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Acute response to cholinergic challenge predicts long-term response to galantamine treatment in patients with Alzheimer's Disease
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  • Anne Catrien Baakman,
  • Carmen Gavan,
  • Lotte Van Doeselaar,
  • Marieke de Kam,
  • Karen Broekhuizen,
  • Ovidiu Bajenaru,
  • Laura Camps,
  • Eleonora Swart,
  • Kees Kalisvaart,
  • Nikki Schoonenboom,
  • Evelien Lemstra,
  • Philip Scheltens,
  • Adam Cohen,
  • Joop Van Gerven,
  • Geert Jan Groeneveld
Anne Catrien Baakman
Amsterdam UMC Locatie VUmc

Corresponding Author:a.baakman@amsterdamumc.nl

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Carmen Gavan
Spitalului Universitar de Urgenta
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Lotte Van Doeselaar
Centre for Human Drug Research
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Marieke de Kam
Centre for Human Drug Research
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Karen Broekhuizen
Centre for Human Drug Research
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Ovidiu Bajenaru
Spitalului Universitar de Urgenta
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Laura Camps
Centre for Human Drug Research
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Eleonora Swart
Amsterdam University Medical Centres
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Kees Kalisvaart
Kennemer Gasthuis
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Nikki Schoonenboom
Spaarne Gasthuis
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Evelien Lemstra
Amsterdam UMC VUMC Site
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Philip Scheltens
Amsterdam UMC VUMC Site
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Adam Cohen
Centre for Human Drug Research
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Joop Van Gerven
Central Committee on Research Involving Human Subjects (CCMO
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Geert Jan Groeneveld
Centre for Human Drug Research
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Abstract

Cholinesterase inhibitors have been shown to improve cognitive functioning in patients with Alzheimer’s Disease (AD), but are associated with side effects and only 20-40% of the patients clinically improve. In this study, we aimed to investigate the acute pharmacodynamic (PD) effects of a single dose of galantamine on CNS functioning in mild to moderate AD patients and its potential to predict long-term treatment response. This study consisted of a challenge phase, in which a single dose of 16 mg galantamine was administered to 50 mild to moderate AD patients in a double-blind, placebo-controlled cross-over fashion. Acute PD effects were monitored with use of a CNS test battery. In the subsequent treatment phase of the study, patients were treated with open-label galantamine according to regular care. After 6 months of galantamine treatment, patients were categorized as either responder or as non-responder based on their MMSE, NPI and DAD scores. An analysis of covariance was performed to study the difference in acute PD effects between responders and non-responders. Acute decreases of absolute frontal alpha (-20.4; 95%CI=-31.6,-7.47; p=.0046), beta (-15.7; 95% CI=-28.3,-0.93; p=.0390) and theta (-25.9; 95%CI=-38.4,-10.9; p=.0024) EEG parameters and of relative frontal theta power (-3.27%; 95%CI=-5.96,-0.58; p=.0187) on EEG after a single dose administration of galantamine significantly distinguished long-term treatment responders (n=11) from non-responders (n=32) after 6 months. This study demonstrates that patients who demonstrate a reduction in EEG power in the alpha and theta frequency after a single administration of galantamine 16 mg will most likely respond to treatment.
18 Jun 2021Submitted to British Journal of Clinical Pharmacology
19 Jun 2021Submission Checks Completed
19 Jun 2021Assigned to Editor
07 Jul 2021Reviewer(s) Assigned
06 Oct 2021Review(s) Completed, Editorial Evaluation Pending
11 Oct 2021Editorial Decision: Revise Major
30 Nov 20211st Revision Received
01 Dec 2021Submission Checks Completed
01 Dec 2021Assigned to Editor
01 Dec 2021Review(s) Completed, Editorial Evaluation Pending
09 Dec 2021Editorial Decision: Accept
Jun 2022Published in British Journal of Clinical Pharmacology volume 88 issue 6 on pages 2814-2829. 10.1111/bcp.15206