Sustained cognitive improvement following treatment of Alzheimer's disease with donepezil.
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.
Evans
M
M
Elderly Mental Health Directorate, Wirral and West Cheshire Community NHS Trust, Clatterbridge Hospital, Bebington, UK.
Ellis
A
A
Watson
D
D
Chowdhury
T
T
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
D000928:Antidepressive Agents; D002800:Cholinesterase Inhibitors; D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil