Effect of treatment gaps in elderly patients with dementia treated with cholinesterase inhibitors
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In their interesting article, Pariente et al. conclude that "Treatment gaps do not compromise the outcome of patients treated with cholinesterase inhibitors in a real-life setting." [1] However, their conclusion is based on the effect of treatment gaps on risk of institutionalization and death, rather than on disease-specific endpoints. It has been shown that the beneficial effect of cholinesterase inhibitors on cognition, an important disease-specific endpoint, disappears within 3 weeks of discontinuation. [2,3] In addition, as mentioned by Patiente et al., treatment gaps are likely to occur in patients in whom re-initiation of treatment is worthy. From this, we infer that selection may have played a role, consequently limiting the generalizability of the study to a 'real life setting'. [4] This study is welcome because the authors address an important issue. However, because of these caveats, we feel that clinicians should not discontinue treatment too readily, as discontinuation of treatment does effect cognition, thereby compromising the outcome of patients.
1. Patiente A, Fourrier-R?glat, Bazin F, et al. Effect of treatment gaps in elderly patients with dementia treated with cholinesterase inhibitors. Neurology 2012;78:957-963.
2. Greenberg SM, Tennis MK, Brown LB, et al. Donepezil therapy in clinical practice. A randomized crossover study. Arch Neurol 2000;57:94- 99.
3. Gaudig M, Richarz U, Han J, et al. Effects of galantamine in Alzheimer's disease: double-blind withdrawal studies evaluating sustained versus interrupted treatment. Current Alzheimer Research 2011;8:771-780.
4. Stang A. Appropriate epidemiologic methods as a prerequisite for valid study results. Eur J Epidemiol 2008;23:761-765.
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