THE EFFICACY OF ACETYLCHOLINESTERASE INHIBITORS USING THE RIVERMEAD BEHAVIOURAL MEMORY TEST IN ALZHEIMER'S DISEASE PATIENTS

Abstract

Assessment of memory is critical for evaluation for possible dementia. Usually, the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) is held to be clinically importance. The Rivermead Behavioural Memory Test (RBMT) is one of the few measures known to have ecological validity when used with memory disturbed older adults. The present study compared three drugs (donepezil, galantamine and rivastigmine) by the RBMT in Japan. Acetylcholinesterase inhibitors (AChEIs), including donepezil, galantamine, and rivastigmine, have attracted growing interest from people with Alzheimer's disease (AD) and their caregivers. This analysis consists of a 12 month prospective open-label study of 22 patients diagnosed with mild to moderate AD patients treated with AChEI. Subjects received a total daily dose of 10mg donepezil, 24mg galantamine or 18mg rivastigmine at final visit. The RBMT is comprised of 12 subtests (recall of name, recall and whereabouts of a belonging, remembering to make an appointment, immediate and delayed recall of a story and a route traced around the room, recall of faces and objects, orientation and knowledge if the data). Raw scores are converted to Profile scores of 0 (abnormal), 1 (borderline) or 2 (normal) adding to a total possible Profile score of 24. Screening scores are determined on a pass (1) or fail (0) basis. The RBMT and its subscales provided maximum information at moderate level of cognitive dysfunction. Mean improvements from baseline were similar with three drugs in total Profile score. On its subscales, galantamine was superior to the other drugs for improving the “(immediate & delayed) route” functional area (prospective memory) of the RBMT. Although donepezil showed improvement in the “belonging” area. The utility of the RBMT and its subscales is optimal in the moderate range of memory dysfunction, but raw score differences in cognitive dysfunction. The open-label design of this study does not allow us to know whether this is a treatment effect, which requires further investigation.