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Withdrawal of Alzheimer’s dementia drugs doubles risk of nursing home placement

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Posted October 29, 2015

The most common form of dementia is Alzheimer’s disease. It is impossible to cure it, but those affected are still treated with a variety of drugs. Still, in advanced stages of Alzheimer’s disease some clinicians do not see the benefit of using such drugs as donepezil and they discontinue it. However, it may have some negative consequences.

Aricept is one of oral pills based on donepezil. It is meant to treat mild to moderate dementia caused by Alzheimer's disease. Scientists found that withdrawing donepezil course doubles the risk of nursing home placement after a year and encourage altering prescription patterns accordingly. Image credit: NLM via Wikimedia, Public Domain

Aricept is one of oral pills based on donepezil. It is meant to treat mild to moderate dementia caused by Alzheimer’s disease. Scientists found that withdrawing donepezil course doubles the risk of nursing home placement after a year and encourage altering prescription patterns accordingly. Image credit: NLM via Wikimedia, Public Domain

Now research at the University College London revealed that withdrawing this commonly-prescribed Alzheimer’s disease drug from people in the advanced stages of the disease increases the risk of being placed in a nursing home within a year.

Researchers followed 295 people with Alzheimer’s disease, varying from moderate to severe stages. They wanted to figure out the effects of discontinuing the drug donepezil. Scientists chose participants randomly to either continue the course of donepezil or to withdraw from it. Those, who were not getting donepezil, got placebo, in order to avoid psychological effects altering the results of the research. These two groups then were divided once more to test the other dementia drug, called memantine. The study showed that withdrawing the donepezil doubled the risk of the patient to be placed into the nursing home within a year.

In United Kingdom, where the research was conducted, 70% of care home residents have dementia or severe memory problems. This is actually a great problem, since the average cost for people with dementia to stay in the nursing home is estimated to be between £30,732 and £34,424 per year.

For comparison, the cost of donepezil is around £21.59 per year – more than a thousand times less. Robert Howard, professor of old age psychiatry at UCL, said: “our new results show that these benefits translate into a delay in becoming dependant on residential care, a point that many of us dread. We are all impatient for the advent of true disease-modifying drugs that can slow or halt the Alzheimer process, but donepezil is available right now and at modest cost.”

Scientists say that the major achievement of this study is that it provides evidence that donepezil can benefit patients of Alzheimer’s disease for a much longer time than previously believed. Even though there still is no cure for dementia, scientists say that science is getting closer to it.

Meantime, researchers are trying to improve care to better the quality of life for people with Alzheimer’s disease. Scientists also note that it is also important to help people with dementia to remain in their own homes for as long as possible. However, in some cases residential care is the best option, as professionals may provide services that are too difficult for family.

National Institute for Health and Care Excellence approved the use of three anticholinesterase inhibitors in the early and moderate stages of Alzheimer’s disease. This included donepezil. Researches proved that these drugs reduce the symptoms of Alzheimer’s and were the first treatments to be approved for the disease. However, when disease is advancing the effect of the donepezil seems to be insignificant and many clinicians withdraw the course. This research shows that even if the effect is not so visible as in early stages, course of donepezil should continue as it helps patients to avoid moving to residential care institutions for longer.

These results may help clinicians to alter their prescribing patterns accordingly. It is important for people with Alzheimer’s disease dementia to remain at home for their own benefit as well as economical effect. Scientists are hopeful – cure for dementia is coming, but we will still have to wait for it. Dr Doug Brown, director of research and development at the Alzheimer’s Society, said that new treatments for Alzheimer’s disease will not come in the coming decade. This is why clinicians have to use current drugs in their full potential.

Source: UCL

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