NEUROPSYCHOLOGICAL AND NEUROPSYCHIATRIC ASSESSMENTS IN ALZHEIMER’S DISEASE PATIENTS TREATED WITH PLASMA EXCHANGE WITH ALBUMIN REPLACEMENT FROM THE AMBAR STUDY
- Antonio Páez, Spain
Abstract
Aims
Recently, the primary results of cognitive, functional, and global assessment outcomes of the Alzheimer’s Management By Albumin Replacement (AMBAR) trial demonstrated that plasma exchange (PE) with albumin replacement slowed the cognition and functional decline associated with the progression of the disease. Here we report the AMBAR results on neuropsychological and neuropsychiatric outcomes.
Methods
Out of 496 patients enrolled, 347 were randomized into three PE-treatment arms with different doses of albumin and intravenous immunoglobulin (IVIG) replacement, and placebo (sham PE). Initially, a weekly conventional therapeutic PE (TPE), the same for the three PE-treatment arms, was done for 6 weeks. After this period, each arm underwent a 12-month period of monthly low-volume PE (LVPE). Specific test measurements were performed at month 0 (baseline), month 2 (end of TPE period), months 6, 9 and 12 (during LVPE period), and month 14.
Results
While neuropsychological scores of placebo patients declined across the study, all-patient and mild-AD (MMSE: 22-26) cohorts treated with PE and high-dose albumin plus IVIG showed improvement in language fluency (effect sizes: 106%-362%; p-values: 0.03 to 0.001), and processing speed (effect sizes: 318%-743%; p-values: 0.03 to 0.04) at month 14. All-patient and moderate-AD (MMSE: 18-21) cohorts significantly improved short-term verbal memory (effect sizes: 94%-1100%; p-values: 0.02 to 0.003). The progression of the neuropsychiatric symptoms, including depression and suicide, of PE-treated and placebo patients was similar to placebo across the study.
Conclusions
PE-treated AD patients showed improvement in specific neuropsychological tests of memory and language, without a worsening of their psychoaffective status.