Use of donepezil for the treatment of mild - moderate Alzheimer's disease: an audit of the assessment and treatment of patients in routine clinical practice

Abstract

There have been a number of randomised, placebo‐controlled trials of donepezil in the treatment of mild – moderate Alzheimer's disease and these report significant benefits for a proportion of patients. Little is known about the use of donepezil in routine clinical practice. The aims of this study were to examine the use of donepezil in routine clinical practice and to identify some of the practical and resource implications associated with treatment. A number of areas were examined against published guidelines including assessment, diagnosis, initiation of treatment, monitoring and discontinuation of treatment. This was a retrospective case note study involving patients with mild – moderate Alzheimer's disease over a one‐year period. One hundred and seventeen patients were commenced on donepezil and 93 successfully completed three months of treatment. Of these, 47% demonstrated an improvement in cognition, activities of daily living or carer observation (or a combination). Compliance with accepted guidelines with respect to assessment, diagnosis and monitoring requires a standardised approach that has both clinical and resource implications. Copyright © 2000 John Wiley & Sons, Ltd.

Reversal of visual attention dysfunction after AMPA lesions of the nucleus basalis magnocellularis (NBM) by the cholinesterase inhibitor donepezil and by a 5-HT1A receptor antagonist WAY 100635

“…Reversible AchE inhibitors correct the impairment in memory and cognitive and Dr. Rosario Samanin died on 5 June 2001 C. Balducci · M. Nurra · A. Pietropoli · R. Samanin · M. Carli ( ) ) Istituto di Ricerche Farmacologiche "Mario Negri", via Eritrea 62, 20157 Milano, Italy e-mail: mirjana@marionegri.it Tel. : +39-0239014466 Fax: +39-023546277 attentional functions of AD patients (Beller et al 1985;Summers et al 1986;Sahakian et al 1993;Cameron et al 2000;Evans et al 2000), probably by enhancing central cholinergic function (Shinotoh et al 2001).…”

Reversal of visual attention dysfunction after AMPA lesions of the nucleus basalis magnocellularis (NBM) by the cholinesterase inhibitor donepezil and by a 5-HT1A receptor antagonist WAY 100635

“…Reversible AchE inhibitors correct the impairment in memory and cognitive and Dr. Rosario Samanin died on 5 June 2001 C. Balducci · M. Nurra · A. Pietropoli · R. Samanin · M. Carli ( ) ) Istituto di Ricerche Farmacologiche "Mario Negri", via Eritrea 62, 20157 Milano, Italy e-mail: mirjana@marionegri.it Tel. : +39-0239014466 Fax: +39-023546277 attentional functions of AD patients (Beller et al 1985;Summers et al 1986;Sahakian et al 1993;Cameron et al 2000;Evans et al 2000), probably by enhancing central cholinergic function (Shinotoh et al 2001).…”

Adherence, persistence and continuation with cholinesterase inhibitors in Alzheimer's disease

“…By 15 months, the percentage of ‘good responders’ decreased to 7% and those with a stable MMSE decreased to 40% [28]. In a smaller study of 117 patients, there was improvement in cognitive assessment in 26% of people after 3 months and the authors concluded that after a 3‐month trial period, only about one‐third of the patients should be continued on therapy [22]. Overall, reports on cognitive responders seem to show that about 10–15% will improve over a background placebo response rate of about 20% or less, giving an overall responder rate of 30–35%.…”

“…There have also been a number of reports of the persistence rates after about 3–6 months in open‐label, real‐life observational clinical studies. In this situation continuation rates of 62.7% [19], 74% [20], 64–70% [11], 83% [21] and 79% [22] have been reported while persistence rates of 40–54% have been reported in real‐life patients over 12 months [23].…”

Cognitive performance in Alzheimer's disease patients receiving rivastigmine for up to 5 years

“…If these findings were shown to be applicable to AD patients in general and to translate into clinical benefit, they may have important practical implications. Currently, few patients remain on treatment with cholinesterase inhibitors for more than a year (13), but as the long‐term benefits of these drugs are elucidated the average treatment duration may increase.…”

