Drug May Fight Severe Alzheimer's

March 22, 2006 -- The Alzheimer's drug Aricept may fight severe Alzheimer's disease, according to a new study.

The study, published online in The Lancet, was funded by Pfizer, which makes Aricept. Participants were 248 patients with severe Alzheimer's living in nursing homes in Sweden. Pfizer is a WebMD sponsor.

For six months, patients either took Aricept or a fake pill (placebo). They took before-and-after tests of memory, language, and other mental skills, as well as their ability to eat, bathe, and handle other tasks.

Those in the Aricept group showed improvement on the mental tests and had less decline in daily tasks, the study shows. However, a journal editorial questions whether those results have much meaning in real life.

Drug Study

Researchers working on the Aricept study included Bengt Winblad, MD, of the geriatric medicine division at Sweden's Karolinska Institute. Professional nurses at the patients' nursing homes dispensed the drugs and oversaw the patients' care.

Aricept is part of a family of drugs called acetylcholinesterase inhibitors. Those drugs slow the breakdown of a chemical called acetylcholine, which helps nerve cells in the brain communicate with each other. Most of these, including Aricept, are indicated for treatment of mild to moderate Alzheimer's dementia.

The benefits seen in the Aricept group's test scores were "clinically significant," meaning that they could have some impact on patients, the researchers write.

Vulnerable Group

The patients were in a vulnerable condition and many were taking other drugs for other illnesses, Winblad and colleagues note. It's hard to pinpoint drug-related changes in such patients, the researchers point out.

Editorialist David Hogan, MD, FACP, FRCPC, works at Canada's University of Calgary as a specialist in geriatric medicine. He agrees that the patients in Winblad's group were probably "challenging" to study.

Hogan congratulates Winblad and colleagues on their work. But he questions whether the test scores truly mark improvement in the patients' lives.

"For various reasons, I believe such treatment might be a case of too little, too late," Hogan writes. "More meaningful outcomes are needed in dementia trials."

Side Effects

Most adverse events were mild or moderate, and brief, Winblad's team writes.

However, more patients in the Aricept group dropped out due to side effects than those taking the placebo. Of the most common adverse events, diarrhea and hallucinations were reported at more than twice the rate in the Aricept group as in the placebo group, the study shows.

Both groups had a similar number of deaths, and no deaths were considered to be due to Aricept, the researchers write.

In an unrelated study reported earlier this month, 11 patients taking Aricept for vascular dementiaAricept for vascular dementia in a clinical trial died. It's not known if Aricept had anything to do with those deaths.

Alzheimer's disease is the most common form of dementia in older adults.