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Which Drugs (or None) for Alzheimer Disease?

In patients with severe dementia, neither quetiapine nor rivastigmine helped with agitation, and quetiapine actually worsened cognitive function.

Because antipsychotics often are employed to treat agitation that accompanies dementia, British investigators conducted this randomized, placebo-controlled trial to evaluate the effects of quetiapine (Seroquel, an atypical antipsychotic) and rivastigmine (Exelon, a cholinesterase inhibitor). They recruited 93 patients, most with severe dementia, from a variety of nursing facilities and assigned them to one of three treatment groups: quetiapine plus placebo, rivastigmine plus placebo, or double placebo.

Patients were evaluated at 6, 12, and 26 weeks. The primary outcome variable was the effect of treatment on agitation, but cognitive function also was assessed. Of the 93 subjects, 71 (22 rivastigmine, 23 quetiapine, 26 placebo) completed the trial. Neither of the active drugs had a significant effect on agitation. However, compared with placebo, quetiapine was associated with significant declines in cognitive function. Rivastigmine had no significant effect on cognitive function.

Comment: These findings sound a cautionary note: In patients with severe dementia, neither quetiapine nor rivastigmine helped with agitation, and quetiapine, an atypical antipsychotic drug, actually worsened cognitive function. The author of an accompanying editorial agrees with this caution, but he notes that the key to managing dementia is knowing what drugs to use during the different stages of disease. At the time of publication, the full text of the original article was available free of charge.

— Keith I. Marton, MD

Published in Journal Watch General Medicine May 17, 2005

Citation(s):

Ballard C et al. Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: Randomised double blind placebo controlled trial. BMJ 2005 Apr 16; 330:874-7.

• Original article (Subscription may be required)
• Medline abstract (Free)

Gauthier S. Drugs for Alzheimer's disease and related dementias. BMJ 2005 Apr 16; 330:857-8.

• Original article (Subscription may be required)
• Medline abstract (Free)