The MMSE and MoCA score changes showed similar trends during the follow-up period (Fig. 2), suggesting a robust benefit when patients with mixed AD were treated with cognitive enhancers. As clinical trials with cognitive enhancers in AD

only include patients with probable AD, effectively excluding AD patients with concomitant svCVD, this real-life study from a clinic cohort for the first time provided direct evidence for benefit when patients with mixed AD with svCVD were treated with cognitive enhancers. A ACY-241 manufacturer previous longitudinal study of AD showed that the annual rate of cognitive decline based on MMSE scores was 2.3 without treatment with cognitive enhancers [32]. A review of cholinesterase inhibitors for AD showed that MMSE mean change from baseline to 6 months ranged from −0.5 to 1.35 [33]. In this current study, we demonstrated in a long-term real-life clinic study that, with cognitive enhancers, the average annual decline

in MMSE scores was 0.84 for patients with pure AD and 0.48 for patients with AD + svCVD. The change of −0.84 for pure AD is in keeping with previous literature. More importantly, we demonstrated that patients with mixed AD of the svCVD category showed less annual cognitive decline when treated with cognitive selleck products enhancers. Patients with long-standing hypertension have been shown to have increased rates of white matter lesions, both periventricular and subcortical, while hyperlipidemia had been associated with less severe WMH [34, 35]. In our cohort, cardiovascular risk factors were more prevalent, significantly so for hypertension, in mixed AD patients than in pure AD patients, Farnesyltransferase which is consistent with current literature. WMH has been associated with greater cognitive impairment in AD [10]. The baseline MMSE scores of our patients with mixed AD were significantly lower than those of the pure AD patients (20.1 vs. 23), although this significance disappeared after adjusting for years of education in the multivariable analysis. Interestingly, there were no sharp changes in MMSE scores over the period

of follow-up, and the baseline MMSE scores did not influence the progression of MMSE scores. Cholinergic dysfunction has been well described in AD [13]. In vivo imaging studies provided supportive evidence that periventricular white matter lesions were associated with cortical cholinergic deafferentation in elderly patients with HKI-272 purchase leukoaraiosis [17]. CVD may directly affect cholinergic white matter projections and may exacerbate pre-existing cholinergic deficits in AD [36]. The presence of periventricular WMH is also significantly associated with lower cortical cholinergic activity, supporting a regionally specific disruption of cholinergic projection fibers by WMH [37]. The cognitive benefit seen in our analysis confirmed the presence of cholinergic dysfunction in both patients with pure AD and those with mixed AD.