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Alzheimer's Disease

Aricept Usage

04/16/1999

Question:

I have heard that Aricept is not effective after prolonged use (i.e., six months to one year). Is this true?

Answer:

The notion that the Aricept effects last only for six months may be related to the fact that the clinical trials conducted prior to Aricept`s approval by the Food and Drug Administration were six months in duration. Patients in those trials were then withdrawn from medication, as part of the study design. However, it has been the clinical experience here at the University Alzheimer Center that many patients continue to receive benefit from Aricept for many more months, and sometimes for years, as measured by neuropsychological tests.

Two other issues need to be addressed. First is that the effect of Aricept, and medications like it, may be more pronounced early in the disease course before severe damage to the neurotransmitters and nerve cells occurs, so that the body can respond fully to the Aricept effect. Second, is that for the individual patient, it becomes impossible to say what might have been if they had never taken the medication. Thus, a patient may start Aricept, and `not be better` or even slightly worse six to 12 months later, but there would be no way to tell what might have been if they were never treated. With disease progression (and there is no data to support the concept that Aricept changes the natural history of the disease), individuals may decline despite Aricept.

The major issues to address when considering whether to continue the use of Aricept are:

(1) What does the patient want? (2) In terms of disease stage, other medications, medical conditions, etc. is Aricept appropriate? (3) What are reasonable expectations for therapy in terms of functional outcome? (4) What are the alternatives? (5) What are the follow-up plans?

For more information:

Go to the Alzheimer's Disease health topic, where you can:

Response by:

Jon Stuckey, PhD
Formerly
Case Western Reserve University

Alan J Lerner, MD
Professor of Neurology
School of Medicine
Case Western Reserve University