedish Nursing Homes

Journal of the American Medical Directors Association, 2016

To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nurs... more To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nursing home (NH) residents in Malmö, the third largest city in Sweden. DLB is a neurocognitive disorder with core features, such as parkinsonism, visual hallucinations, and fluctuating cognition/excessive daytime sleepiness, and supportive features, such as rapid eye movement sleep behavior disorder. DLB is often misdiagnosed and unrecognized in elderly individuals. A questionnaire, designed to cover the main DLB symptoms, according to consensus criteria from the third report of the DLB Consortium from 2005, was distributed in 40 NHs. The questionnaires were completed by the nursing staff after receiving specifically designed teaching. Medication lists were collected from the Swedish national medication dispensing system. Nursing homes. Of 650 eligible residents, 620 (96%) were included. The mean age was 86.0 ± 7.5 years; 467 (75%) were women. We found a prevalence of 16% of 2 or more main symptoms of DLB in the NH residents. However, when a wider more inclusive parkinsonism variable was used, the prevalence of DLB symptoms increased to 20%. We conclude that elderly with 2 or more DLB symptoms may constitute between 16% and 20% of all residents in NHs. This emphasizes the importance of identification of DLB and guides clinicians to deliver appropriate treatment for this fragile patient group.

Research paper thumbnail of Long-term outcome and prediction models of activities of daily living in Alzheimer disease with cholinesterase inhibitor treatment

Alzheimer Disease and Associated Disorders, 2011

In untreated patients with Alzheimer disease (AD) the functional ability is gradually lost. What ... more In untreated patients with Alzheimer disease (AD) the functional ability is gradually lost. What happens to the patients after continuous long-term cholinesterase inhibitor (ChEI) treatment is less investigated. The objective of this study was to describe the longitudinal functional outcome and analyze factors affecting the outcome in ChEI-treated patients. In an open, 3-year, nonrandomized, prospective, multicenter study in a routine clinical setting, 790 patients were treated with either donepezil, rivastigmine, or galantamine. At baseline and every 6 months, they were assessed with several rating scales including Instrumental Activities of Daily Living (IADL), Physical Self-Maintenance Scale (PSMS), and Mini-Mental State Examination (MMSE). A faster functional decline was associated with lower cognitive ability at baseline, older age, and the interaction of higher education and longer time in the study. The patients residing with a spouse or relative showed slower deterioration in IADL score. A higher mean dose of ChEI, regardless of drug agent, was also related to slower instrumental ADL decline. Prediction models for longitudinal functional outcome were provided. AD severity at baseline is a key factor in obtaining reliable clinical prognoses of the long-term ADL ability. The dosage of ChEI treatment could possibly lead to a different functional outcome.

Research paper thumbnail of Mild versus Moderate Stage of Alzheimer’s Disease—Three-year Outcomes of Cholinesterase Inhibitor Therapy in a Routine Clinical Setting

Research paper thumbnail of Early- versus late-onset Alzheimer's disease: 3-year outcomes of cholinesterase inhibitor treatment in routine clinical practice

F1000posters, Feb 3, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Various outcomes of cholinesterase inhibitor treatment influence survival of patients with Alzheimer's disease

F1000posters, Mar 26, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Two-year outcome of Galantamine treatment in Alzheimer’s disease in a routine clinical setting

Research paper thumbnail of Alzheimer's disease - Safety and dropout in long-term galantamine treatment in a routine clinical setting

New Trends in Alzheimer and Parkinson Related Disorders Adpd 2007, 2007

Research paper thumbnail of The effect of functional capacity and concomitant medications on life expectancy in Alzheimer's disease

F1000posters, May 21, 2015

Research paper thumbnail of Lack of orthostatic symptoms in dementia patients with orthostatic hypotension

Clinical Autonomic Research Official Journal of the Clinical Autonomic Research Society, 2015

Orthostatic hypotension (OH) is common and increases with age. OH is part of the autonomic dysfun... more Orthostatic hypotension (OH) is common and increases with age. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB). Commonly OH is diagnosed when the patient falls which is a risk factor of premature death. Our objective was to systematically investigate the clinical symptoms associated with measurement of OH in different neurodegenerative dementias and normal controls (NC). 154 patients [50 DLB, 50 Alzheimer's disease (AD), 54 AD and vascular components (ADvasc)] were examined with systolic and diastolic blood pressure measurements in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. They were compared with 50 NC. Orthostatic symptoms were registered according to a predefined protocol. Twenty-seven percent of all the investigated individuals reported OH symptoms during the measurement while 43 % fulfilled the criteria of OH. Sixty-three percent of orthostatic patients did not have any symptoms during the measurement. The prevalence of any orthostatic symptoms during the measurement differed significantly (p < 0.001) between the diagnostic groups with 40 % in DLB patients, 37 % in ADvasc, 28 % in AD and 2 % in NC. The most frequent symptom was dizziness 13.7 %. Classical orthostatic symptoms are absent in the majority of dementia patients with OH. The orthostatic reaction must therefore be routinely measured in this patient group. This is particularly important for patients with DLB where falls as a result of OH are common.

