Long-Term Effects of Rivastigmine Treatment on the Need for Psychotropic Medications in Nursing??Home Patients with Alzheimer???s Disease

Abstract

Neuropsychiatric symptoms and behavioural disturbances occur in most patients with Alzheimer's disease (AD), are a source of stress for caregivers, and are the primary cause of patient institutionalisation. These symptoms often are treated with psychotropic medications. However, adverse drug interactions, adverse effects and nursing home regulations make reducing the use of psychotropic medications in elderly AD patients an important goal of therapy. Fifty-two-week data including data from a 26-week prospective open-label, multicentre study and its 26-week open-label extension were analysed. 173 patients with moderate to severe AD residing in nursing homes were treated with rivastigmine 1.5-6mg twice daily. In the study, psychotropic drug use and behavioural symptoms were measured at baseline and at 52 weeks. Results showed that 40% of patients who were receiving psychotropic medications at baseline had discontinued use or reduced their dose of psychotropic medications at week 52. Furthermore, significant improvements were observed from baseline in 10 of the 12 behavioural domains of the Nursing Home version of the Neuropsychiatric Inventory, including delusions (mean change from baseline -2.0; p = 0.002), hallucinations (mean change -3.1; p < 0.001), anxiety (mean change -1.1; p = 0.014), and euphoria (mean change -3.2; p = 0.006). These data suggest favourable tolerability, behavioural and pharmacoeconomic outcomes in nursing home residents with AD who are treated with rivastigmine.