Initiating and monitoring cholinesterase inhibitor treatment for Alzheimer's disease

Abstract

The availability of acetylcholinesterase inhibitors for the treatment of Alzheimer's disease raises a number of clinical and ethical questions. Many of the guidelines published in an attempt to tackle these questions lack either clinical or scientific validity. Against this background a model is proposed whereby specialist monitoring using formal tests is neither appropriate nor necessary to determine whether an individual patient should continue or stop treatment. Instead the primary care physician should refer potentially suitable patients for specialist assessment to confirm the diagnosis/ He/she should then initiate, monitor, and discontinue treatment based on the establishment of realistic treatment goals agreed with the patient/carer at the outset. Copyright © 1999 John Wiley & Sons, Ltd.

Goal setting and attainment in Alzheimer's disease patients treated with donepezil

“…11 14 Understanding such trade offs, providing a role for patient and carer involvement, and clarifying treatment expectations will be necessary if the recommendation that a global clinical measure be used in routine monitoring of cholinesterase inhibitor use in AD is taken up. 10 Whether such trade offs account for the at best modest correlations between GAS scores and the scores on standard tests is not clear. In this study, with the exception of the CIBIC-plus, most correlations between other measures and GAS were in the low to moderate range, although they tended to increase over time.…”

“…9 A biologically plausible hypothesis exists 2 ; there is a reproducible, dose response effect, and the outcome measures converge. 9 Still, a ready summary of clinical meaningfulness has proved elusive 10 despite the requirement that trials undertaken for regulatory approval use a global clinical measure as a primary outcome. 11 Of note, none of these measures incorporate the preferences of patients and carers in the assessment of benefit, even though this is held to be both an essential part of a clinically meaningful effect 12 and a practical guide to prescribing cholinesterase inhibitors.…”

Associations between physical strength, cerebral function and mental health in independent-living elderly Japanese women

“…Unfortunately, it is usually difficult to diagnose early dementia using the conventional tests (28), although early diagnosis of dementia is important because recent advances in medicine have developed drugs that are expected to prevent or delay mental dysfunction (29,30).…”

The primary care physician and Alzheimer's disease: An international position paper

“…In Europe, the prevalence of patients treated with AChEIs is extremely variable, with AChEIs ranging from 16% in the Netherlands to 31% in France ( 37 ). According to some authors, general practitioners should also be able to write the initial prescription of AChEIs, as waiting for confirmation of diagnosis from a specialist is not in contradiction with an initial prescription by the PCP when the diagnosis is easy, since the wait to see a specialist is 2 to 6 months ( 77 ). Moreover most of these drugs will be soon available in a generic version.…”