A class of drugs commonly used to treat Alzheimer’s disease and other dementias in nursing home residents has been found to slow cognitive decline over a five-year period in patients diagnosed with Lewy body dementia.
Researchers with the Karolinska Institute in Stockholm, Sweden, compared cholinesterase inhibitors (ChEI) to memantine treatment and nonuse of the drugs in more than 1,000 patients. Data was gathered from the Swedish Registry on cognitive and dementia disorders.
Lewy body dementia is one of the most common forms of dementia and accounts for approximately 10% to 15% of dementia cases, according to the authors. ChEIs, which include donepezil, rivastigmine and galantamine, are licensed treatments for this and other dementias, as is memantine, an NMDA receptor antagonist. These drugs also often are used to treat Parkinson’s disease, which is a risk factor for Lewy body dementia.
The study examined long-term cognitive changes, the risk of major adverse cardiovascular events and death within 90 days of diagnosis with Lewy body dementia. Five-year outcomes were compared between patients treated with the three ChEI drugs, and those treated with memantine as well as those who did not receive treatment with any of these drugs.
Patients who were treated with donepezil and galantamine, but not those given rivastigmine, showed significantly improved scores on the Mini Mental State Examination (MMSE). No changes in cognitive scores were found for people taking memantine.
Notably, higher ChEI doses were associated with greater cognitive benefits, reported lead author Hong Zu, PhD, and colleagues. In addition, the study found a significantly lower incidence of death with rivastigmine treatment, but only in the first year. There was no effect found for major cardiovascular events.
The results support a change in guideline recommendations regarding ChEI in Lewy body dementia, the authors concluded. The study was published in the journal Alzheimer’s & Dementia.
