The aim of this 12-week, open-label study was to determine the safety and efficacy of donepezil in participants with Alzheimer’s disease (AD) residing in assisted living facilities (ALFs). Participants received 5 mg donepezil daily for 6 weeks followed by 10 mg daily for 6 weeks. Primary and secondary outcomes were change from baseline in Mini-Mental State Examination (MMSE) and Neuropsychiatric Inventory 8 (NPI-8) scores, respectively. Safety was assessed by adverse events (AEs) and laboratory tests. Of the 97 participants, 76 completed the study. Mean MMSE score (18.7 at baseline) improved 1.8 points (P < .0001) at study end. Total NPI-8 score improved 1.8 points (P = .043). The most frequent AEs were nausea and diarrhea. Donepezil improved cognition and behavior and was safe and well tolerated. The results suggest a need for proactive screening and diagnosis of AD and support the value of treatment and use of donepezil in participants residing in ALFs.
Wright B.Assisted living in the United States. AARP Public Policy Institute. http://assets.aarp.org/rgcenter/post.import/fs62_assisted.pdf . Accessed April 7, 2009.
2.
Mollica R.State assisted living policy 2002. AARP Public Policy Institute . http://www.nashp.org/Files/ltc_15_AL_2002.pdf . Accessed April 7, 2009.
3.
National Center for Assisted Living.Resident profile. National Center for Assisted Living Web site. www.ahcancal.org/ncal/resources/Pages/ResidentProfile.aspx. Accessed November 18, 2009.
4.
Rosenblatt A. , Samus QM, Steele CD, et al. The Maryland Assisted Living Study: prevalence, recognition, and treatment of dementia and other psychiatric disorders in the assisted living population of central Maryland. J Am Geriatr Soc. 2004;52(10):1618-1625.
5.
Magsi H., Malloy T.Underrecognition of cognitive impairment in assisted living facilities. J Am Geriatr Soc. 2005;53(2):295-298.
6.
Carlson JM, Gerding G., Estoup MWEvaluation of demographics and medication use in patients with dementia in assisted living and skilled nursing facilities. Consult Pharm . 2005;20(7):584-594.
7.
Geldmacher DS , Frolich L., Doody RS, et al. Realistic expectations for treatment success in Alzheimer’s disease. J Nutr Health Aging . 2006;10(5):417-429.
8.
Beusterien KM , Thomas SK, Gause D., Kimel M., Arcona S., Mirski D.Impact of rivastigmine use on the risk of nursing home placement in a US sample. CNS Drugs. 2004;18(15):1143-1148.
9.
Geldmacher DS , Provenzano G., McRae T., Mastey V., Ieni JRDonepezil is associated with delayed nursing home placement in patients with Alzheimer’s disease. J Am Geriatr Soc. 2003;51(7):937-944.
10.
Gillette-Guyonnet S., Andrieu S., Cortes F., et al. Outcome of Alzheimer’s disease: potential impact of cholinesterase inhibitors. J Gerontol A Biol Sci Med Sci. 2006;61(5):516-520.
11.
Lopez OL, Becker JT, Wisniewski S., Saxton J., Kaufer DI, DeKosky STCholinesterase inhibitor treatment alters the natural history of Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2002 ;72(3):310-314.
12.
Lopez OL, Becker JT, Saxton J., Sweet RA, Klunk W., DeKosky STAlteration of a clinically meaningful outcome in the natural history of Alzheimer’s disease by cholinesterase inhibition. J Am Geriatr Soc. 2005;53(1):83-87.
13.
Feldman H., Gauthier S., Hecker J., et al. Efficacy of donepezil on maintenance of activities of daily living in patients with moderate to severe Alzheimer’s disease and the effect on caregiver burden. J Am Geriatr Soc. 2003;51(6):737-744.
14.
Winblad B., Kilander L., Eriksson S., et al. Donepezil in patients with severe Alzheimer’s disease: double-blind, parallel-group, placebo-controlled study. Lancet . 2006;367(9516):1057-1065.
15.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition-Text Revision. Washington, DC: American Psychiatric Association Press; 2000.
16.
McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan EMClinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology. 1984;34(7):939-944.
17.
Folstein MF , Folstein SE, McHugh PR‘‘Mini-mental state.’’ A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;12(3):189-198.
18.
Cummings JL , Mega M., Gray K., Rosenberg-Thompson S., Carusi DA, Gornbein J.The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308-2314.
19.
McCarron M. , Gill M., Lawlor B., Beagly C.A pilot study of the reliability and validity of the Caregiver Activity Survey-Intellectual Disability (CAS-ID). J Intellect Disabil Res. 2002;46(pt 8):605-612.
20.
Rabins PV, Kasper JD, Kleiman L., Black BS, Patrick DLConcepts and methods in the development of the ADRQL: an instrument for assessing health-related quality of life in persons with Alzheimer’s disease. J Mental Health Aging. 1999;5:33-48.
21.
Gelinas I., Gauthier L., McIntyre M., Gauthier S.Development of a functional measure for persons with Alzheimer’s disease: the disability assessment for dementia. Am J Occup Ther. 1999;53(5):471-481.
22.
Whitehead A. , Perdomo C., Pratt RD, Birks J., Wilcock GK, Evans JGDonepezil for the symptomatic treatment of patients with mild to moderate Alzheimer’s disease: a meta-analysis of individual patient data from randomised controlled trials. Int J Geriatr Psychiatry. 2004;19(7):624-633.
23.
Mohs RC, Doody RS, Morris JC, et al. A 1-year, placebo-controlled preservation of function survival study of donepezil in AD patients. Neurology. 2001;57(3):481-488.
24.
Rogers SL, Friedhoff LT and the Donepezil Study Group. The efficacy and safety of donepezil in patients with Alzheimer’s disease: results of a US multicentre, randomized, double-blind, placebo-controlled trial. Dementia. 1996;7(6):293-303.
25.
Rogers SL, Doody RS, Mohs RC, Friedhoff LTthe Donepezil Study Group.Donepezil improves cognition and global function in Alzheimer disease: a 15-week, double-blind, placebo-controlled study. Arch Intern Med. 1998;158(9):1021-1031.
26.
Rogers SL, Farlow MR, Doody RS, Mohs R., Friedhoff LTDonepezil Study Group.A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer’s disease . Neurology. 1998;50(1):136-145.
27.
Seltzer B., Zolnouni P., Nunez M., et al. Efficacy of donepezil in early-stage Alzheimer disease: a randomized placebo-controlled trial. Arch Neurol. 2004 ;61(12):1852-1856.
28.
Winblad B., Engedal K., Soininen H., et al. A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology. 2001;57(3):489-495.
29.
Tariot PN, Cummings JL, Katz IR, et al. A randomized, double-blind, placebo-controlled study of the efficacy and safety of donepezil in patients with Alzheimer’s disease in the nursing home setting. J Am Geriatr Soc. 2001;49(12):1590-1599.
30.
Feldman H., Gauthier S., Hecker J., Vellas B., Subbiah P., Whalen E.A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer’s disease. Neurology. 2001 ;57(4):613-620.
31.
Burns A., Rossor M., Hecker J., et al. The effects of donepezil in Alzheimer’s disease: results from a multinational trial. Dement Geriatr Cogn Disord. 1999;10(3):237-244.
32.
Winblad B., Black SE, Homma A., et al. Donepezil treatment in severe Alzheimer’s disease: a pooled analysis of three clinical trials. Curr Med Res Opin.2009;25(11):2577-2587.
