Magazine article Clinical Psychiatry News

Start Cholinesterase Inhibitor Immediately after Alzheimer's Dx. (Improves Cognitive Function)

Magazine article Clinical Psychiatry News

Start Cholinesterase Inhibitor Immediately after Alzheimer's Dx. (Improves Cognitive Function)

Article excerpt

BALTIMORE -- Treatment with a cholinesterase inhibitor should start as soon as a patient is diagnosed with Alzheimer's disease and be continued for life, Dr. Adam Rosenblatt said at a meeting on Alzheimer's disease and other dementias sponsored by Johns Hopkins University.

Ample evidence shows that early treatment can improve cognitive function, but that the gains are completely reversed within months of stopping the drug.

Given how safe some of these preparations are and how short life expectancy is after Alzheimer's is diagnosed, there is no reason to ever stop treatment, according to Dr. Rosenblatt, a psychiatrist who is affiliated with Johns Hopkins.

Dr. Rosenblatt cited evidence showing that cholinesterase inhibitors offer the greatest benefit when treatment starts soon after diagnosis.

"Don't wait for the disease to get real bad. Once you've made the clinical diagnosis, give the patient [one of] these drugs," Dr. Rosenblatt advised at the meeting, which was cosponsored by the American Geriatrics Society and the Maryland Chapter of the Alzheimer's Association.

In one study, 473 patients who had mild to moderate Alzheimer's disease were randomly assigned to receive either 5 mg or 10 mg of donepezil daily or placebo for 24 weeks.

Cognitive function--as measured by the cognitive portion of the Alzheimer's Disease Assessment Scale and the Mini-Mental State Examination--improved significantly only in the treated patients.

All benefits disappeared when the drug was stopped for 6 weeks at the end of the trial (Neurology 50[1]:136-45, 1998). …

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