title: Sustained cognitive improvement following treatment of Alzheimer's disease with donepezil.
abstract: OBJECTIVE
  To audit response to the anticholinesterase inhibitor donepezil in patients referred to a specialist memory clinic, to identify possible means of targeting the drug more accurately.
  
  
  METHODS
  All referrals to the clinic who were assessed and treated against a protocol, with structured follow-up.
  
  
  METHODS
  All referrals of any age with the diagnosis of probable Alzheimer's disease, mild to moderately severe. Main outcome measures Cognitive improvement as measured by serial ADAS-cog and MMSE examinations.
  
  
  RESULTS
  Two hundred and eight-two patients commenced on treatment, improved cognitive functioning in over 65% of patients reaching 3 months (N=184), 51% on intention to treat analysis (N=231), with significantly greater improvement (p=0.03) in those aged 65 and under. Carer reports of behavioural improvement not always linked to cognitive improvement. Trend to increased response in those on concomitant antidepressants.
  
  
  CONCLUSIONS
  Three-month assessment for response prior to agreeing continuation of treatment selects a group who maintain their response. Younger patients should be targeted for early assessment and treatment.
authors.affiliation: Elderly Mental Health Directorate, Wirral and West Cheshire Community NHS Trust, Clatterbridge Hospital, Bebington, UK.
authors.forename: M
authors.initials: M
authors.lastname: Evans
authors.forename: A
authors.initials: A
authors.lastname: Ellis
authors.forename: D
authors.initials: D
authors.lastname: Watson
authors.forename: T
authors.initials: T
authors.lastname: Chowdhury
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000523:psychology*; D000928:Antidepressive Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D000077265:Donepezil; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008485:Medical Audit; D008609:Mental Status Schedule; D008875:Middle Aged; D018697:Nootropic Agents / Q000627:therapeutic use*; D018579:Patient Selection; D010880:Piperidines / Q000627:therapeutic use*; D012017:Referral and Consultation; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D002800:Cholinesterase Inhibitors; D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil