Objective: To evaluate the efficacy, safety, and tolerability of “very” high dose rivastigmine for a patient with the diagnosis of Alzheimer's disease.
Design: chart review
Methods: Dr. AM is a 77 year old retired dentist who presented initially in September 2000 with the complaint of memory loss. His initial evaluation was negative for dementia and his Folstein MMSE was 29. He had no family history. He was taking no medication and had no co morbid diseases. CT scan of the head was normal for age (mild atrophy). In subsequent evaluation (November 2000) his MMSE was 27 (recent recall was 1 out of 3). His wife gave multiple examples of anomia, decreased functional activity, mild apathy, and increased anxiety. His clock drawing ability was significant impaired. At this time, the patient and his wife agreed to begin treatment with rivastigmine, started at 1.5 mg with dinner for 7 days and then twice a day for the next 3 weeks. His dose was gradually increased to 12 mg/day over a 5 month period. Subsequent testing in March & July of 2001 revealed that his MMSE was 30. His wife was satisfied with his progression and no changes in dosage were recommended. However, follow up testing in January 2002 showed that his MMSE dropped to 21. At that time he was started on sertraline for anxiety and depression (Yassevage score was 6/15). In a desperate effort to slow his deterioration, another dose of 1.5mg of rivastigmine was added at noon time with lunch. This dose was subsequently increased to 6mg. At that time patient was taking 6mg rivastigmine three times a day (18mg /day). His MMSE again rose to 27 on August 2002. Six months later his MMSE dropped again to 25. Again, rivastigmine dose was increased gradually to a total of 22.5mg /day (7.5mg three times a day with meals). His most recent MMSE (April 2003) is 29. No adverse effect was reported during treatment with these doses of rivastigmine.
Results: His most recent MMSE (April 2003) is 29. No adverse effect was reported during treatment with these doses of rivastigmine.
Conclusion: In this case report, high dose rivastigmine (22.5 mg/day in three divided doses,) was well-tolerated with no reported side effects. Of significant notes are the clinical and caregiver reports of improved cognitive ability.
Back to PC Wednesday Poster Sessions
Back to The Eleventh International Congress