Specific symptomatic changes following donepezil treatment of Alzheimer's disease: a multi-centre, primary care, open-label study.
BACKGROUND
Standard measurement scales used in anti-dementia trials may not capture symptomatic changes recognized by clinicians and caregivers. We studied a symptom checklist, completed separately by caregivers and by clinicians, to identify patterns of change associated with donepezil treatment.


METHODS
In a multi-centre, 6-month, open-label study of 101 primary care patients, changes in a 19-symptom checklist were assessed in relation to changes in standardized scales of cognition, activities of daily living, behavior, and caregiver burden.


RESULTS
Three symptoms were reported in more than 80% of patients by both clinicians and caregivers: problems in remembering, (97%), temporal orientation (89%), and repetitiveness (85%). Five others overlapped on each of the clinician and caregiver 'top ten', including cognitive activation, spatial orientation, leisure, attention, and apathy. Clinicians reported that symptoms did not improve in 38 patients, whereas there was some improvement in 43, and improvement in most symptoms in 20. Caregivers reported that symptoms did not improve in 55 patients, whereas 27 and 19 patients showed some and most symptoms improving respectively. Patients with the greatest symptomatic improvement also improved most on the ADAS-Cog and the other standardized measures, whereas no improvement (or decline) in each standardized measure was observed in people whose symptoms worsened or did not improve.


CONCLUSIONS
A symptom checklist allowed clinically meaningful profiles to be identified, but revealed different estimates of response between clinicians and caregivers. Both agreed that improved executive function was the most common response. A symptom checklist can help translate between standard measures and everyday practice.
Rockwood
Kenneth
K
Geriatric Medicine and Neurology, Dalhousie University, Halifax, Canada.
Black
Sandra
S
Bedard
Marc-Andre
MA
Tran
Thang
T
Lussier
Isabelle
I
D000203:Activities of Daily Living / Q000145:classification* / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D001288:Attention / Q000187:drug effects*; D017028:Caregivers / Q000523:psychology; D017281:Cost of Illness; D000077265:Donepezil; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007189:Indans / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011939:Mental Recall / Q000187:drug effects*; D008609:Mental Status Schedule; D009042:Motivation; D018697:Nootropic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009949:Orientation / Q000187:drug effects*; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use*; D011320:Primary Health Care; D013239:Stereotyped Behavior / Q000187:drug effects*; D016896:Treatment Outcome
D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil