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Effect of galantamine on verbal repetition in AD

A secondary analysis of the VISTA trial

From the Division of Geriatric Medicine (K.R., S.F., E.A.), QEII Health Sciences, Dalhousie University, Halifax, NS, Canada; and Department of Geriatrics (P.J.), St. Joseph’s Hospital, Saint John, NB, Canada.

Address correspondence and reprint requests to Dr. Kenneth Rockwood, Division of Geriatric Medicine, Dalhousie University, 1421-5955 Veterans’ Memorial Lane, Halifax, NS, B3H 2E1 Canada; e-mail: Kenneth.Rockwood{at}Dal.ca

Objectives: To understand how commonly diminution of verbal repetition was a goal of treatment in patients with Alzheimer disease (AD), how commonly that goal was achieved, whether goal attainment might be attributable to galantamine treatment, and whether change in verbal repetition is a marker of the overall treatment response.

Methods: This is a secondary analysis of the Video-Imaging Synthesis of Treating Alzheimer’s Disease study, a 4-month, double-blind, randomized, placebo-controlled trial of galantamine in 130 community-dwelling patients with mild to moderate AD. The primary outcome was Goal Attainment Scaling, in which individualized problems identified by patients/caregivers and treating physicians were assessed bimonthly.

Results: Reduction of verbal repetition was set as a treatment goal in 44% (n = 57) of randomized patients. More patients/caregivers (32%) set repetition goals than did physicians (18%). After 4 months, more galantamine-treated patients showed diminution of verbal repetition (58%) than did placebo-treated patients (24%; p < 0.01). Reduction of verbal repetition correlated with improvement in clinical measures, but not in standardized ones.

Conclusions: Reduction of verbal repetition is a common goal of Alzheimer disease treatment. After 4 months, patients treated with galantamine were more likely to experience a reduction of verbal repetition than those treated with placebo. Diminution of verbal repetition was associated with other improvements, suggesting it might be a clinical marker of a positive treatment response.

Disclosure: This study was cofunded by Janssen-Ortho Inc. and by the Canadian Institutes of Health Research, through a CIHR Rx & D operating grant, DCT-49981. Janssen-Ortho Inc. provided all medications and matching placebos, conducted on-site monitoring, and gathered and electronically coded the case report forms. All data are held by the Principal Investigator (K.R.), who initiated and supervised all analyses. Janssen-Ortho received a draft of this paper 45 days before submission to verify protocol details and review results, but publication decision rested with the Principal Investigator.

Kenneth Rockwood receives career support from the Canadian Institutes of Health Research through Investigator awards and is also supported by the Dalhousie Medical Research Foundation as the Kathryn Allen Weldon Professor of Alzheimer Research. Kenneth Rockwood has undertaken consultancies and received honoraria from Janssen Ortho, the study’s cosponsor, and from Pfizer, Novartis, and Merck. He is also part owner of DementiaGuide, which is developing a Web site to aid in goal setting for people with dementia. Pamela Jarrett has received honoraria from Janssen Ortho Inc. Sherri Fay and Elissa Asp have nothing to disclose.

Received July 4, 2006. Accepted in final form November 28, 2006.

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				V. S.S. Wong and K. Rockwood EFFECT OF GALANTAMINE ON VERBAL REPETITION IN AD: A SECONDARY ANALYSIS OF THE VISTA TRIAL Neurology, August 21, 2007; 69(8): 809 - 810. [Full Text] [PDF]

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