title: Treatment of a whole population sample of Alzheimer's disease with donepezil over a 4-year period: lessons learned.
abstract: 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.
authors.affiliation: Services for Older People, Shelton Hospital, Shrewsbury, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lyle
authors.forename: Moni
authors.initials: M
authors.lastname: Grizzell
authors.forename: Sasi
authors.initials: S
authors.lastname: Willmott
authors.forename: Susan
authors.initials: S
authors.lastname: Benbow
authors.forename: Michael
authors.initials: M
authors.lastname: Clark
authors.forename: David
authors.initials: D
authors.lastname: Jolley
mesh_terms: 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
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil