In clinical trials, the ADAS-cog is the most commonly used cognitive test [28,29]. It measures a broader span of cognitive functions, but has the disadvantage reference of taking 45 minutes to administer compared with 3 to 5 minutes for AQT and 10 to 15 minutes for the MMSE. Because of the length of the ADAS-cog, it cannot really be regarded as a brief cognitive test suitable for clinical practice. ADAS-cog and the MMSE are well studied for ChEI evaluation of AD, but no previous studies of AQT were performed in this context. However, in a recent randomized, placebo-controlled, multinational study, AQT was used to evaluate the treatment effect of memantine on dementia with Lewy bodies and Parkinson disease dementia [30].
In that study, both AQT and the global cognitive measure CGIC improved significantly after 24 weeks of treatment, compared with placebo, whereas the MMSE failed to improve significantly. Future evaluation issues In the future, it is likely that more patients with mild cognitive impairment (MCI) will be included in therapeutic trials and treated in clinical practice. It is then essential to have a sensitive test with no ceiling effect. The MMSE and the ADAS-cog have detected in MCI studies significant cognitive changes [31,32], but they have also been criticized for their ceiling effects and inability to detect small cognitive changes [28]. In the only study in which AQT has been used to evaluate MCI treatment, AQT improved significantly, whereas the other cognitive tests failed to do so (WAIS III Digit Span, WAIS-R NI Spatial Span, Digit Symbol Modalities, and Rey’s Complex Figure Test) [33].
Further, AQT has no ceiling effect and, in this study, was able to significantly detect the subtle disease progress of AD during the nontreatment period of 8 weeks (Table ?(Table1).1). Although the results are promising, more studies are needed to warrant the sensitivity of AQT to cognitive change and to systematically compare it with the MMSE and the ADAS-cog. Another important future issue is that by 2040, it is predicted that 71% of all dementia patients will be in developing countries [34]. Therefore, the International Psychogeriatric Association (IPA) and the Alzheimer’s Association have pointed out the need for a culturally independent test [7,28].
AQT has so far been validated in Western, Arabic, and African countries and does not exhibit any culturally dependent questions or exercises [8,9,35], whereas the MMSE is affected by ethnicity [36,37]. Detecting treatment responders Carfilzomib In the present study, inhibitor Enzastaurin we evaluated the treatment response after 8 weeks. Previously, it was shown that 4 to 8 weeks of AD treatment results in a significant treatment effect compared with placebo [38-41]. This supports our evaluation of treatment effects already after 8 weeks. It is also is in agreement with the guidelines by NICE and the American College of Physicians (ACP) [5,7].
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