Sustained cognitive improvement following treatment of Alzheimer's disease with donepezil

Objectives. To audit response to the anticholinesterase inhibitor donepezil in patients referred to a specialist memory clinic, to identify possible means of targeting the drug more accurately. Design. All referrals to the clinic who were assessed and treated against a protocol, with structured follow-up. Subjects. All referrals of any age with the diagnosis of probable Alzheimer's disease, mild to moderately severe. Main outcome measures. Cognitive improvement as measured by serial ADAS-cog and MMSE examinations. Results. Two hundred and eight-two patients commenced on treatment, improved cognitive functioning in over 65% of patients reaching 3 months (N = 184), 51% on intention to treat analysis (N = 231), with significantly greater improvement (p = 0.03) in those aged 65 and under. Carer reports of behavioural improvement not always linked to cognitive improvement. Trend to increased response in those on concomitant antidepressants. Conclusion. Three-month assessment for response prior to agreeing continuation of treatment selects a group who maintain their response. Younger patients should be targeted for early assessment and treatment. Copyright (C) 2000 John Wiley & Sons, Ltd.