Research paper thumbnail of Plasma concentration of galantamine - influence of dose and body mass index in Alzheimer's disease

F1000posters, May 21, 2015

Research paper thumbnail of Three-year outcome of Galantamine treatment in Alzheimer's disease in a routine clinical setting

F1000posters, May 21, 2015

Long-term galantamine treatment in a routine clinical setting was safe and resulted in a positive... more Long-term galantamine treatment in a routine clinical setting was safe and resulted in a positive effect in cognitive tests compared to historical controls and mathematical models. After 3 years of treatment a positive global outcome was observed in more than 40% of the patients. Dropout was less than expected.

Research paper thumbnail of Long Term Outcome and Prediction Models of Cognition, Activities of Daily Living and Nursing Home Placement in Alzheimer’s Disease with Cholinesterase Inhibitor Treatment

Lund University Faculty of Medicine Doctoral Dissertation Series, 2011

Summary in Swedish / Populärvetenskaplig sammanfattning på svenska 13

Research paper thumbnail of Evaluation of Systolic and Diastolic Hypotension in Dementia with Lewy Bodies and Alzheimer’s Disease

Healthy Aging Clinical Care in the Elderly, 2013

BACKGROUND: Orthostatic hypotension (OH) can be seen in as many as 30% to 50% of the elderly popu... more BACKGROUND: Orthostatic hypotension (OH) can be seen in as many as 30% to 50% of the elderly population as well as in dementia. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB) and prevalent in the majority of these patients. It is also suggested to be a negative prognostic factor for survival in DLB. A detailed interpretation of the 10-minute orthostatic blood pressure measurement has shown prolonged orthostasis in DLB compared with other dementias. The type of OH (systolic and diastolic) has not been separately investigated in different dementias. OBJECTIVES: The aims of this study were to analyze the type of orthostatic hypotension, systolic and/or diastolic, in different dementia groups compared with normal controls. PATIENTS AND METHODS: One-hundred fifty-six individuals, 52 with DLB, 50 with Alzheimer's disease (AD), 54 AD with vascular components (ADvasc), and 62 normal controls, were included. As part of each patient's routine clinical dementia investigation, systolic and diastolic blood pressure measurements were examined in the supine position, immediately after standing up, and after 1, 3, 5, and 10 minutes of standing. OH was defined as a blood pressure drop of 20 mmHg systolic or 10 mmHg diastolic, and the type of OH-systolic, diastolic or both-was defined. RESULTS: Orthostatic hypotension was severely underdiagnosed before the dementia investigation with only 2% to 4% in the dementia groups, while we found that 69% of DLB, 50% of ADvasc, 38% of AD, and 13% of normal controls had OH. A combination of systolic and diastolic OH was the most common type of OH both in the DLB (67%) and ADvasc (48%) groups, while systolic OH was the most common type in AD (63 %) as well as in normal controls (63%). Mini Mental State Examination scores differed significantly (P  0.001) between the group with no OH (25.2 ± 4.8) and the group with combined systolic and diastolic OH (22.0 ± 4.8). CONCLUSION: Patients with DLB showed a greater proportion of combined systolic and diastolic hypotension. This might suggest a more complex OH than in patients with AD or elderly controls, possibly exacerbating the clinical picture in DLB. Further investigations of the relevance of these findings and the relation to clinical symptoms are needed.

