Objective: To investigate patterns of dose escalation, adverse events and duration of therapy in a population of memory clinic patients with a diagnosis of Alzheimer’s disease (AD) attending a treatment clinic.
Design: Retrospective analysis of systematically collected longitudinal clinic data.
Materials and Methods: All patients with confirmed AD commencing treatment with donepezil, rivastigmine or galantamine at the Leicester General Hospital Memory Clinic between January 1998 and February 2003 were considered for inclusion. Baseline assessment included CAMCOG, MMSE, RSS and BADLS plus a full physical assessment including brain MRI. Follow up data collected included, MMSE, BADLS RSS plus ratings of side effects, compliance and drug dosage. All patients were reviewed at 3 monthly intervals by medical or nursing staff. Data were entered into an SPSS database and descriptive statistics calculated.
Results: Data from 76 subjects (39 male; 37 female) were extracted and analysed. Mean age of subjects was 70.6 years, mean baseline MMSE was 23.1, mean RSS was 18.0, and mean BADL score was 8.2. At 1 year, 71% of patients had remained on treatment and of these 69% had achieved the maximum therapeutic dose of their respective drugs. Adverse events occurred in 26% of patients of which the most common were nausea (15%), vomiting (10%) and cramps (7%). There appeared to be some difference in the proportion of patients experiencing side effects with donepezil (24%), rivastigmine (44%) and galantamine (8%).
Conclusion: The majority of patients commencing cholinesterase inhibitor therapy in this clinic remained on treatment at 1 year. Side effects were common and may have limited the achievement of maximal therapeutic dosing.
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