P3‐107: Long‐term clinically meaningful change in verbal repetition following cholinesterase inhibitor treatment can be detected early
Bibliographic record
Abstract
Verbal repetition (repetitive stories, questions) is a common, troubling, but comparatively under-studied problem in people with Alzheimer's disease (AD). Clinically meaningful change in verbal repetition following cholinesterase inhibitor treatment can track the overall treatment effect. When such an effect might be discerned is less clear. Here, we evaluated how soon after treatment a change in verbal repetition might be identified, and whether the effect was sustained. Patients attending a Canadian tertiary care memory clinic and their care partners were asked to target 4–6 symptoms for treatment. Diagnoses were made using standardized criteria. Symptoms were defined using the 60-item SymptomGuide™, which includes verbal repetition. At each visit, symptoms were tracked using a 7 point scale anchored at 0 (no change) to +/- 3 (very much better/very much worse). Time-to-event (improvement/worsening) was defined as the time from entry to the first non-zero score. We tracked both change in symptoms and the Mini-Mental State Examination (MMSE) score. The time-to-event distribution was calculated using the Kaplan-Meyer estimator. Between group (better/worse) differences were calculated using the log rank test, significant at P<0.05. Of 243 patients with AD in whom a verbal repetition tracking goal was set, 107 (44%) had clinically meaningful change in symptoms, of whom 69 also had corresponding MMSE score changes. Of the 37 patients who improved, the median time to improvement was 43 days range (1–594). By two years, 88% of those with initial improvement also showed final visit improvement in both MMSE and symptoms. Of the 32 patients who worsened, the median time to both symptom and MMSE worsening was 164 days range (1–720). By two years, 85% who initially had shown worsening were also worse at their final visit. In evaluating the impact of a cholinesterase inhibitor on verbal repetition, half the cases of clear improvement were detected by 6 weeks, and half those with clear worsening by six months; both corresponded to two year effects. Simple clinical inquiries can help track the impact of AD treatment.
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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 | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 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".