Pilot service has been created to help members of the primary care teams of England get answers to their clinical questions.This is the first visit to the site we rmend you read "".View by speciality MOST RECENT QUESTIONS: (Please click on a question for the answer) When should one stop giving a patient aricept?31/Aug/07 ANSWER: The NICE technology appraisal on Donepezil, galatamine and rivastigamine and memantine, issued in November 2006, states: "_The three acetylcholinesterase inhibitors donepezil, galantamine and rivastigmine are rmended as options in the management of people with Alzheimer's disease of moderate severity only (that is, those with a Mini Mental State Examination score of between 10 and 20 points), and under the following conditions"_ Patients who continue on the drug should be reviewed every 6 months by MMSE score and global, functional and behavioural assessment.On the patient's condition at follow-up should be sought.Should only be continued while the patient's MMSE score remains at or above 10 points and their global, functional and behavioural condition remains at a level where the drug is considered to be having a worthwhile effect.Review involving MMSE assessment should be undertaken by an appropriate specialist team, unless there are locally agreed protocols for shared care.People with mild Alzheimer's disease who are currently receiving donepezil, galantamine or rivastigmine, and people with moderately severe to severe Alzheimer's disease currently receiving memantine, whether as routine therapy or as part of a clinical trial, may be continued on therapy (including after the conclusion of a clinical trial) until they, their carers and/or specialist consider it appropriate to stop. The guideline gives an explanation of MMSE scores: "MMSE score, for example, denotes the severity of cognitive impairment as follows: • mild Alzheimer's disease: MMSE 21 to 26 • moderate Alzheimer's disease: MMSE 10 to 20 • moderately severe Alzheimer's disease: MMSE 10 to 14 • severe Alzheimer's disease: MMSE less than 10.On the 14th August 2007, NICE posted a summary of a judicial enquiry on its guideline on acetycholinerase inhibitors.Makes the same rmendations as above and can be accessed at: SIGN produced its guideline on the management of patients with dementia in February 2006.Notes: "4.There is a significant body of evidence to support the use of the cholinesterase inhibitor donepezil in people with mild to moderate AlzheimerЎ¦s disease.Evidence to suggest that its efficacy may extend to the treatment of people with more severe forms of AlzheimerЎ¦s disease.At daily doses of 5 mg and above, can be used to treat cognitive decline in people with AlzheimerЎ¦s disease.And severity of AlzheimerЎ¦s disease should not be contraindications to the use of donepezil.It adds: "_Evidence for similar effects in patients with moderate to severe dementia is lacking, and for a diagnosis other than AlzheimerЎ¦s disease is not available at the RCT level.A search in the Medline database identified two randomised placebo- controlled trials of donepezil in the patients with severe dementia published in the last two years.Suggests Donepezil may offer some benefit to patients with severe dementia.The Medline abstract of these studies read: _"Patients with severe AD (Mini-Mental State Examination scores > or =6) were enrolled in this multinational, double-blind, placebo-controlled trial at 98 sites.Were randomized to donepezil 10 mg daily or placebo for 24 weeks._Primary endpoints were the Severe Impairment Battery (SIB) and Clinician's Interview-Based Impression of Change-Plus caregiver input (CIBIC-Plus).Endpoints included the MMSE, the Alzheimer Disease Cooperative Study-Activities of Daily Living-severe version (ADCS-ADL-sev), the Neuropsychiatric Inventory (NPI), the Caregiver Burden Questionnaire (CBQ), and the Resource Utilization for Severe Alzheimer Disease Patients (RUSP).Analyses were performed in the intent-to-treat (ITT) population using last post-baseline observation carried forward (LOCF).Assessments were performed for patients receiving > or =1 dose of donepezil or placebo.Patients were randomized to donepezil (n = 176) or placebo (n = 167).Was superior to placebo on SIB score change from baseline to endpoint (least squares mean difference 5.= 0.And MMSE scores favored donepezil at endpoint (p = 0.= 0.Was not significantly different from placebo on the ADCS-ADL-sev, NPI, CBQ, or RUSP.Events reported were consistent with the known cholinergic effects of donepezil and with the safety profile in patients with mild to moderate AD.With severe AD demonstrated greater efficacypared to placebo on measures of cognition and global function.The second study was undertaken by Winbald et al.Report: "_Alzheimer's disease (mini mental state examination score 1-10) who were living in assisted care nursing homes ran by trained staff in Sweden.Assigned patients oral donepezil (5 mg per day for 30 days then up to 10 mg per day thereafter, n=128) or matched placebo (n=120).Primary endpoints were change from baseline to month 6 in the severe impairment battery (SIB) and modified Alzheimer's Disease Cooperative Study activities of daily living inventory for severe Alzheimer's disease (ADCS-ADL-severe).FINDINGS: 95 patients assigned donepezil and 99 patients assigned placebopleted the study.Treated with donepezil improved more in SIB scores and declined less in ADCS-ADL-severe scores at 6 months after initiation of treatmentpared with baseline than did controls (least squares ), with most being transient and mild or moderate in severity.Patients discontinued treatment because of adverse events in the donepezil group (n=20) than in the placebo group (n=8)._INTERPRETATION: Donepezil improves cognition and preserves function in individuals with severe Alzheimer's disease who live in nursing homes.REFERENCES 1.Donepezil, galatamine and rivastigamine and memantine for the treatment of AlzheimerЎ¦s Disease.2006. SIGN.Of patients with dementia.2006.3.SE, Doody R, Li H et al.Preserves cognition and global function in patients with severe Alzheimer disease.Jul 31;69(5):459-69.4.B, Kilander L, Eriksson S; Severe AlzheimerЎ¦s Disease Group.In patients with severe Alzheimer's disease: double-blind, parallel-group, placebo-controlled study.2006 Apr 1;367(9516):1057-65. The NLH Question Answering Service aims to answer questions quickly, it is not a systematic review.You have any doubt as to the implications of this contact the Q&A Service Provider for further information.Read more Statin linked to sleep disruption
Get more Topiramate is as effective as acetazolamide for the treatment of idiopathic intracranial hypertension