Reversal of visual attention dysfunction after AMPA lesions of the nucleus basalis magnocellularis (NBM) by the cholinesterase inhibitor donepezil and by a 5-HT1A receptor antagonist WAY 100635

“…Reversible AchE inhibitors correct the impairment in memory and cognitive and Dr. Rosario Samanin died on 5 June 2001 C. Balducci · M. Nurra · A. Pietropoli · R. Samanin · M. Carli ( ) ) Istituto di Ricerche Farmacologiche "Mario Negri", via Eritrea 62, 20157 Milano, Italy e-mail: mirjana@marionegri.it Tel. : +39-0239014466 Fax: +39-023546277 attentional functions of AD patients (Beller et al 1985;Summers et al 1986;Sahakian et al 1993;Cameron et al 2000;Evans et al 2000), probably by enhancing central cholinergic function (Shinotoh et al 2001).…”

Adherence, persistence and continuation with cholinesterase inhibitors in Alzheimer's disease

“…By 15 months, the percentage of ‘good responders’ decreased to 7% and those with a stable MMSE decreased to 40% [28]. In a smaller study of 117 patients, there was improvement in cognitive assessment in 26% of people after 3 months and the authors concluded that after a 3‐month trial period, only about one‐third of the patients should be continued on therapy [22]. Overall, reports on cognitive responders seem to show that about 10–15% will improve over a background placebo response rate of about 20% or less, giving an overall responder rate of 30–35%.…”

“…There have also been a number of reports of the persistence rates after about 3–6 months in open‐label, real‐life observational clinical studies. In this situation continuation rates of 62.7% [19], 74% [20], 64–70% [11], 83% [21] and 79% [22] have been reported while persistence rates of 40–54% have been reported in real‐life patients over 12 months [23].…”

Cognitive performance in Alzheimer's disease patients receiving rivastigmine for up to 5 years

“…If these findings were shown to be applicable to AD patients in general and to translate into clinical benefit, they may have important practical implications. Currently, few patients remain on treatment with cholinesterase inhibitors for more than a year (13), but as the long‐term benefits of these drugs are elucidated the average treatment duration may increase.…”

Reversal of visual attention dysfunction after AMPA lesions of the nucleus basalis magnocellularis (NBM) by the cholinesterase inhibitor donepezil and by a 5-HT1A receptor antagonist WAY 100635

“…Reversible AchE inhibitors correct the impairment in memory and cognitive and Dr. Rosario Samanin died on 5 June 2001 C. Balducci · M. Nurra · A. Pietropoli · R. Samanin · M. Carli ( ) ) Istituto di Ricerche Farmacologiche "Mario Negri", via Eritrea 62, 20157 Milano, Italy e-mail: mirjana@marionegri.it Tel. : +39-0239014466 Fax: +39-023546277 attentional functions of AD patients (Beller et al 1985;Summers et al 1986;Sahakian et al 1993;Cameron et al 2000;Evans et al 2000), probably by enhancing central cholinergic function (Shinotoh et al 2001).…”

Adherence, persistence and continuation with cholinesterase inhibitors in Alzheimer's disease

“…By 15 months, the percentage of ‘good responders’ decreased to 7% and those with a stable MMSE decreased to 40% [28]. In a smaller study of 117 patients, there was improvement in cognitive assessment in 26% of people after 3 months and the authors concluded that after a 3‐month trial period, only about one‐third of the patients should be continued on therapy [22]. Overall, reports on cognitive responders seem to show that about 10–15% will improve over a background placebo response rate of about 20% or less, giving an overall responder rate of 30–35%.…”

“…There have also been a number of reports of the persistence rates after about 3–6 months in open‐label, real‐life observational clinical studies. In this situation continuation rates of 62.7% [19], 74% [20], 64–70% [11], 83% [21] and 79% [22] have been reported while persistence rates of 40–54% have been reported in real‐life patients over 12 months [23].…”

Cognitive performance in Alzheimer's disease patients receiving rivastigmine for up to 5 years

“…If these findings were shown to be applicable to AD patients in general and to translate into clinical benefit, they may have important practical implications. Currently, few patients remain on treatment with cholinesterase inhibitors for more than a year (13), but as the long‐term benefits of these drugs are elucidated the average treatment duration may increase.…”