Research paper thumbnail of Activities of daily living - outcome during two years in galantamine treated Alzheimer patients

F1000posters, May 21, 2015

Research paper thumbnail of Short-term response to cholinesterase inhibitors in Alzheimer’s disease delays time to nursing home placement

Neurobiology of Aging, 2016

Research paper thumbnail of Alzheimer's disease with normal CSF biomarkers

F1000posters, May 21, 2015

Research paper thumbnail of Risk factors for nursing home placement in cholinesterase inhibitor treated naturalistic Alzheimer patients

F1000posters, May 21, 2015

40 50 60 70 80 90 1 00 P e rc e n M ales Fe m a le s L iv in g alon e L iv in g w ith fam ily N u... more 40 50 60 70 80 90 1 00 P e rc e n M ales Fe m a le s L iv in g alon e L iv in g w ith fam ily N ursing h o m e pla c e me n t n on -N H P

Research paper thumbnail of Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of cholinesterase inhibitor therapy

Alzheimer's Research & Therapy, 2016

There is an increasing interest in cognitive and functional outcomes in the respective stages of ... more There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer's disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of cholinesterase inhibitor (ChEI) therapy. This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20-26) and 287 had moderate AD (MMSE score, 10-19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.

Research paper thumbnail of Cholinesterase inhibitors do not alter the length of stay in nursing homes among patients with Alzheimer's disease: a prospective, observational study of factors affecting survival time from admission to death

BMC neurology, Jan 31, 2016

The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by soc... more The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by sociodemographic/clinical characteristics, rate of disease progression, and use of specific medications and community-based services. Whether different aspects of cholinesterase inhibitor (ChEI) therapy modify time spent in NHs is unclear. Therefore, we examined the relationship between these potential predictors and survival time in NHs. This prospective, multicenter study of ChEI treatment in clinical practice included 220 deceased patients clinically diagnosed with mild-to-moderate AD who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) performance, ChEI dose, and amount of services used/week were evaluated every 6 months over 3 years. Dates of nursing-home placement (NHP) and death were recorded. Variables that determined survival time in NHs were analyzed using general linear models. The mean survival time in NHs was 4.06 years (men, 2.78 years; wom...

Research paper thumbnail of Response to the Letter From Abid Iraqi, MD, CMD and Terry Hughes, RN, CS

Journal of the American Medical Directors Association, 2017

Research paper thumbnail of Prevalence of Dementia With Lewy Body Symptoms: A Cross-Sectional Study in 40 Swedish Nursing Homes

Journal of the American Medical Directors Association, 2016

To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nurs... more To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nursing home (NH) residents in Malmö, the third largest city in Sweden. DLB is a neurocognitive disorder with core features, such as parkinsonism, visual hallucinations, and fluctuating cognition/excessive daytime sleepiness, and supportive features, such as rapid eye movement sleep behavior disorder. DLB is often misdiagnosed and unrecognized in elderly individuals. A questionnaire, designed to cover the main DLB symptoms, according to consensus criteria from the third report of the DLB Consortium from 2005, was distributed in 40 NHs. The questionnaires were completed by the nursing staff after receiving specifically designed teaching. Medication lists were collected from the Swedish national medication dispensing system. Nursing homes. Of 650 eligible residents, 620 (96%) were included. The mean age was 86.0 ± 7.5 years; 467 (75%) were women. We found a prevalence of 16% of 2 or more main symptoms of DLB in the NH residents. However, when a wider more inclusive parkinsonism variable was used, the prevalence of DLB symptoms increased to 20%. We conclude that elderly with 2 or more DLB symptoms may constitute between 16% and 20% of all residents in NHs. This emphasizes the importance of identification of DLB and guides clinicians to deliver appropriate treatment for this fragile patient group.

Research paper thumbnail of Long-term outcome and prediction models of activities of daily living in Alzheimer disease with cholinesterase inhibitor treatment

Alzheimer Disease and Associated Disorders, 2011

In untreated patients with Alzheimer disease (AD) the functional ability is gradually lost. What ... more In untreated patients with Alzheimer disease (AD) the functional ability is gradually lost. What happens to the patients after continuous long-term cholinesterase inhibitor (ChEI) treatment is less investigated. The objective of this study was to describe the longitudinal functional outcome and analyze factors affecting the outcome in ChEI-treated patients. In an open, 3-year, nonrandomized, prospective, multicenter study in a routine clinical setting, 790 patients were treated with either donepezil, rivastigmine, or galantamine. At baseline and every 6 months, they were assessed with several rating scales including Instrumental Activities of Daily Living (IADL), Physical Self-Maintenance Scale (PSMS), and Mini-Mental State Examination (MMSE). A faster functional decline was associated with lower cognitive ability at baseline, older age, and the interaction of higher education and longer time in the study. The patients residing with a spouse or relative showed slower deterioration in IADL score. A higher mean dose of ChEI, regardless of drug agent, was also related to slower instrumental ADL decline. Prediction models for longitudinal functional outcome were provided. AD severity at baseline is a key factor in obtaining reliable clinical prognoses of the long-term ADL ability. The dosage of ChEI treatment could possibly lead to a different functional outcome.

