Background: Laboratory evidence of cholesterol-induced production of amyloid βas a putative neurotoxin precipitating Alzheimer disease, along with epidemiol ogical evidence, suggests that cholesterol-lowering statin ...Background: Laboratory evidence of cholesterol-induced production of amyloid βas a putative neurotoxin precipitating Alzheimer disease, along with epidemiol ogical evidence, suggests that cholesterol-lowering statin drugs may favorably influence the progression of the disorder. Objective: To determine if treatment with atorvastatin calcium affects the cognitive and/or behavioral decline in pat ients with mild to moderate Alzheimer disease. Design: Pilot intention-to-trea t, proof-of-concept, double-blind, placebo-controlled, randomized (1:1) tria l with a 1-year exposure to once-daily atorvastatin calcium (80 mg; two 40-mg tablets) or placebo using last observation carried forward analysis of covarian ce as the primary method of statistical assessment. Participants: Individuals wi th mild to moderate Alzheimer disease (Mini-Mental State Examination score of 1 2-28) were recruited. Of the 98 participants providing informed consent, 71 wer e eligible for randomization, 67 were randomized, and 63 subjects completed the 3-month visit and were considered evaluable. Main Outcome Measures: The primary outcome measures were change in Alzheimer’s Disease Assessment Scale-cognitive subscale and the Clinical Global Impression of Change Scale s cores. The secondary outcome measures included scores on the Mini-Mental State Examination, Geriatric Depression Scale, the Neuropsychiatric Inventory Scale, a nd the Alzheimer’s Disease Cooperative Study-Activities of Daily Living Invent ory. The tertiary outcome measures included total cholesterol, low-density lipo protein cholesterol, and very low-density lipoprotein cholesterol levels. Resul ts: Atorvastatin reduced circulating cholesterol levels and produced a positive signal on each of the clinical outcome measures compared with placebo. This bene ficial effect reached significance for the Geriatric Depression Scale and the Al zheimer’s Disease Assessment Scale-cognitive subscale at 6 months and was sign ificant at the level of a trend for the Alzheimer’s Disease Assessment Scalec ognitive subscale, Clinical Global Impression of Change Scale, and Neuropsychiatric Inventory Scale at 12 months assessed by analysis of covariance with last observation carried forward. Conclusion: Atorvastatin treatment may be of some clinical benefit and could be established as an effective therapy for Alzheimer disease if the current findings are substantiated by a much larger multicenter trial.展开更多
文摘Background: Laboratory evidence of cholesterol-induced production of amyloid βas a putative neurotoxin precipitating Alzheimer disease, along with epidemiol ogical evidence, suggests that cholesterol-lowering statin drugs may favorably influence the progression of the disorder. Objective: To determine if treatment with atorvastatin calcium affects the cognitive and/or behavioral decline in pat ients with mild to moderate Alzheimer disease. Design: Pilot intention-to-trea t, proof-of-concept, double-blind, placebo-controlled, randomized (1:1) tria l with a 1-year exposure to once-daily atorvastatin calcium (80 mg; two 40-mg tablets) or placebo using last observation carried forward analysis of covarian ce as the primary method of statistical assessment. Participants: Individuals wi th mild to moderate Alzheimer disease (Mini-Mental State Examination score of 1 2-28) were recruited. Of the 98 participants providing informed consent, 71 wer e eligible for randomization, 67 were randomized, and 63 subjects completed the 3-month visit and were considered evaluable. Main Outcome Measures: The primary outcome measures were change in Alzheimer’s Disease Assessment Scale-cognitive subscale and the Clinical Global Impression of Change Scale s cores. The secondary outcome measures included scores on the Mini-Mental State Examination, Geriatric Depression Scale, the Neuropsychiatric Inventory Scale, a nd the Alzheimer’s Disease Cooperative Study-Activities of Daily Living Invent ory. The tertiary outcome measures included total cholesterol, low-density lipo protein cholesterol, and very low-density lipoprotein cholesterol levels. Resul ts: Atorvastatin reduced circulating cholesterol levels and produced a positive signal on each of the clinical outcome measures compared with placebo. This bene ficial effect reached significance for the Geriatric Depression Scale and the Al zheimer’s Disease Assessment Scale-cognitive subscale at 6 months and was sign ificant at the level of a trend for the Alzheimer’s Disease Assessment Scalec ognitive subscale, Clinical Global Impression of Change Scale, and Neuropsychiatric Inventory Scale at 12 months assessed by analysis of covariance with last observation carried forward. Conclusion: Atorvastatin treatment may be of some clinical benefit and could be established as an effective therapy for Alzheimer disease if the current findings are substantiated by a much larger multicenter trial.
