The purpose of this study is to investigate the clinical and caregiver impression on AriceptTM treatment. In a prospective study, 57 consecutive Alzheimer's disease patients were treated with Donepezil for 16 weeks, using a 5mg tablet, administered once daily at bedtime. Patients met the criteria of NINCDS-ADRDAI for probable Alzheimer's disease. There were no exclusion criteria for the study. After 16-weeks of treatment, the caregiver completed a questionnaire regarding the effectiveness of the drug. Subjective cognitive improvement, MMSE,2 ADL,3 and IADL4 outcomes were all assessed before and after treatment. Behavioral improvements included those of depression, agitation, violence, anxiety, and paranoid thoughts. Functional and overall family satisfaction was also evaluated Side effects and reason for discontinuation of the medication were also reported. Out of the 57 patients in the study, 15 patients (26 percent) terminated participation due to side-effects. Total adverse event was reported in 24 (42 percent) of the patients. Cognitive improvement was reported in 27 (47 percent) of patients. Verbal skills and attention were the most commonly-reported cognitive improvement. Average MMSE declined by two points after 16 weeks of treatment. No behavioral improvement was reported Behavioral deterioration was reported in three (5 percent) of patients. Functional improvement was reported in 21 (37 percent) of patients. Favorable overall family satisfaction was reported in 27 (47 percent) patients. Although the overall clinical impression from AriceptTM (Donepezil) treatment (as measured by the MMSE, ADL, IADL and behavior) was unfavorable, there was a high family and caregiver satisfaction. This satisfaction was due mainly to functional improvement. The main cognitive improvement reported was in verbal skills and attention span.

Objective: To develop a simple clock drawing score system for patients with Alzheimer's disease, that correlates with the MMSE (Folstein Mini Mental Status Examination).1 Design: A retrospective analysis of 88 patients with the diagnosis of Alzheimer's disease Setting: Outpatient Memory Disorder Institute of a large community teaching hospital. Measurements: MMSE score and two different clock drawing ratings. The MMSE and the clock drawing scoring were performed by different raters. We present a “simple clock scoring system” and compared it with a previously published scoring system by Sunderland et al,2 referred to as the standard score system. Results: There is a strong correlation between the “new score system” and the standard scoring (Pearsons Correlation Coefficient r = 0.91, p < 0.001). However, when both systems were evaluated in a multivariate linear regression analysis, the “ simple score system “ was a significant predictor of Folstein MMSE (P < 0.01), while the standard scoring system was not. Conclusion: The “simple score system” is an easy to use, accurate predictor of the MMSE score, in patients with the diagnosis of Alzheimer's disease.

The purpose of this study was to investigate the clinical and caregivers impression of Aricept ® treatment in patients suffering from Multi-Infarct Dementia (MID).In a prospective study 73 MID patients 1 were treated with Donepezil (Aricept ® ) for 16-to 20-weeks. Donepezil was administered as a 5mg tablet once daily at bedtime. After four weeks, patients tolerant of the 5-mg dose were increased to 10 mg daily. All patients satisfied the DSM-III-R criteria for Multi-Infarct Dementia. 2 After 16-to 20-weeks of treatment, the patient's caregiver completed a questionnaire concerning the effectiveness of the drug. Subjective cognitive improvement, MMSE, 3 ADL 4 and IADL 5 outcomes were all assessed before and after treatment (referred to as Clinical Impression). Behavioral outcomes evaluated included depression, agitation, violence, anxiety, and paranoid thoughts.Functional and overall family satisfaction were also evaluated. Side effects as well as reasons for discontinuation from the study were also reported.Seventy-three patients participated in the study. Twelve patients (16 percent) terminated participation due to side effects. Total adverse events were reported in 34 (46.5 percent) of patients. Cognitive improvement was reported in 31 (42.4 percent) patients. Verbal skills and attention were the most commonly reported cognitive improvement. Average MMSE declined by 2.6 points after 16-weeks of treatment. No behavioral improvement was reported. Behavioral deterioration was reported in 16 (21.9 percent) of patients. Functional improvement was reported in 32 (42.8 percent) patients. Overall positive family satisfaction was reported in 54 (73.9 percent) patients.Although Donepezil treatment was approved by the FDA for the treatment of Alzheimer's Disease (AD), such treatment for MID patients appears to be a reasonably safe and effective treatment from the caregiver and family's point of view.

When should I take away the car keys? Is it still safe for him/her to drive? Are all patients diagnosed with Alzheimer's disease (AD) a hazard on the road? What about driving for short distances in a familiar territory? Can people with AD drive with family or caregiver supervision? Those are but a few of the difficult questions asked by caregivers of people with AD. There is confusion regarding the optimal time to recommend that a patient with AD stop driving.1-5 In an attempt to assist caregivers with this difficult question, guidelines have been issued, although they frequently have conflicting recommendations in this matter.6-10