[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 8, March 2012].
A study was performed by researchers at King’s College London, to see whether the benefits of cholinesterase inhibitors for the treatment of Alzheimer’s Disease might continue after the progression from mild-to-moderate Alzheimer’s Disease into moderate-to-severe phases of the disease.
295 community-dwelling patients who had been treated with donepezil for at least 3 months and with moderate or severe Alzheimer’s Disease were assigned randomly to either continue donepezil, discontinue donepezil, discontinue donepezil and start memantine, or continue donepezil and start memantine. Patients received this treatment for 1 year.
It was found that continued treatment with donepezil resulted in cognitive benefits for patients with moderate or severe Alzheimer’s Disease over 12 months. The relative efficacy of donepezil and memantine (which is usually prescribed only in the later stages of Alzheimer’s at present) did not differ significantly in the presence or absence of the other.
This research demonstrates that thousands of patients with more advanced Alzheimer’s Disease could benefit from continued prescription of drugs such as Aricept, whereas up until now cholinesterase inhibitors have tended not to be prescribed once sufferers progress beyond moderate symptoms. This new evidence could result in twice as many Alzheimer’s sufferers worldwide being given medication.
Note: These drugs do not halt the decline of patients, but they slow it down and help patients cope with the activities of daily living at the more severe disease stages, for longer than would otherwise be the case. Patients who continue to take donepezil are expected to show about four months worth of improvement (i.e. postponed decline) in their ability to remember, communicate and perform daily tasks. These improvements are sustained over one year.
Note: The patent for Aricept expired recently so cheaper generic versions, under the name donepezil, are available for £12 a month.
Dreaper, J. (2012). Alzheimer’s patients ‘should stay on drugs for longer’. London: BBC Health News, March 8th 2012.
Full Text Link (b) (Access online requires a journal subscription or payment).
Howard, R. McShane, R. [and] Lindesay, J. [et al] (2012). Donepezil and memantine for moderate-to-severe Alzheimer’s disease. The New England Journal of Medicine, March 8th 2012, Vol.366(10), pp.893-903. (Click here to view the PubMed abstract).
Full Text Link (c) (Access online requires a journal subscription or payment).
Schneider, LS. (2012). Discontinuing donepezil or starting memantine for Alzheimer’s disease. The New England Journal of Medicine, March 8th 2012, Vol.366(10), pp. 957-9.