The medication donepezil (Aricept), which is typically used to treat mild to moderate Alzheimer's disease, seems to reverse some cognitive and functional deterioration in patients who have severe forms of the disease, Swedish researchers report.

Approximately 20% of Alzheimer's patients have severe dementia, but the potential benefit of using Aricept to treat them had not been studied until now.

The Study

In the trial, a research team led by Dr. Bengt Winblad, director of the Karolinska Institute's neurology department, assigned 248 Alzheimer's patients who were living in nursing homes to receive either donepezil or a placebo for a period of six months.

Winblad's team found that the patients taking donepezil experienced improvements in cognitive function and in their ability to perform daily activities, compared with patients receiving a placebo.

The patients receiving donepezil were more likely to have side effects than those on a placebo, but these side effects were usually short lived and mild to moderate in severity, according to the researchers.

Helpful For Caregivers

"This drug is effective in the severe stage of Alzheimer's," 'S7inblad says. "It greatly reduces caregiver burden."

The results are significant, Winblad continues, because the high cost of caring for Alzheimer's patients is largely due to the need for intensive caregiver attention. "You have to support the patient in every activity of life," 'Winblad says. "If they understand better, if they communicate better, it makes it easier for caregivers to do their job."

Dr. David B. Hogan, holder of the Brenda Strafford chair in geriatric medicine at the University of Calgary Health Sciences Centre in Alberta, Canada, agrees that the people who care for Alzheimer's patients need help. "If you can decrease the strain on families, that would be very beneficial," he says. "It would also be beneficial to the staff caring for these people in nursing homes."

However, Hogan is not impressed with donepezil's benefit to patients. "There was some effect of treatment, but it was not substantial or significant." he notes.

"Even if there was some benefit to the patients, it may not be worth the effort and cost of prescribing the medication. The money might be better spent elsewhere," such as on better nursing care to improve the patients' quality of life or on resources to help relatives cope with the loss of a loved one, Hogan suggests.

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