Effect of galantamine on verbal repetition in AD - A secondary analysis of the VISTA trial

Objectives: To understand how commonly diminution of verbal repetition was a goal of treatment in patients with Alzheimer disease ( AD), how commonly that goal was achieved, whether goal attainment might be attributable to galantamine treatment, and whether change in verbal repetition is a marker of the overall treatment response. Methods: This is a secondary analysis of the Video-Imaging Synthesis of Treating Alzheimer's Disease study, a 4-month, double-blind, ;randomized, placebo-controlled trial of galantamine in 130 community-dwelling patients with mild to moderate AD. The primary outcome was Goal Attainment Scaling, in which individualized problems identified by patients/caregivers and treating physicians were assessed bimonthly. Results: Reduction of verbal repetition was set as a treatment goal in 44% (n = 57) of randomized patients. More patients/caregivers (32%) set repetition goals than did physicians (18%). After 4 months, more galantamine-treated patients showed diminution of verbal repetition (58%) than did placebo- treated patients (24%; p < 0.01). Reduction of verbal repetition correlated with improvement in clinical measures, but not in standardized ones. Conclusions: Reduction of verbal repetition is a common goal of Alzheimer disease treatment. After 4 months, patients treated with galantamine were more likely to experience a reduction of verbal repetition than those treated with placebo. Diminution of verbal repetition was associated with other improvements, suggesting it might be a clinical marker of a positive treatment response.