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Preservation of Cognitive Functioning in Patients with Mild Dementia After Two Year Combined Treatment (Cholinesterase Inhibitors, Antidepressants and Non- Pharmacological Interventions): A Naturalistic Study

Valentin Bragin M.D., Marina Chemodanova PhD, Narmina Dzhafarova M.D, Gary Shereshevsky B.A., Ilya Bragin, Jennifer L. Czerniawski.

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

Poster presentation at the 9th international Conference on Alzheimer’s Disease and Related Disorders Philadelphia, USA, July 17- 22, 2004 P1- 103

Objectives: The aim of our ongoing study is to evaluate the possibility of preservation of cognitive functioning in patients with dementia and depression.

Methods: In this study, 27 medically ill patients with memory problems and depression were evaluated at baseline and after 6, 12, and 24 months of treatment. Their diagnosis were probable Alzheimer’s or Vascular Dementia (MMSE mean = 25.6). Treatment was conducted with cholinesterase inhibitors (Donepezil, Rivastigmine, or Galantamine) and antidepressants (Sertraline, Citalopram or Venlafaxine XR, alone or in combination with Bupropion XR). They were encouraged to take vitamins, maintain healthy diets, modify their lifestyles and perform mild physical exercises. The battery consisted of 11 tests evaluating three cognitive domains (attention, memory, and executive function).

Results: By the end of two years of treatment, there was no decline on test performance. We found improvement (p< 0.05) in all cognitive domains after 6 months of treatment, which remained at the same level by the end of the 24 months. Reaction time on the physical reflexes was decreased to 282 ms (baseline- 567 ms, p< 0.01). On the Neurobehavioral Cognitive Status Examination, we found increased performance on attention, comprehension, repetition, naming, construction, memory, and similarities. Significant improvement was found on World List Memory Test, five minutes recall (baseline- 4.2; 2 years – 4.8, p<0.05) and Ruff Light Trailing Learning Test, 60 minutes delayed memory (baseline – 10.7; 2 years- 12.7, p < 0.01). Performance was increased on tests related to right and left prefrontal region functions (Ruff Figural Fluency Test and World Fluency Test, respectively). The number of preservations was decreased on Wisconsin Card Sorting Test (from 35.1 to 15.7, p < 0.001), and Ruff Figural Fluency Test (from 12.1 to 7.2, p < 0.05).

Conclusions: Combined treatment approach (medications with non- pharmacological interventions) in dementia patients demonstrates measurable improvement in all cognitive domains and slows cognitive decline.

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