The Pharmaceutical Journal
Vol 279 No 7472 p377
6 October 2007

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Agitation associated with Alzheimer's not relieved by donepezil

Donepezil is not an effective treatment for agitation in people with Alzheimer's disease, a study published this week suggests (New England Journal of Medicine 2007;357:1382).

Patients whose agitation scores were considered severe enough to warrant treatment after a psychosocial treatment programme of up to four weeks’ duration were randomised to receive donepezil or placebo. Analysis of 259 patients revealed no difference in agitation scores between patients taking donepezil and those given placebo.

“However,” the study authors say, “agitation may not represent a homogenous clinical phenomenon, and this is a potential limitation of the trial.”

In an accompanying editorial (ibid, p1441), Kristine Yaffe, from the department of psychiatry, neurology and epidemiology at the University of California, comments on the study design: “The rationale for providing [psychosocial] treatment was that first-line therapy for neuropsychiatric symptoms should be non-pharmacologic.”

However, she suggests that this may have led to the selection of patients most resistant to any type of treatment or those with the most severe symptoms.