Evaluation of donepezil in Alzheimer's disease - Experience from an Australian memory clinic

Objectives: To describe our experience using cholinesterase inhibitors for mild-moderate Alzheimer's disease in a memory clinic. In particular we reviewed response in cognition, activities of daily living and quality of life for patients. Design: A prospective descriptive study with patients and carers being assessed before and 3-6 months after commencing treatment with a cholinesterase inhibitor. Setting: Memory clinic at Repatriation General Hospital, Adelaide. Subjects: Sixty-four consecutive patients with mild-moderate Alzheimer's disease commencing treatment with a cholinesterase inhibitor and their carers. Outcome Measures: The primary outcome was a change in cognition as measured 6y the Mini-Mental Status Examnination (MMSE). Secondary outcomes were The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS), patient self-assessed measures of quality of life (Dementia Quality of Life Instrument (DQOL) with sub-scales in self-esteem, positive affect, negative affect, belonging and aesthetics, and a five point likert scale of overall quality of life (QOL)) and carer assessed proxy direct scaling of patient quality of life. Results: All patients were commenced on Donepezil. Fifty-four (84%) patients remained on drug treatment and completed the study with follow-up at an average of 13 weeks. Ten patients (16%) stopped treatment due to side-effects or non-compliance. There was a mean change of 1.1 points on the MMSE (p < 0.05) and a small but significant (p < 0.05) improvement in the positive affect sub-scale of the DQOL. There were no improvements in other sub-scales of the DQOL or overall quality of life. A similar number of patients improved 14 (26%) in activities of daily living as those who deteriorated 12 (22%) with the majority 28 (52%) remaining unchanged. Conclusion: Donepezil has a beneficial effect on cognition and affect when used in the setting of a memory clinic. There was little evidence to suggest an improvement in activities of daily living and overall quality of life.