Donepezil and Psychosocial Approaches in Alzheimer’s Disease

The featured article is a letter in the Journal ‘Age and Ageing’. Meguro and colleagues begin by identifying the benefits of medication and reminiscence therapy in Alzheimer’s disease and ask the question of what happens when these two approaches are combined. In their study, 36 people were entered into three arms of the trial. People had a diagnosis of dementia, MMSE’s 10-20 and were excluded if they had significant behavioural or ‘psychological’ disturbances measured using the BPSD or aphasia. Patient’s families consented. 12 people were entered into the psychosocial group, 12 into the donepezil and psychosocial group and 12 into the donepezil group.

The Donepezil group received 5mg daily, the Donepezil plus psychosocial group received 40 interventions over a year, as did the psychosocial intervention group. The psychosocial intervention consisted of reminiscence therapy supported by Japanese traditional flower arranging. There were no significant differences between the three groups on measures of mean educational years and MMSE scores at baseline.

The results showed a significant difference between the psychosocial group and the other two groups in differences between MMSE scores at baseline and at 12 months. The psychosocial group showed a greater decline in MMSE scores than the other two groups. However the other two groups didn’t appear to differ significantly on these measures. WIth regards to Quality of Life measurements however, using the QOL-AD measure, there was a significant difference between the Donepezil group and the Donepezil group plus psychosocial intervention group favouring the latter.

The authors comment that the sample size in the study was small and there wasn’t randomisation into the different arms of the trial (some of the psychosocial intervention group were people that had been unable to tolerate Donepezil). Nevertheless the study suggests that the strength of the psychosocial intervention may come in improving quality of life scores. The inclusion criteria raise the question of how psychosocial interventions should be modified for people with aphasia or significant behavioural problems. Further studies in this area will be needed.

STT3

Reference

Meguro M, Kasai M, Akanuma K, Ishii H, Yamaguchi S and Meguro K. Comprehensive approach of donepezil and psychosocial interventions on cognitive function and quality of life for Alzheimer’s disease: the Osaki-Tajiri Project. Age and Ageing. 2008. Vol 37. Issue 5.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

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