Treatment of a whole population sample of Alzheimer's disease with donepezil over a 4-year period: lessons learned.
BACKGROUND
In the UK it is recommended that acetylcholinesterase inhibitors be restricted to patients with moderate Alzheimer's disease, and progress monitored within specialist clinics.


OBJECTIVE
To describe a cohort of patients with Alzheimer's disease from a whole city population treated with donepezil, and to analyse outcomes over 4 years.


METHODS
Historical cohort design: 88 patients recruited 1997-1998, assessed at baseline with 4-year follow-up, using an agreed protocol and validated measures: survival, retention in treatment, cognition, non-cognitive symptoms, weight change, carer stress.


RESULTS
64.7% remained on treatment beyond 6 months, 57.9% beyond 1 year and 12.5% beyond 4 years. 56% remained alive at 4 years - almost twice the number predicted. Mean MMSE score amongst patients in treatment did not deteriorate over 4 years. Survival, retention in treatment, maintenance/improvement of cognition was greater with high baseline MMSE. Non-cognitive symptoms, carer stress and weight change remained low throughout.


CONCLUSIONS
A minority of people with dementia from the population (88 of potential 2,000 at outset, 11 by 4 years) received treatment. Benefits for individuals were confirmed, especially for those with mild impairment. Expenditure on medication was modest in a population context. These findings question recent guidance from the National Institute for Clinical Excellence, which would restrict therapy to patients with moderate cognitive impairment.
Lyle
Sarah
S
Services for Older People, Shelton Hospital, Shrewsbury, UK.
Grizzell
Moni
M
Willmott
Sasi
S
Benbow
Susan
S
Clark
Michael
M
Jolley
David
D
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis; D015331:Cohort Studies; D000077265:Donepezil; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010880:Piperidines / Q000627:therapeutic use*; D012720:Severity of Illness Index
D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil