Differential response to Donepezil in MRI subtypes of mild cognitive impairment

Abstract

Abstract Background Donepezil is an approved therapy for the treatment of Alzheimer’s disease (AD). Results across clinical trials have been inconsistent, which may be explained by design-methodological issues, the pathophysiological heterogeneity of AD, and diversity of included study participants. We investigated whether response to Donepezil differs in mild cognitive impaired (MCI) individuals demonstrating different magnetic resonance imaging (MRI) subtypes. Methods From the Hippocampus Study double-blind, randomized clinical trial, we included 173 MCI individuals (donepezil = 83; placebo = 90) with structural MRI data, at baseline and at clinical follow-up assessments (6-12-month). Efficacy outcomes were the annualized percentage change (APC) in hippocampal, ventricular, and total grey matter volumes, as well as in the AD cortical thickness signature. Participants were classified into MRI subtypes as typical-AD, limbic-predominant, hippocampal-sparing, or minimal atrophy at baseline. We compared two subtyping approaches: the conventional categorical approach and an approach based on continuous dimensions. Results Donepezil treated MCI individuals showed slower atrophy rates compared to the placebo group, but only if they belonged to the minimal atrophy or hippocampal sparing subtypes. Importantly, only the continuous subtyping approach, but not the conventional categorical approach, captured this differential response. Conclusions Our data suggest that individuals with MCI, with hippocampal sparing or minimal atrophy subtype, may have improved benefit from donepezil, as compared with MCI individuals with typical or limbic predominant patterns of atrophy. The newly proposed continuous subtyping approach may have advantages compared to the conventional categorical approach. Future research is warranted to demonstrate the potential of subtype stratification for disease prognosis and response to treatment. Trial registration: Clinical Trial.gov Number: NCT00403520, Submission Date: November 21, 2006.