Objective: Previous study shows different clinical efficacy and tolerability of various cholinergic drugs used in Alzheimer's disease. Most experiences were accumulated concerning donepezil and rivastigmine.
Design: The aim of the study was to assess cognitive abilities in patients with Alzheimer's disease treated with donepezil or rivastigmine for 12 months.
Materials and Methods: 125 patients with mild to moderate stage of Alzheimer's disease, aged 56-86 (mean 70) years, were treated with donepezil, 5-10 mg/day, (90 patients) or rivastigmine, 6-12 mg/day, (35 patients) for 12 months. Clinical and cognitive measurements included: Trail Making Test, Stroop Color-Word Interference Test, Digit Span backward (DS), Verbal Fluency Test, ADAS-COG, and MMSE as well as clinical interview with patient and caregiver. Neuropsychological assessment was performed before and after 3, 6, and 12 months of treatment. Statistical evaluation was performed using ANOVA Friedman test.
Results: Both after 3 and 6 months of treatment patients receiving donepezil showed significant improvement on MMSE (especially those with mild cognitive impairment), while in patients treated with rivastigmine, such effect was observed only in patients receiving drug 12 mg/day. The results of selected neuropsychological tests were significantly improved in patients treated with donepezil. Verbal abilities were also improved after 3 months treatment with high dosage of rivastigmine. No changes on frontal lobe tests (TMT B, Stroop B and DS) were noted after donepezil and rivastigmine treatment. After 12 months of treatment the results of some cognitive tests show deterioration, especially measured frontal function. After 12 months patients receiving rivastigmine show greater deterioration on verbal (VF) and spatial function (TMT B) compared to donepezil group.
Conclusion: The results obtained suggest that donepezil exerts more robust effect on different cognitive domains in patients with Alzheimer's disease in short- and long-term treatment.
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