Evaluation of donepezil in Alzheimer's disease ‐Experience from an Australian memory clinic

Abstract

Objectives: To describe our experience using cholinesterase inhibitors for mild‐moderate Alzheimer's disease in a memory clinic. In particular we reviewed response in cognition, activities of daily living and quality of life for patients.Design: A prospective descriptive study with patients and carers being assessed before and 3–6 months after commencing treatment with a cholinesterase inhibitor. Setting: Memory clinic at Repatriation General Hospital, Adelaide.Subjects: Sixty‐four consecutive patients with mild‐moderate Alzheimer's disease commencing treatment with a cholinesterase inhibitor and their carers.Outcome Measures The primary outcome was a change in cognition as measured by the Mini‐Mental Status Examnination (MMSE). Secondary outcomes were The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS), patient self‐assessed measures of quality of life (Dementia Quality of Life Instrument (DQOL) with sub‐scales in self‐esteem, positive affect, negative affect, belonging and aesthetics, and a five point likert scale of overall quality of life (QOL)) and carer assessed proxy direct scaling of patient quality of life.Results: All patients were commenced on Donepezil. Fifty‐four (84%) patients remained on drug treatment and completed the study with follow‐up at an average of 13 weeks. Ten patients (16%) stopped treatment due to side‐effects or non‐compliance. There was a mean change of 1.1 points on the MMSE (p< 0.05) and a small but significant (p<0.05) improvement in the positive affect sub‐scale of the DQOL. There were no improvements in other sub‐scales of the DQOL or overall quality of life. A similar number of patients improved 14 (26%) in activities of daily living as those who deteriorated 12 (22%) with the majority 28 (52%) remaining unchanged.Conclusion: Donepezil has a beneficial effect on cognition and affect when used in the setting of a memory clinic. There was little evidence to suggest an improvement in activities of daily living and overall quality of life.