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P3‐429: Response to cholinesterase inhibitor medication at first renewal in a Canadian provincial drug coverage initiative: the British Columbia Alzheimer's Drug Therapy Initiative (BC ADTI) experience
Claudia Jacova, Malcolm Maclure, David Hosick, Ron Mattson, Ging‐Yuek Robin Hsiung, Philip John Lee, Kiran Rabheru, B. Lynn Beattie et al.. Alzheimer s & Dementia, 2010-07-01
Topic: Amyloid, tau and blood-test diagnosis
Uncertainty surrounds cholinesterase inhibitor (ChEIs) effectiveness in mild to moderate Alzheimer Disease (AD). The Alzheimer's Disease Drug Therapy Initiative (ADTI) was launched in 2007 as a ChEI coverage program with evidence development in British Columbia, Canada. The program requires prior authorization (PA) by fax to renew coverage approximately every six months. This study describes the clinical/cognitive response of ADTI participants to ChEIs at the first renewal cycle. ADTI enrolment required diagnosis of AD, a Standardized Mini Mental Exam (SMMSE) score 10-26, and a Global Deterioration Scale (GDS) staging 4-6. Assessment for renewal included SMMSE, GDS, and an Overall Patient Assessment Rating (OPAR): Very much improved (+4), Much improved (+2.5), Minimally improved (+1), grouped as positive response; No change (0) and Minimally worse (-1) grouped as indeterminate response; Much worse (-2.5) and Very much worse (-4) grouped as negative response. For this study OPAR and SMMSE PA data for first renewal were analyzed for ChEI-naïve subjects and those non-naïve, i.e. on ChEI medication prior to ADTI. Means (M), standard errors (SE), 95% confidence intervals (CI) and correlations were calculated for naïve and non-naïve subjects. There were 2678 subjects with first-renewal data: 1094 were ChEI-naïve (SMMSE M = 20.8, SE = 0.12), 1584 non-naïve (SMMSE M = 20.5, SE = 0.10). OPAR positive response was more frequent for naïve (45.3% positive, 52.1% indeterminate, 2.6% negative response) than non- naïve (36% positive, 61.2% indeterminate, 2.7% negative response). The mean OPAR score difference was 0.23, 95%CI 0.22-0.25. SMMSE change was similarly higher for naïve than non- naïve: 0.28 vs. -0.22, difference = 0.5, 95%CI 0.28-0.70. OPAR and SMMSE change were correlated (naïve r = 0.86, non-naïve r = 0.56). Subjects with moderate AD (SMMSE 18): 43.2 vs. 38.6% OPAR positive, 1.58 vs. -0.39 SMMSE change. This study showed global and cognitive improvement with publicly covered ChEI therapy in a proportion of subjects. Those naïve to the medication had noticeably greater score improvement than those already on medication. Yet, the most frequent response was clinically indeterminate defined as no change or minimal worsening. Longer-term follow-up will be needed to substantiate these findings, and clarify the meaning and outcome of indeterminate responders.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Jacova, C., Maclure, M., Hosick, D., Mattson, R., Hsiung, G. R., Lee, P. J., et al. (2010). P3‐429: Response to cholinesterase inhibitor medication at first renewal in a Canadian provincial drug coverage initiative: the British Columbia Alzheimer's Drug Therapy Initiative (BC ADTI) experience. Alzheimer s & Dementia. https://doi.org/10.1016/j.jalz.2010.05.1972
Vancouver
Jacova C, Maclure M, Hosick D, Mattson R, Hsiung GR, Lee PJ, et al. P3‐429: Response to cholinesterase inhibitor medication at first renewal in a Canadian provincial drug coverage initiative: the British Columbia Alzheimer's Drug Therapy Initiative (BC ADTI) experience. Alzheimer s & Dementia. 2010. doi:10.1016/j.jalz.2010.05.1972.
BibTeX
@article{jacova2010-5ee8585a,
author = {Jacova, Claudia and Maclure, Malcolm and Hosick, David and Mattson, Ron and Hsiung, Ging‐Yuek Robin and Lee, Philip John and Rabheru, Kiran and Beattie, B. Lynn and others},
title = {{P3‐429: Response to cholinesterase inhibitor medication at first renewal in a Canadian provincial drug coverage initiative: the British Columbia Alzheimer's Drug Therapy Initiative (BC ADTI) experience}},
journal = {Alzheimer s \& Dementia},
year = {2010},
doi = {10.1016/j.jalz.2010.05.1972},
url = {https://doi.org/10.1016/j.jalz.2010.05.1972}
}
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Key findings
- Assessment for renewal included SMMSE, GDS, and an Overall Patient Assessment Rating (OPAR): Very much improved (+4), Much improved (+2.5), Minimally improved (+1), grouped as positive response; No change (0) and Minimally worse (-1) grouped as indeterminate response; Much worse (-2.5) and Very much worse (-4) grouped as negative response.
- Longer-term follow-up will be needed to substantiate these findings, and clarify the meaning and outcome of indeterminate responders.
Why it matters
This study described clinical and cognitive responses to cholinesterase inhibitor medication at first renewal among participants in a Canadian drug coverage program for mild to moderate Alzheimer's disease. The authors state that longer-term follow-up is needed to substantiate the findings, so it does not establish any cure or prevention.
Study details
- Participants2,678
- Effect size45.3%; 52.1%; 2.6%
- Evidence strengthLow
How this study scored 36/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2010 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,678 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 18 year(s) since 2010 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Neena L. Chappell: h-index 42 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of British Columbia: institution h-index 1,424 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 36 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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