The Spectrum of Behavioral Responses to Cholinesterase Inhibitor Therapy in Alzheimer Disease

• DOI: 10.1001/archneur.56.11.1388
• Publication Date: 2003-03-18T14:38:01Z
• Authors: Michael S. Mega; Donna M. Masterman; Susan M. O'Connor; Terry R. Barclay; Jeffrey L. Cummings
• Keywords: Disinhibition; Irritability; Apathy; Depression; Rivastigmine

<h3>Background</h3> Behavioral abnormalities are common in Alzheimer disease (AD); cholinergic treatment reduces the behavioral disturbances of some patients with AD. Characterizing pretreatment profile who likely to respond therapy will aid efficient use clinical resources. <h3>Objective</h3> To determine baseline for 86 AD treated cholinesterase inhibitor donepezil hydrochloride. <h3>Methods</h3> Open-label retrospective study treatment-related assessments. Based on previous double-blind placebo-controlled experience using Neuropsychiatric Inventory (NPI), were divided into responder (≥4-point total NPI score decrease, indicating improvement), unchanged (±3-point change), or nonresponder increase, worsening) groups. The Mini-Mental State Examination assessed cognitive response. <h3>Results</h3> improvement was seen 35 (41%), worsening 24 (28%), and no change 27 (31%). Comparison profiles responders vs nonresponders revealed significantly worse delusions (<i>P</i>=.04), agitation depression (<i>P</i>=.006), anxiety (<i>P</i>=.02), apathy (<i>P</i>=.003), disinhibition irritability (<i>P</i>&lt;.001) at responders. Five behaviors changed from baseline, improving nonresponders: (<i>P</i>=.003 nonresponders,<i>P</i>=.004 responders), (<i>P</i>=.01), (<i>P</i>=.006 (<i>P</i>=.02 nonresponders,<i>P</i>=.05 nonresponders,<i>P</i>=.001 responders). changes dose dependent. Cognition did not within any group. <h3>Conclusions</h3> Donepezil has psychotropic properties, help predict patients' responses treatment.