The Use of Medications for Cognitive Enhancement

Abstract

Objective:To provide Canadian physicians and allied health care professionals with the evidence they need to help them make treatment decisions in the management of patients with Alzheimer’s disease or other dementias.Options:The full range and quality of diagnostic and therapeutic modalities available to Canadian physicians for the management of dementia.Outcomes:Improvement in the treatment of dementias, leading to reduced suffering, increased functional capacity and decreased economic burden.Evidence and values:The creation of these evidence-based consensus statements involved literature reviews of the subject by the authors; comparison of alternative clinical pathways and description of the methods whereby published data were analyzed; definition of the level of evidence for data in each case; evaluation and revision in a conference setting (involving primary care physicians, neurologists, psychiatrists, geriatricians, psychologists, consumers and other interested parties); insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all authors.Benefits, harms, and costs:A rational plan for the therapy of dementias is likely to lead to substantial benefits in both human and economic terms.Recommendations:Treatment decisions should be made taking into account the severity or stage of the disease, the availability of caregivers, the presence of disease affecting other bodily systems and the ability of the subject to pay the cost of the medications. Donepezil is considered to have positive effects upon certain tests of neuropsychological function and may produce some improvement in Alzheimer’s disease of mild to moderate severity as measured by rating scales. Its ability to improve quality of life remains uncertain. No other drug treatments* (apart from symptomatic therapies) are at present approved for the treatment of Alzheimer’s disease.Validation:These recommendations were created by a writing committee, evaluated and revised at a consensus conference and further reviewed and revised by the writing committee prior to publication.

Canadian Outcomes Study in Dementia: Study Methods and Patient Characteristics

“…The relatively frequent use of cholinesterase inhibitors in this study population (that is, 83% of patients at baseline) must be considered in the context that the use of cholinesterase inhibitors for the treatment of dementia has not been met with unconditional endorsement in Canada (25,26). However, there was fair evidence from the Canadian Consensus Conference on Dementia (CCCD) (2), and further recommendation from the American Academy of Neurology (AAN) (27), to support the use of cholinesterase inhibitors for mild-tomoderate dementia.…”

Development of a Brief Cognitive Screen for Mild Cognitive Impairment and Neurocognitive Disorder

“…Substantial recent interest in MCI has undoubtedly been stimulated by the development of novel pharmacologic treatments that can potentially slow the progression of dementia (Pryse-Phillips et al, 2001). Given that approximately 10% of persons with amnestic MCI (Petersen, Doody et al, 2001) go on to develop Alzheimer's disease (AD) per year (Petersen et al, 1999;Rubin, Morris, Grant, & Vendegna, 1989), this group of individuals may profit most from early pharmacologic interventions.…”

Donepezil in Alzheimer’s disease: an evidence-based review of its impact on clinical and economic outcomes

“…Also, there was significant benefit with both the 5 mg/day and 10 mg/day doses of donepezil, with no clear dosedependent differences. Six systematic reviews found statistically significant differences from placebo in groups treated with donepezil 5 or 10 mg/day in up to seven RCTs (Pryse-Phillips et al 2001;Clegg et al 2002;Wolfson et al 2002;Birks & Harvey 2003;Warner et al 2004;NICE 2005; Table 6). In a meta analysis of individual patient data from 10 RCTs (Whitehead et al 2004), the odds of improvement in CIBIC-plus scores was approximately twice as great with donepezil 5 or 10 mg/day as with placebo at 12 and 24 weeks.…”