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Current pharmacologic options for patients with Alzheimer's disease.

Reichman WE - Ann Gen Hosp Psychiatry (2003)

Bottom Line: In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine.There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment.MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated).

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103. reichman@umdnj.edu

ABSTRACT
BACKGROUND: The aim of the current study was to provide general practitioners with an overview of the available treatment options for Alzheimer's disease (AD). Since general practitioners provide the majority of medical care for AD patients, they should be well versed in treatment options that can improve function and slow the progression of symptoms. DESIGN: Biomedical literature related to acetylcholinesterase inhibitors (AChEIs) was surveyed. In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine. There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment. MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated). Clinical trials have demonstrated that patients with AD who do not receive active treatment decline at more rapid rates than those who do. CONCLUSIONS: Given that untreated AD patients show decline in three major areas (cognition, behavior, and functional ability), if drug treatment is able to improve performance, maintain baseline performance over the long term, or allow for a slower rate of decline in performance, each of these outcomes should be viewed a treatment success.

No MeSH data available.


Related in: MedlinePlus

Cognitive function in AD patients receiving donepezil 5 or 10 mg/day or placebo [22]. Values are mean (± standard error of the mean [SEM]) change from baseline. Reassessment 6 weeks after withdrawal of donepezil reveals that the benefits of drug treatment were lost upon withdrawal. (From Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology. 1998;50:136-45.)
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Figure 2: Cognitive function in AD patients receiving donepezil 5 or 10 mg/day or placebo [22]. Values are mean (± standard error of the mean [SEM]) change from baseline. Reassessment 6 weeks after withdrawal of donepezil reveals that the benefits of drug treatment were lost upon withdrawal. (From Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology. 1998;50:136-45.)

Mentions: The efficacy of donepezil in improving/maintaining cognition has been demonstrated in a 15-week and two 24-week clinical trials [21-23]. Doses of 5 mg and 10 mg showed significantly better results than placebo in measures of cognition (according to the AD Assessment Scale-cognitive subscale [ADAS-cog] [24]; Figure 2) and global function (according to the Clinician's Interview-Based Impression of Change-plus Caregiver Input [CIBIC-plus] [25]) [21-23]. In another open-label study over a period of 254 weeks comparing donepezil to a historical placebo (estimated from annualized changes in ADAS-cog from historical cohorts of untreated AD patients), patients treated with donepezil 10 mg/day maintained cognitive function until Week 38 [26]. Benefits in ability to perform ADL were also seen with donepezil 5 and 10 mg/day during clinical use [21,22].


Current pharmacologic options for patients with Alzheimer's disease.

Reichman WE - Ann Gen Hosp Psychiatry (2003)

Cognitive function in AD patients receiving donepezil 5 or 10 mg/day or placebo [22]. Values are mean (± standard error of the mean [SEM]) change from baseline. Reassessment 6 weeks after withdrawal of donepezil reveals that the benefits of drug treatment were lost upon withdrawal. (From Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology. 1998;50:136-45.)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC149431&req=5

Figure 2: Cognitive function in AD patients receiving donepezil 5 or 10 mg/day or placebo [22]. Values are mean (± standard error of the mean [SEM]) change from baseline. Reassessment 6 weeks after withdrawal of donepezil reveals that the benefits of drug treatment were lost upon withdrawal. (From Rogers SL, Farlow MR, Doody RS, Mohs R, Friedhoff LT. A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology. 1998;50:136-45.)
Mentions: The efficacy of donepezil in improving/maintaining cognition has been demonstrated in a 15-week and two 24-week clinical trials [21-23]. Doses of 5 mg and 10 mg showed significantly better results than placebo in measures of cognition (according to the AD Assessment Scale-cognitive subscale [ADAS-cog] [24]; Figure 2) and global function (according to the Clinician's Interview-Based Impression of Change-plus Caregiver Input [CIBIC-plus] [25]) [21-23]. In another open-label study over a period of 254 weeks comparing donepezil to a historical placebo (estimated from annualized changes in ADAS-cog from historical cohorts of untreated AD patients), patients treated with donepezil 10 mg/day maintained cognitive function until Week 38 [26]. Benefits in ability to perform ADL were also seen with donepezil 5 and 10 mg/day during clinical use [21,22].

Bottom Line: In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine.There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment.MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated).

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103. reichman@umdnj.edu

ABSTRACT
BACKGROUND: The aim of the current study was to provide general practitioners with an overview of the available treatment options for Alzheimer's disease (AD). Since general practitioners provide the majority of medical care for AD patients, they should be well versed in treatment options that can improve function and slow the progression of symptoms. DESIGN: Biomedical literature related to acetylcholinesterase inhibitors (AChEIs) was surveyed. In the United States, there are four AChEIs approved for the treatment of AD: tacrine, donepezil, rivastigmine, and galantamine. There are other agents under investigation, but at present, AChEIs are the only approved drug category for AD treatment. MEASUREMENTS AND MAIN RESULTS: AD is becoming a major public health concern and underdiagnosis is a significant problem (with only about half of AD patients being diagnosed and only half of those diagnosed actually being treated). Clinical trials have demonstrated that patients with AD who do not receive active treatment decline at more rapid rates than those who do. CONCLUSIONS: Given that untreated AD patients show decline in three major areas (cognition, behavior, and functional ability), if drug treatment is able to improve performance, maintain baseline performance over the long term, or allow for a slower rate of decline in performance, each of these outcomes should be viewed a treatment success.

No MeSH data available.


Related in: MedlinePlus