Donepezil in Alzheimer’s Disease: What to Expect after 3 Years of Treatment in a Routine Clinical Setting

Abstract

Background/Aims: Clinical short-term trails have shown positive effects of donepezil treatment in patients with Alzheimer’s disease. The outcome of continuous long-term treatment in the routine clinical settings remains to be investigated. Methods: The Swedish Alzheimer Treatment Study (SATS) is a descriptive, prospective, longitudinal, multicentre study. Four hundred and thirty-five outpatients with the clinical diagnosis of Alzheimer’s disease, received treatment with donepezil. Patients were assessed with Mini-Mental State Examination (MMSE), Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), global rating (CIBIC) and Instrumental Activities of Daily Living (IADL) at baseline and every 6 months for a total period of 3 years. Results: The mean MMSE change from baseline was positive for more than 6 months and in subgroups of patients for 12 months. After 3 years of treatment the mean change from baseline in MMSE-score was 3.8 points (95% CI, 3.0–4.7) and the ADAS-cog rise was 8.2 points (95% CI, 6.4–10.1). This is better than expected in untreated historical cohorts, and better than the ADAS-cog rise calculated by the Stern equation (15.6 points; 95% CI, 14.5–16.6). After 3 years with 38% of the patients remaining, 30% of the them were unchanged or improved in the global assessment. Conclusion: Three-year donepezil treatment showed a positive global and cognitive outcome in the routine clinical setting.

Differences in Survival between Patients with Dementia with Lewy Bodies and Patients with Alzheimer's Disease - Measured from a Fixed Cognitive Level

“…The fact that such a large fraction of patients in both diagnostic groups was treated with cholinesterase inhibitors should be taken into consideration since this has been shown to alter the cognitive progression in AD [32,38,39,40,41] and is most likely to do so in DLB as well [42,43,44]. …”

“…The AD patients were followed in the Swedish Alzheimer Treatment Study (SATS) [32], where the baseline was the time of diagnosis and when treatment with cholinesterase inhibitor was initiated. Diagnosis was made according to the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria [25] for probable/possible AD.…”

Risk Factors That Affect Life Expectancy in Alzheimer's Disease: A 15-Year Follow-Up

“…The SATS is a prospective, open-label, observational, nonrandomized, multicenter study that has been described in several publications [18,19,20,21]. In total, 1,258 participants were recruited until April 2008 by 14 memory clinics that cover different parts of Sweden.…”

Role of Neuroimaging in Alzheimer's Disease, with Emphasis on Brain Perfusion SPECT

“…The most profound and earliest cognitive deficits seem to be impairment of episodic memory-the ability to recall events that are specific to a time and place. Medications such as cholinesterase inhibitors are able to delay the progression of AD (2). Moreover, patients who have AD and in whom the start of cholinesterase inhibitor therapy is delayed demonstrate fewer benefits than do patients starting therapy early in the course of AD (3).…”