Dear Editor,
As clinical neurologists, our research in dementia has been focused on the contribution of lifestyle changes to the pathology underlying Alzheimer’s disease (AD). Recent studies have revealed the significant role of lifestyle improvement in AD by demonstrating that vascular risk factors such as hypertension, diabetes mellitus, hyperlipidemia and smoking are associated with the progression of not only vascular dementia but also ADCitation1. We have read the article by Kapaki and Paraskevas entitled “The cognitive effects of cholinesterase inhibitor treatment in every-day practice” published in 2005 with great interestCitation2. We agree with the authors on the effect of the commonly used cholinesterase inhibitors (ChEIs) on AD.
We would like to highlight an intriguing finding we came across while comparing the effect of ChEIs demonstrated by Kapaki and ParaskevasCitation2 in 2005 with the outcomes of treatment of vascular risk factors reported by Deschaintre et al. in 2009Citation1. The results of these two studies demonstrated that the Mini-Mental State Examination (MMSE) score in patients with AD declined with age. Interestingly, in the patients who were treated for all vascular risk factors, the decline in the MMSE score was slower, with a two-point drop in a 30 month period, compared to the patients who did not undergo intervention. Similarly, the decline in the MMSE score in the patients treated with ChEIs was approximately two points in a 24 month period, although ChEIs can provide a honeymoon period. This result is consistent with other recent studies on the effects of ChEIsCitation3,Citation4. These studies illustrate that the outcomes of treatment for vascular risk factors are comparable to those of treatment with ChEIs.
We would like to highlight this hitherto unaddressed comparison between the two approaches and emphasize that improvement of vascular risk factors in lifestyle-related comorbidities of AD should be considered as important as treatment with anti-dementia drugs such as ChEIs.
Transparency
Declaration of funding
No funding for this letter was provided.
Declaration of financial/other relationships
No potential conflict of interest was reported by the authors.
Acknowledgements
None.
References
- Deschaintre Y, Richard F, Leys D, et al. Treatment of vascular risk factors is associated with slower decline in Alzheimer disease. Neurology. 2009;73:674–680.
- Kapaki E, Paraskevas GP. The cognitive effects of cholinesterase inhibitor treatment in every-day practice. Curr Med Res Opin. 2005;21:871–875.
- Wattmo C, Minthon L, Wallin ÅK. Mild versus moderate stages of Alzheimer's disease: three-year outcomes in a routine clinical setting of cholinesterase inhibitor therapy. Alzheimers Res Ther. 2016;8:7.
- Perera G, Khondoker M, Broadbent M, et al. Factors associated with response to acetylcholinesterase inhibition in dementia: a cohort study from a secondary mental health care case register in London. PLoS One. 2014;9:e109484.