Study proves drug success for the treatment of severe dementia

A drug commonly used to treat mild to moderate Alzheimer’s Disease (AD) can have positive benefits for patients in the later stages of dementia, research has found.
The study, involving academics at The University of Nottingham, is the first trial to establish that the dementia drug donepezil can be successfully used to treat patients with moderate to severe AD who have deteriorated beyond the point where the drug would currently be recommended.
It found the drug has even greater benefits for patients with severe AD than those in the earlier stages of the disease, the only group of patients that would normally be prescribed the treatment.
Dr Rob Jones, of the University’s Division of Psychiatry, was among the experts who conducted the research, which was published recently in the New England Journal of Medicine. He said: “The National Institute for Health and Clinical Excellence (NICE) has advised use of this drug for people with mild to moderate dementia for some years but until now there has not been sufficient evidence to suggest its use is worthwhile in patients who are in the later stages of the illness.
“Our study has shown that the drug can have significant benefits to patients with severe dementia in slowing the decline in cognition and function. This large scale study has plugged a gap in our knowledge in a big way and this is important and helpful news for people with dementia and their carers.”
Around 750,000 people in the UK and 18 million worldwide suffer from AD. The multi-centre study, conducted in collaboration with King’s College London and funded by the Medical Research Council (MRC) and the Alzheimer’s Society, looked at two drugs: donepezil and memantine. Donepezil is the most commonly prescribed of the dementia drugs but doctors are currently advised to stop prescribing the drug when the disease progresses to moderate and severe because there has been no clear evidence that continuing treatment is beneficial to patients.
The study found that those patients who continued to take donepezil showed considerably less decline in cognition, including memory, orientation and language skills, and function (retained ability to carry out simple daily tasks and self-care) than those taking a placebo drug.

The benefits were clinically important and were actually greater than in patients with less severe AD. While the effect was slightly smaller, starting memantine treatment also resulted in significantly better cognitive and functional abilities compared with those taking a placebo.
Professor Clive Ballard, Director of Research at Alzheimer’s Society, said: “Thanks to the Alzheimer’s drug donepezil, tens of thousands of people in the early to moderate stages of the condition are able to recognise their family for longer, play with their grandchildren and make vital plans for the future. This major new trial now shows that there could also be significant benefits on continuing the treatment into the later stages too. There are 750,000 people with dementia in the UK, yet currently prescription levels of Alzheimer’s drugs are still low. If this is to change we have to improve the shocking diagnosis rates and ensure everyone is given the opportunity to try treatments.”

The study was sponsored by King’s College London and funded by the UK Medical Research Council (MRC) and Alzheimer’s Society. Pfizer-Eisa and Lundbeck donated supplies of drugs but had no involvement in the study design, conduct analyses or reporting.

A full copy of the academic paper can be found on the website for the New England Journal of Medicine <>

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