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Br J Psychiatry. 2018 Mar;212(3):155-160. doi: 10.1192/bjp.2017.21.

Impact of cholinesterase inhibitors or memantine on survival in adults with Down syndrome and dementia: clinical cohort study.

Author information

1
Division of Psychiatry,University College London,London.
2
Education Unit,Institute of Neurology,London.
3
Cornwall Partnership Foundation Trust,Cornwall.
4
Westminster Learning Disability Partnership,London.
5
Plymouth Community Learning Disabilities Team,Livewell Southwest,Plymouth.
6
Haringey Learning Disability Partnership,Barnet Enfield Haringey Mental Health NHS Trust,London.
7
Surrey and Borders Partnership NHS Foundation Trust,Leatherhead.
8
Hillingdon Learning Disabilities Service,Uxbridge,London.
9
Islington Learning Disabilities Partnership,London.
10
Plymouth Teaching Primary Care Trust,Plymouth.
11
Hertfordshire Partnership NHS Foundation Trust,Stevenage.
12
South West London and St George's Mental Health NHS Trust,London.
13
Royal Borough of Kensington and Chelsea Learning Disability Service,London.
14
Hackney Learning Disability Team,East London NHS Foundation Trust,London.
15
Institute of Psychiatry,Psychology and Neuroscience,King's College London,London.
16
Division of Psychiatry,University College London,London;Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK;The LonDownS Consortium.

Abstract

BACKGROUND:

There is little evidence to guide pharmacological treatment in adults with Down syndrome and Alzheimer's disease. Aims To investigate the effect of cholinesterase inhibitors or memantine on survival and function in adults with Down syndrome and Alzheimer's disease.

METHOD:

This was a naturalistic longitudinal follow-up of a clinical cohort of 310 people with Down syndrome diagnosed with Alzheimer's disease collected from specialist community services in England.

RESULTS:

Median survival time (5.59 years, 95% CI 4.67-6.67) for those on medication (n = 145, mainly cholinesterase inhibitors) was significantly greater than for those not prescribed medication (n = 165) (3.45 years, 95% CI 2.91-4.13, log-rank test P<0.001). Sequential assessments demonstrated an early effect in maintaining cognitive function.

CONCLUSIONS:

Cholinesterase inhibitors appear to offer benefit for people with Down syndrome and Alzheimer's disease that is comparable with sporadic Alzheimer's disease; a trial to test the effect of earlier treatment (prodromal Alzheimer's disease) in Down syndrome may be indicated. Declaration of interest A.S. has undertaken consulting for Ono Pharmaceuticals, outside the submitted work. Z.W. has received a consultancy fee and grant from GE Healthcare, outside the submitted work.

PMID:
29486820
DOI:
10.1192/bjp.2017.21

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