FYI Daily

Alzheimer's Drugs Seem to Work Later in Disease

Last updated: Mar 08, 2012

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To continue Alzheimer's medications or to stop them? It can be an agonizing decision. New research indicates there may be some benefit to continuing the drugs into the severe stage, although it also suggests the benefits are modest.

A new study in the New England Journal of Medicine finds that patients with moderate or severe Alzheimer's disease appeared to retain a small but significant benefit with the donepezil (Aricept) -- even as their condition still continued to worsen -- over those who added or switched to memantine (Namenda) or stopped taking any medication for Alzheimer's.

Many caregivers and families of someone with Alzheimer's wonder, as the disease progresses and the sufferer's condition declines, if the medications are really making a difference that justifies their cost and side effects (which can include weight loss, dizziness, and agitation). And yet, it can be very difficult to decide to quit one of these drugs, in the event a loved one's cognition might worsen faster.

According to Clinical Psychiatry News, the 1-year study, called DOMINO (Donepezil and Memantine in Moderate to Severe Alzheimer's Disease), which was done at King's College London, also found:

  • Patients who continued on donepezil showed improved cognitive and functional outcomes, compared with all other groups

  • Patients who stopped donepezil and started memantine showed smaller but still significant benefits.

  • Patients who stopped donepezil and didn't switch to memantine did not improve.

  • Patients who continued donepezil and added memantine to their regimen did not improve further than those who simply continued donepezil.

"For the first time we have robust and compelling evidence that treatment with these drugs can continue to help patients at the later and more severe stages of the disease," lead researcher Robert Howard told The Telegraph. "We observed that patients who continued taking donepezil and memantine were better able to remember, understand, communicate, and perform daily tasks for at least a year longer than those who stopped taking the drugs."

However, the report also noted that "improvements in cognition and function associated with donepezil and memantine were small relative to the overall size of the decline in cognitive and functional status that was seen in all patients."

The findings can be viewed in two ways, said Lon S. Schneider, a physician in both the department of psychiatry and behavioral sciences and the department of neurology at the University of Southern California, Los Angeles:

1) That the small improvement in scores of patients who continued taking donepezil is clinically important enough to affect their ability to remain at home a bit longer, and

2) That those who decide to discontinue donepezil are also supported by the research, "by the fact that only half of the patients who were assigned to continue donepezil for the one-year trial actually did so for the full year. That rate of withdrawal suggests that many patients perceived that continuing medication was not effective."

Does that help you decide? Or just muddy an already confusing decision?

Image by Flickr user Patrick Hoesly, used under a Creatice Commons license.