Research paper thumbnail of Mild versus Moderate Stage of Alzheimer’s Disease—Three-year Outcomes of Cholinesterase Inhibitor Therapy in a Routine Clinical Setting

Research paper thumbnail of Early- versus late-onset Alzheimer's disease: 3-year outcomes of cholinesterase inhibitor treatment in routine clinical practice

F1000posters, Feb 3, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Various outcomes of cholinesterase inhibitor treatment influence survival of patients with Alzheimer's disease

F1000posters, Mar 26, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Two-year outcome of Galantamine treatment in Alzheimer’s disease in a routine clinical setting

Research paper thumbnail of Alzheimer's disease - Safety and dropout in long-term galantamine treatment in a routine clinical setting

New Trends in Alzheimer and Parkinson Related Disorders Adpd 2007, 2007

Research paper thumbnail of The effect of functional capacity and concomitant medications on life expectancy in Alzheimer's disease

F1000posters, May 21, 2015

Research paper thumbnail of Lack of orthostatic symptoms in dementia patients with orthostatic hypotension

Clinical Autonomic Research Official Journal of the Clinical Autonomic Research Society, 2015

Orthostatic hypotension (OH) is common and increases with age. OH is part of the autonomic dysfun... more Orthostatic hypotension (OH) is common and increases with age. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB). Commonly OH is diagnosed when the patient falls which is a risk factor of premature death. Our objective was to systematically investigate the clinical symptoms associated with measurement of OH in different neurodegenerative dementias and normal controls (NC). 154 patients [50 DLB, 50 Alzheimer's disease (AD), 54 AD and vascular components (ADvasc)] were examined with systolic and diastolic blood pressure measurements in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. They were compared with 50 NC. Orthostatic symptoms were registered according to a predefined protocol. Twenty-seven percent of all the investigated individuals reported OH symptoms during the measurement while 43 % fulfilled the criteria of OH. Sixty-three percent of orthostatic patients did not have any symptoms during the measurement. The prevalence of any orthostatic symptoms during the measurement differed significantly (p < 0.001) between the diagnostic groups with 40 % in DLB patients, 37 % in ADvasc, 28 % in AD and 2 % in NC. The most frequent symptom was dizziness 13.7 %. Classical orthostatic symptoms are absent in the majority of dementia patients with OH. The orthostatic reaction must therefore be routinely measured in this patient group. This is particularly important for patients with DLB where falls as a result of OH are common.

Research paper thumbnail of Plasma concentration of galantamine - influence of dose and body mass index in Alzheimer's disease

F1000posters, May 21, 2015

Research paper thumbnail of Three-year outcome of Galantamine treatment in Alzheimer's disease in a routine clinical setting

F1000posters, May 21, 2015

Long-term galantamine treatment in a routine clinical setting was safe and resulted in a positive... more Long-term galantamine treatment in a routine clinical setting was safe and resulted in a positive effect in cognitive tests compared to historical controls and mathematical models. After 3 years of treatment a positive global outcome was observed in more than 40% of the patients. Dropout was less than expected.

Research paper thumbnail of Long Term Outcome and Prediction Models of Cognition, Activities of Daily Living and Nursing Home Placement in Alzheimer’s Disease with Cholinesterase Inhibitor Treatment

Lund University Faculty of Medicine Doctoral Dissertation Series, 2011

Summary in Swedish / Populärvetenskaplig sammanfattning på svenska 13

Research paper thumbnail of Evaluation of Systolic and Diastolic Hypotension in Dementia with Lewy Bodies and Alzheimer’s Disease

