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Publications (2)2.98 Total impact

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    ABSTRACT: To determine whether donepezil treatment (10 mg/day over 24 weeks) is associated with delayed emergence of apathy in patients with mild to moderate Alzheimer's disease (AD) and to explore relationships between donepezil's effects on apathy and other Neuropsychiatric Inventory (NPI)-measured behavioural symptoms. Two randomised, double-blind, parallel-group, placebo-controlled studies that met prespecified criteria and were sufficiently similar to allow data pooling were derived from all donepezil AD clinical trials. Patients scoring from 10 to 26 on baseline Mini-Mental Status Examination were included. A clinical milestone for apathy and other NPI items was defined as the first emergence of a composite score (frequency × severity) ≥ 3. Differences in time to event (i.e. milestone) between donepezil- and placebo-treated groups were assessed using the Kaplan-Meier method and log-rank test. Shift tables were constructed to evaluate clinical milestone status for apathy and other NPI items at baseline and endpoint, and were analysed using the Cochran-Mantel-Haenszel (CMH) test, stratified by baseline status. Of all NPI items, apathy had the highest proportion of subjects scoring ≥ 3 at baseline. Donepezil was superior to placebo on both apathy milestone analyses (time-to-event log-rank test and shift table CMH test, p = 0.01). Aberrant motor behaviour demonstrated similar benefit. Donepezil treatment appears to have resulted in a significant reduction over 6 months of the emergence of apathy in patients with AD. These data suggest that a prospective clinical trial in patients with early AD that includes apathy as a primary outcome measure may be warranted.
    International Journal of Geriatric Psychiatry 02/2011; 26(2):150-7. · 2.98 Impact Factor
  • Sean Knox, Craig W Ritchie
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    ABSTRACT: The prevalence of Alzheimer's disease is expected to significantly increase over the next few decades. Recognising symptoms in the routine clinical setting can be challenging, particularly in the early stages. Memory loss that causes disruption to everyday life may be the first presenting complaint; however, more subtle changes may occur much earlier. These may include difficulty in performing complex activities of daily living, decline in objective neuropsychological testing and apathy, which may be present for a decade before a diagnosis is made. In the non-specialist setting, the Mini Mental State Examination and the clock-drawing test still predominate and there is limited scope for applying tests such as magnetic resonance imaging (MRI) scanning or plasma markers. At present we remain poor at diagnosing Alzheimer's dementia, particularly in the early stages; therefore, improved awareness of early symptoms as well as a belief in the value of early diagnosis may lead to more effective management of patients.