Cholinesterase inhibitors delay nursing-home placement
Cholinesterase inhibitors may delay nursing-home placement in Alzheimer's
There is considerable debate on the value of the cholinesterase inhibitors (donepezil, rivastigmine, galantamine, etc.) in Alzheimer's Disease (AD), as the clinical trials have often shown uncertain benefits. A fairly small observational study has compared the outcome of patients being treated with one of these drugs to that of a similar group not being so treated. Each group had 135 patients with probable AD, matched as closely as possible; assessment was annually, and mean duration of observation was three years. The results showed that, as expected, there was an initial benefit of the drugs in cognitive and functional state that waned over time. Patients on the drugs were also less likely to be admitted to a nursing home - 6% vs. 40% - but there seemed to be no effect on time to death. The authors conclude that these drugs do have a long term benefit in AD, in reducing the likelihood of admission to nursing homes. They suggest that they allow patients to maintain relatively normal daily activity for longer without prolonging life.
[Editor's note: if these results are correct, they are just what we've been waiting for in relation to these drugs. Since they appeared, it has been suggested that they could save money by delaying the need for nursing home admission: but if they also prolonged life, the net result would be no gain either for the patient or the payer. However, the study must come with a significant health warning - firstly, it is not particularly large at a total of 270 patients, and secondly (and more importantly) it was not a randomised prospective study. The authors seem to have made reasonable efforts to match the groups, but it is possible that some unrecognised characteristic of patients in the control group made it both less likely that they would be treated with one of the drugs and more likely that they would end up in a nursing home. Ideally, we need follow-up data from one of the large placebo-controlled trials to confirm the results.]
J Neurol Neurosurg Psychiatry 2002; 72: 310-314 - from Reuters Health for 26th March 2002
