PMID- 30085899 OWN - NLM STAT- MEDLINE DCOM- 20191115 LR - 20231004 IS - 1931-843X (Electronic) IS - 1540-9996 (Print) IS - 1540-9996 (Linking) VI - 27 IP - 11 DP - 2018 Nov TI - Gender Differences in Neuropsychiatric Symptoms in Mild to Moderate Alzheimer's Disease Patients Undergoing Switch of Cholinesterase Inhibitors: A Post Hoc Analysis of the EVOLUTION Study. PG - 1368-1377 LID - 10.1089/jwh.2017.6420 [doi] AB - BACKGROUND: Alzheimer's disease (AD) is characterized by progressive cognitive decline, often associated with Behavioral and Psychological Symptoms of Dementia (BPSD). Acetylcholinesterase inhibitors (ChEi) may attenuate cognitive decline and mitigate BPSD. The EVOLUTION group found that the switch from oral ChEi to transdermal rivastigmine patch formulation resulted in improvement/stabilization in the frequency of clinically relevant BPSD, but gender-specific subgroup analyses were not reported. METHODS: Participants underwent Neuropsychiatric Inventory to assess the frequency and severity of neuropsychiatric symptoms at baseline and 3 and 6 months after the switch from oral ChEi to transdermal rivastigmine patch. A descriptive post hoc analysis was conducted to assess whether there were gender-based differences in BPSD profile during the 6 months after the switch. RESULTS: The entire sample consisted of 475 patients, 274 women and 201 men. Women were on average slightly older and with poorer cognitive performance (60.6% of the women had moderate-AD, defined as Mini-Mental State Examination [MMSE] score of 10-17, vs. 43.8% of men). In mild-AD patients (MMSE score 18-26), the frequency of BPSD did not change significantly over time and an association was found between gender and depression (odds ratio; OR [95% confidence interval; CI] female vs. male = 3.32 [1.44-7.67]), anxiety (2.42 [1.23-4.79]), apathy (2.25 [1.07-4.70]), nighttime behavior disturbances (3.97 [1.66-9.49]), and appetite/eating abnormalities (2.39 [1.10-5.18]). Moderate-AD female patients had euphoria more frequently than male patients (OR [95% CI] female vs. male = 3.67 [1.25-10.74]). The frequency of delusions, anxiety, and irritability decreased during the first 3 months after the switch, independently of gender. CONCLUSION: Mild-AD women tended to suffer more frequently from BPSD than men; in the 3 months after treatment switch, moderate-AD patients showed a decrease in delusions, anxiety, and irritability, with no significant differences between genders. Ad hoc studies to investigate this potential gender effect in AD could be well worthwhile. FAU - Colombo, Delia AU - Colombo D AD - 1 Patient Access, Novartis Farma S.p.A. , Origgio, Italy . FAU - Caltagirone, Carlo AU - Caltagirone C AD - 2 Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology , IRCCS Santa Lucia Foundation, Rome, Italy . AD - 3 Department of System Medicine, University of Rome "Tor Vergata," Rome, Italy . FAU - Padovani, Alessandro AU - Padovani A AD - 4 Department of Clinical and Experimental Sciences, University of Brescia , Brescia, Italy . FAU - Sorbi, Sandro AU - Sorbi S AD - 5 Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence , Florence, Italy . AD - 6 IRCCS Don Gnocchi , Florence, Italy . FAU - Spalletta, Gianfranco AU - Spalletta G AD - 2 Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology , IRCCS Santa Lucia Foundation, Rome, Italy . FAU - Simoni, Lucia AU - Simoni L AD - 7 MediNeos Observational Research , Modena, Italy . FAU - Ori, Alessandra AU - Ori A AD - 7 MediNeos Observational Research , Modena, Italy . FAU - Zagni, Emanuela AU - Zagni E AD - 1 Patient Access, Novartis Farma S.p.A. , Origgio, Italy . LA - eng PT - Journal Article PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20180908 PL - United States TA - J Womens Health (Larchmt) JT - Journal of women's health (2002) JID - 101159262 RN - 0 (Cholinesterase Inhibitors) RN - PKI06M3IW0 (Rivastigmine) SB - IM MH - Administration, Oral MH - Aged MH - *Alzheimer Disease/diagnosis/drug therapy/epidemiology/psychology MH - *Behavioral Symptoms/drug therapy/etiology/psychology MH - Cholinesterase Inhibitors/administration & dosage/adverse effects MH - Cognition/drug effects MH - Drug Substitution/methods/statistics & numerical data MH - Female MH - Humans MH - Italy/epidemiology MH - Male MH - Mental Competency MH - Mental Status and Dementia Tests MH - Psychological Techniques MH - *Rivastigmine/administration & dosage/adverse effects MH - Sex Factors MH - Transdermal Patch MH - Treatment Outcome PMC - PMC6247376 OTO - NOTNLM OT - Alzheimer's disease OT - Behavioral and Psychological Symptoms of Dementia (BPSD) OT - cholinesterase inhibitors OT - gender COIS- D.C. is a part-time employee of Novartis Farma, Italy, and received grants from Allergan and Aventis. E.Z. is an employee of Novartis Farma, Italy. G.S. has been funded by the Italian Ministry of Health, FB-Health, and the European Commission. L.S. and A.O. are employees of MediNeos Observational Research. No other conflicts of interest in this work have been reported by the authors. EDAT- 2018/08/08 06:00 MHDA- 2019/11/16 06:00 PMCR- 2018/11/02 CRDT- 2018/08/08 06:00 PHST- 2018/08/08 06:00 [pubmed] PHST- 2019/11/16 06:00 [medline] PHST- 2018/08/08 06:00 [entrez] PHST- 2018/11/02 00:00 [pmc-release] AID - 10.1089/jwh.2017.6420 [pii] AID - 10.1089/jwh.2017.6420 [doi] PST - ppublish SO - J Womens Health (Larchmt). 2018 Nov;27(11):1368-1377. doi: 10.1089/jwh.2017.6420. Epub 2018 Sep 8.