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Drug Appears Effective for Severe Alzheimer's Cases

Aricept seems to reverse some of the advanced deterioration

THURSDAY, March 23, 2006 (HealthDay News) -- Aricept, which is typically used to treat mild-to-moderate Alzheimer's disease, seems to reverse some cognitive and functional deterioration in patients with severe forms of the disease, Swedish researchers report.

The potential benefit of Aricept (donepezil) to treat Alzheimer's patients with severe dementia had not been studied until now. Some 20 percent of Alzheimer's patients suffer from severe dementia; as the disease progresses, they become less able to communicate, less mobile, and increasingly reliant on nursing care.

In the trial, a research team led by Dr. Bengt Winblad, director of the Karolinska Institute's neurology department, assigned 248 Alzheimer's patients living in nursing homes to receive donepezil or a placebo for six months.

Winblad's team found that patients receiving donepezil experienced improvements in cognition and in their ability to perform daily activities, compared with patients receiving a placebo.

Those patients receiving donepezil were more likely to have side effects than those on a placebo, but these side effects were usually short-lived and mild to moderate in severity, the researchers said.

"This drug is effective in the severe stage of Alzheimer's," Winblad said. "It greatly reduces caregiver burden."

This finding is significant, Winblad said, because the high cost of caring for Alzheimer's patients is largely due to the need for intensive caregiver attention. "You have to support the patient in every activity of life," Winblad said. "If they understand better, if they communicate better, it makes it easier for caregivers to do their job."

The findings appear in the March 23 early online edition of The Lancet.

One expert questioned the significance of the gains produced by the drug.

"There was some effect of treatment," said Dr. David B. Hogan, holder of the Brenda Strafford chair in geriatric medicine at the University of Calgary Health Sciences Centre, in Alberta, Canada, and author of an accompanying commentary in the journal. "But it wasn't substantial or significant."

"However, even if there was some benefit to the patients, it may not be worth the effort and cost of prescribing the medication," Hogan said. "It might be that instead of helping people in the late stages of Alzheimer's disease, money might be better spent elsewhere."

Perhaps more resources should be spent on things like nursing care to improve the patient's quality of life, or helping relatives cope with the loss of a loved one, he said.

As for Winblad's point that improving the patient's cognitive function, even a little bit, is a help to caregivers, Hogan said that might be a worthy goal for using donepezil. But, he noted, that was not the goal stated in the study.

"If you can decrease the strain on families, that would be very beneficial," Hogan said. "It would also be beneficial to staff caring for these people in nursing homes."

More information

To learn more about donepezil, visit the U.S. National Library of Medicine.

SOURCES: Bengt Winblad, M.D., director, neurology, Karolinska Institute, Huddinge, Sweden; David B. Hogan, M.D., Brenda Strafford chair, geriatric medicine, University of Calgary Health Sciences Centre, Calgary, Alberta, Canada; March 23, 2006, The Lancet online
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