Objective: Previous study show beneficial effect of rivastigmine treatment on cognition in patients with poor reaction to donepezil treatment. Also patients with poor therapeutic effect after rivastigmine show greater improvement on cognition after donepezil treatment.
Design: The aim of the study was to assess the effect of 6 months of treatment with donepezil on cognitive abilities in patients previously treated with rivastigmine with minimal therapeutic effect.
Materials and Methods: 35 patients with mild to moderate stage of Alzheimer's disease, aged 60-86 (mean 73) years, treated with donepezil for 6 months, daily dosage 5-10 mg (mean 7,5 mg) were participants in this study. Neuropsychological assessment was performed after 0-2 days of the end of rivastigmine treatment and after 3 months and 6 months of donepezil treatment. Clinical and cognitive measurements included: Trail Making Test A&B (TMT A&B), Digit Span - backward (DS), Verbal Fluency Test (VF), ADAS-COG and MMSE as well as clinical interview with patient and caregiver. Neuropsychological assessment was performed before, and after 3 and 6 months of treatment. Statistical evaluation was performed using ANOVA Friedman test.
Results: Both 3 and 6 months treatment with donepezil results in significant improvement on MMSE (p<0.05) and most of neuropsychological tests. Among cognitive tests significant improvement on ADAS-cog, VF (p<0.01) and TMT A (p<0.05) were noted. No significant changes on the performance of frontal lobe tests - TMT B and DS were observed.
Conclusion: The results obtained suggest that donepezil can improve most of cognitive function measured with selected neuropsychological tests in patients with Alzheimer Disease previously treated with rivastigmine without positive therapeutic effect.
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