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Executive Function Changes in Dementia Patients after Six Months of Combined Treatment with Anticholinergic Agents and Antidepressants

Valentin Bragin MD, Narmina Dzhafarova MD, Ilya Bragin, Olga Perelmuter, Andrew Persits

Stress Relief and Memory Training Center, Brooklyn, NY, USA.

Presentation at First Annual Dementia Congress in Chicago, Illinois, September 28-29, 2002

Objective: To assess executive function changes in medically ill patients with dementia and concomitant depression before and after six months of outpatient treatment.

Methods: The study consisted of 30 patients (mean age 72 years, education 10.78), including 19 males and 11 females who presented complaints of memory decline and depression. Mean MMSE was 24.83, which corresponded to mild to moderate stage of dementia. The subjects were given a neuropsychological test battery, consisting of twelve tests related to different cognitive domains (attention, memory, and executive functions). In this presentation, we discuss data, mostly related to executive function. Different cholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and SSRIs were used for treatment.

Results: By the end of the six months, the MMSE had a tendency to increase from 24.83 to 26.90; reaction time dropped significantly by 34% (p<0.006). Score on clock drawing test increased by 29% (p<0.05). On the Neuro Behavior Cognitive Status Exam (Cognistat), we found that performance on repetition and naming subtests was increased by 18% (p<0.001) and 7% (p<0.03), respectively. Fluency tests showed positive changes, for category (animals) by 21.6% (p<0.002) and for letters by 42.9% (p<0.026). Right frontal lobe capacity to produce unique design on Ruff Figural Fluency Test (RFFT) also increased by 12% (p<0.04). On the Wisconsin Card Sorting Test (WCST) total correct responses, conceptual level responses, and number of completed categories were increased, while total errors and perseveration responses decreased (p<0.05). Positive correlations were found between Category Fluency test and Category Competed (WCST) before and after the treatment (p<0.01). After the treatment, negative correlations were found between Verbal Flunecy test and WCST (total and nonperseverative errors). These changes in correlation coefficients demonstrated changes in character of memory functioning: after treatment, memory, and logical processes work together, which leads to increased retrieval of memorized data.

The correlation coefficients of the RFFT and the WCST showed other tendencies. Before the treatment, unique designs (RFFT) were produced mostly as a result of perseveration or logical errors (WCST). After the treatment, these correlations disappeared and we had only one significant negative correlation between Error Ratio (RFFT) and total score (WCST). This correlation can be easily interpreted: the less the RFFT Error Ratio, the higher the WCST total correct score.

Conclusions: Patients with mild to moderate dementia of different etiology demonstrated progress in performance on executive function tests after six months of combined outpatient treatment.

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