Healthy Aging Clinical Care in the Elderly, 2013

BACKGROUND: Orthostatic hypotension (OH) can be seen in as many as 30% to 50% of the elderly popu... more BACKGROUND: Orthostatic hypotension (OH) can be seen in as many as 30% to 50% of the elderly population as well as in dementia. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB) and prevalent in the majority of these patients. It is also suggested to be a negative prognostic factor for survival in DLB. A detailed interpretation of the 10-minute orthostatic blood pressure measurement has shown prolonged orthostasis in DLB compared with other dementias. The type of OH (systolic and diastolic) has not been separately investigated in different dementias. OBJECTIVES: The aims of this study were to analyze the type of orthostatic hypotension, systolic and/or diastolic, in different dementia groups compared with normal controls. PATIENTS AND METHODS: One-hundred fifty-six individuals, 52 with DLB, 50 with Alzheimer's disease (AD), 54 AD with vascular components (ADvasc), and 62 normal controls, were included. As part of each patient's routine clinical dementia investigation, systolic and diastolic blood pressure measurements were examined in the supine position, immediately after standing up, and after 1, 3, 5, and 10 minutes of standing. OH was defined as a blood pressure drop of 20 mmHg systolic or 10 mmHg diastolic, and the type of OH-systolic, diastolic or both-was defined. RESULTS: Orthostatic hypotension was severely underdiagnosed before the dementia investigation with only 2% to 4% in the dementia groups, while we found that 69% of DLB, 50% of ADvasc, 38% of AD, and 13% of normal controls had OH. A combination of systolic and diastolic OH was the most common type of OH both in the DLB (67%) and ADvasc (48%) groups, while systolic OH was the most common type in AD (63 %) as well as in normal controls (63%). Mini Mental State Examination scores differed significantly (P  0.001) between the group with no OH (25.2 ± 4.8) and the group with combined systolic and diastolic OH (22.0 ± 4.8). CONCLUSION: Patients with DLB showed a greater proportion of combined systolic and diastolic hypotension. This might suggest a more complex OH than in patients with AD or elderly controls, possibly exacerbating the clinical picture in DLB. Further investigations of the relevance of these findings and the relation to clinical symptoms are needed.

Research paper thumbnail of Activities of daily living - outcome during two years in galantamine treated Alzheimer patients

F1000posters, May 21, 2015

Research paper thumbnail of Short-term response to cholinesterase inhibitors in Alzheimer’s disease delays time to nursing home placement

Neurobiology of Aging, 2016

Research paper thumbnail of Alzheimer's disease with normal CSF biomarkers

F1000posters, May 21, 2015

Research paper thumbnail of Risk factors for nursing home placement in cholinesterase inhibitor treated naturalistic Alzheimer patients

F1000posters, May 21, 2015

40 50 60 70 80 90 1 00 P e rc e n M ales Fe m a le s L iv in g alon e L iv in g w ith fam ily N u... more 40 50 60 70 80 90 1 00 P e rc e n M ales Fe m a le s L iv in g alon e L iv in g w ith fam ily N ursing h o m e pla c e me n t n on -N H P

Research paper thumbnail of Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of cholinesterase inhibitor therapy

Alzheimer's Research & Therapy, 2016

There is an increasing interest in cognitive and functional outcomes in the respective stages of ... more There is an increasing interest in cognitive and functional outcomes in the respective stages of Alzheimer's disease (AD) and in novel therapies particularly for the milder phases of AD. Our aim was to describe and compare various aspects of disease progression in patients with mild versus moderate AD in routine clinical practice of cholinesterase inhibitor (ChEI) therapy. This 3-year, prospective, observational, multicentre study included 1021 participants. Of these, 734 had mild AD (Mini-Mental State Examination (MMSE) score, 20-26) and 287 had moderate AD (MMSE score, 10-19) at the start of ChEI treatment. At baseline and every 6 months, patients were assessed using cognitive, global, instrumental and basic activities of daily living (ADL) scales. Potential predictors of deterioration in moderate AD were analysed using mixed-effects models. The change from baseline between participants with mild and moderate stages of AD after 3 years of ChEI therapy differed significantly on the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and basic ADL, but not using the MMSE and instrumental ADL scales. Protective independent factors for better cognitive long-term outcome in the group with moderate AD were older age, higher instrumental ADL ability, no antipsychotics, usage of non-steroidal anti-inflammatory drugs/acetylsalicylic acid, living with family member, lower education and a higher mean dose of ChEI. Apolipoprotein E genotype did not influence the rates of disease progression or the longitudinal outcomes. Prediction models were provided for moderate AD. More sensitive cognitive measures, such as the ADAS-cog scale, are required to detect a possibly faster deterioration among the participants with moderate AD. This study highlighted the clinical importance of instrumental ADL evaluations in patients at a mild stage of AD, and the importance of optimizing the ChEI dose even for individuals with moderate AD. Solitary living was a risk factor for faster cognitive decline, and probably expanded the need for formal care in the group with moderate AD. The patients with more advanced AD and presumably more pronounced neuroinflammation might have additional cognitive benefits from longer-term treatment with anti-inflammatory drugs.