Drug Keeps Alzheimer's Patients Sharper Longer

Mental decline slowed with donepezil, studies show

MONDAY, Aug. 13, 2001 (HealthDayNews) -- Some Alzheimer's patients who take a drug that preserves a brain chemical linked to memory and learning can still cook, clean and otherwise care for themselves months longer than those who don't use the drug, say researchers.

Two studies in this month's issue of the journal Neurology say donepezil prevents mental decline in patients with mild-to-moderate forms of Alzheimer's by blocking the destruction of acetylcholine, a molecule that helps the mind stay focused and attentive. Ordinarily the disease depletes this chemical. While other studies have shown the drug preserves the ability to function over several months, the latest work is the first to show it helps for longer periods.

Dr. David Geldmacher, an Alzheimer's expert at Case Western Reserve University in Cleveland who has studied donepezil, calls the finding "very meaningful" for families touched by the disease. "Many families are less interested in cognitive test scores than in function," he says.

The studies also will be useful for neurologists who want to know how long they should prescribe donepezil, Geldmacher says. The American Academy of Neurology issued guidelines earlier this year that make the drug the standard of care for patients with mild or moderate forms of Alzheimer's.

The Food and Drug Administration hasn't approved donepezil for people with severe dementia, the extreme mental decline that eventually comes with Alzheimer's, Geldmacher says. But mounting evidence suggests the drug might delay the progression of the disease for these patients, too. Ultimately, however, neither donepezil nor other Alzheimer's drugs now on the market can prevent dementia from setting in for good.

And the drug may not be for everyone. It can cause nausea, diarrhea, sleep loss, vomiting, muscle cramps, fatigue and loss of appetite, though previous studies show these side effects are usually mild and temporary.

In the first trial, Richard Mohs and his colleagues at Mount Sinai School of Medicine in New York City followed 415 Alzheimer's patients for slightly more than a year. Those who took donepezil kept up their daily activities, from maintaining hobbies to doing the laundry, about five months longer than untreated patients. And people in the donepezil group were about 45 percent more likely than those taking placebos to show no clinical loss of function after 48 weeks.

"For Alzheimer's patients and their families, five months can mean another birthday celebration or another holiday, and five months more that they can stay in their own homes," says a statement by Mohs.

In the second year-long study, a group led by Dr. Bengt Winblad of Sweden's Karolinska Institute showed that donepezil cut by about half losses of mental ability and daily function compared with placebo treatment. That trial included 286 Swedish and Dutch patients with mild or moderate Alzheimer's dementia.

The trial "confirms the results of [other work], which have suggested that donepezil is an effective treatment in the long term and stresses the importance of continued donepezil treatment for optimal benefits in patients with mild-to-moderate" Alzheimer's disease, the researchers write.

Both studies found donepezil safe at the top dose of 10 milligrams per day.

Eisai Inc. of Teaneck, N.J., which makes and markets the drug as Aricept, funded the New York trial. New York City-based Pfizer Inc., which distributes and markets the drug, supported both studies.

What To Do

About 4 million Americans suffer from Alzheimer's disease, which is thought to be caused by the buildup of protein plaques in the brain.

To learn more about the condition, visit the Alzheimer's Disease Association or the Alzheimer's Disease Education and Referral Center. You can also try this site at the University of California at Irvine.

To learn more about donepezil and its side effects, click here.

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