Dement Neurocogn Disord.  2015 Sep;14(3):106-113. 10.12779/dnd.2015.14.3.106.

Single Photon Emission Computerized Tomography and Neuropsychological Tests That Predict a Good Response to Donepezil Therapy for Alzheimer's Disease

• Kim DE
• Chong A
• Song HC
• Choi SM
• Kang KW
• Ha JM
• Kim JH
• Kim TH
• Jeong GW
• Park KW
• de Leon MJ
• Kim BC

• KMID: 2442985
• DOI: http://doi.org/10.12779/dnd.2015.14.3.106

Abstract

BACKGROUND AND PURPOSE
Cholinesterase inhibitors (ChEIs) are effective in Alzheimer's disease (AD) treatment. The aim of this study is 1) to find neuropsychological factors that affect the functional response to ChEI therapy and 2) to determine whether regional cerebral blood flow (rCBF) pretreatment predicts a cognitive change in response to ChEI.
METHODS
We prospectively recruited 32 patients diagnosed with probable AD and treated them with donepezil, a ChEI, over one year. The patients were divided into stable (s-AD) and declined (d-AD) AD groups, based on changes in Korean version of Mini-Mental State Examination (K-MMSE) scores. Patients were assessed using the Alzheimer's Disease Co-operative Study-Activities of Daily Living (ADCS-ADL) and Seoul Neuropsychologic Screening Battery, as well as brain single photon emission computerized tomography (SPECT) at baseline and last medical evaluations. The predictors of therapeutic responses were analyzed using general linear models.
RESULTS
Based on their cognitive function changes, AD patients were classified into two groups: s-AD (n=14, annual change in K-MMSE score <0.9), or d-AD (n=18, annual change in K-MMSE score > or =0.9). The s-AD at baseline showed significantly better ADCS-ADL function (p=0.04) and had a tendency to preserve frontal function compared to the d-AD group. Global Statistical Parametric Mapping analysis revealed no significant decrease of rCBF between baseline and follow-up SPECT, in either the s-AD or the d-AD groups. However, on regional perfusion analysis of baseline SPECT, the d-AD group demonstrated perfusion deficits in the supramarginal gyrus, inferior occipital gyrus, and rolandic operculum compared with the s-AD group.
CONCLUSIONS
Highly preserved ADCS-ADLs predicted a better improvement in MMSE scores in response to ChEI therapy and a more positive functional response in the group with preserved frontal function. rCBF provided hints to the variable response to donepezil therapy with ChEI treatment.

Keyword

Alzheimer's disease; acetylcholinesterase inhibitor; regional cerebral blood flow; single photon emission computerized tomography; Korean version of Mini-Mental State Examination

MeSH Terms

Alzheimer Disease*
Brain
Cholinesterase Inhibitors
Follow-Up Studies
Humans
Linear Models
Mass Screening
Neuropsychological Tests*
Perfusion
Prospective Studies
Seoul
Tomography, Emission-Computed, Single-Photon*
Cholinesterase Inhibitors

Figure

• 

  Fig. 1 The change from baseline of the K-MMSE score per year for AD patients (n=32). Patients with at least a 0.9 score decrease in K-MMSE score per year are categorized in the AD decline group (d-AD, n=18), whereas the others are categorized in the stable AD group (s-AD, n=14). AD: Alzheimer's disease, K-MMSE: Korean version of Mini-Mental State Examination.

• 

  Fig. 2 Global Statistical Parametric Mapping software analysis showing a relative decrease in the regional cerebral blood flow of brain single photon emission computerized tomography in the stable Alzheimer's disease (AD) group (s-AD) at baseline (A) and follow up (B); and in the declined AD group (d-AD) at baseline (C) and follow up (D) compared to elderly healthy controls (n=12). We used a threshold Z-score ≥2.33 (which corresponding to a p-value ≤0.01). The color of the outer contour corresponds to a Z score of 0-10.

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