O3‐01‐03: Assessing cognition and function in Alzheimer's disease pharmacotherapy: A comparison of self‐assessment by ChEI users and standardized test‐scores
Bibliographic record
Abstract
Cholinesterase inhibitors (ChEI) are first-line pharmacotherapy in early Alzheimer's disease (AD). Yet their effectiveness is debated beyond six-months. The Alzheimer's Drug Therapy Initiative (ADTI) is a (British Columbia) province-wide initiative (2007-2012) where a prior authorization process (Special Authority (SA)) is used to assess drug improvement every six-months using standardized cognitive and functional measures in physicians' offices. What is not clear is how ChEI users' perception of change (cognition and function) correlates with standardized test scores. This study reports interim findings using data (initial and T1 first renewal) drawn from the longitudinal Seniors' Medication Study (SMS) linked by study ID with SA data from the ADTI. SMS inclusion criteria: diagnosis of AD, ChEI naive, ≥1 SA visit, participating caregiver. SMS data include: adapted Telephone Interview of Cognitive Status (TICS). SA data include: SMMSE, Global Deterioration Scale (GDS) and Clock Drawing Test (CDT). Paired sample t-tests and linear regression were used to assess change in scores for this cohort of ChEI users and associations between test scores and time of measurement. Outcome of groups (continue, switch or stop) was not compared. Three hundred and thirteen SMS participants (mean age = 79, ±8.3) were assessed at initial SA and T1 SA (mean interval= 209 ± 80.5 days). At T1 SA, physician recommendations for the SMS cohort were that ChEI be continued (70.6%), switched (21.0%) or stopped (8.4%). A statistically significant increase of one point was found for the SMMSE (t=-4.6, df=182, p<.001) but not the GDS or CDT. Between initial and T1 TICS (mean interval= 183 ± 41.3 days), a statistically significant decrease of two points was found (t=2.86, df=219, p<.01). Not-scored TICS questions revealed that most ChEI users report ‘no change’ in mood/ motivation (70.0%), IADL (84.3%) and ADL ability (90.6%), orientation (90.6%), reasoning (82.5%), and memory (59.6%). Regression analyses indicated no significant differences in the association between time of testing and observed scores overall. Pharmacotherapeutic interventions should consider clinically meaningful outcomes for persons with AD when assessing continued ChEI use, as self-assessment of no change may be a positive outcome, despite standardized cognitive and functional assessments that may show otherwise.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".