title: Donepezil can improve daily activities and promote rehabilitation for severe Alzheimer's patients in long-term care health facilities.
abstract: BACKGROUND
  Cholinesterase inhibitors can delay the progression of Alzheimer's disease (AD). Several clinical trials of the drug in moderate to severe AD have consistently reported clinically positive effects. A combining effect with psychosocial intervention was reported in mild to moderate AD patients. Since a therapeutic approach or rehabilitation combined with cholinesterase inhibitors for severe AD patients remains controversial, we performed a prospective intervention for patients in Long-Term Care Health Facilities (LTCHF).
  
  
  METHODS
  Two LTCHFs (N1, N2) were enrolled. N1 is a 126-bed facility that does not treat with donepezil but rather with psychosocial intervention (reality orientation and reminiscence). N2 is a 150-bed facility with a 50-bed special dementia unit, in which the physician can prescribe donepezil. On top of the similar psychosocial intervention, rehabilitation is performed in N2. Thirty-two severe AD patients (MMSE < 6) in N1 and N2 (16 vs. 16) were compared for the effect of donepezil (10 mg/d for 3 months) with or without psychosocial intervention (n = 8 vs. 8 for each facility). The Vitality Index was used to assess daily activities and the introduction of rehabilitation.
  
  
  RESULTS
  The response ratio (MMSE 3+) of donepezil was 37.5% in N2. The combination of donepezil with the psychosocial intervention improved the Vitality Index total score, and Communication, Eating, and Rehabilitation subscores (Wilcoxon, p = 0.016, 0.038, 0.023, and 0.011, respectively). Most of them were smoothly introduced to rehabilitation, and the proportion of accidental falls decreased. Psychosocial intervention in N1 without the drug only improved the total score (Wilcoxon, p = 0.046).
  
  
  CONCLUSIONS
  A combined therapeutic approach of donepezil and psychosocial intervention can have a positive effect, even for severe patients through the introduction of rehabilitation and decreasing accidental falls. However, these findings require replication in a larger cohort.
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. k-meg@umin.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Meguro
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. y.ouchi@med.tohoku.ac.jp.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Ouchi
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. k.akanuma@med.tohoku.ac.jp.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Akanuma
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. meguromitsue0721@ezweb.ne.jp.
authors.forename: Mitsue
authors.initials: M
authors.lastname: Meguro
authors.affiliation: Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. sato-mari@umin.ac.jp.
authors.forename: Mari
authors.initials: M
authors.lastname: Kasai
mesh_terms: D000203:Activities of Daily Living; D000544:Alzheimer Disease / Q000188:drug therapy* / Q000534:rehabilitation; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy; D018450:Disease Progression; D000077265:Donepezil; D005260:Female; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D010880:Piperidines / Q000627:therapeutic use*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil