Benefits of treating behavioral, functional problems caused by Alzheimer’s disease

A class of drugs known as cholinesterase inhibitors has a significant impact on behavioral problems and the ability to perform everyday tasks in patients with Alzheimer’s disease, according to a study led by researchers at the San Francisco VA Medical Center (SFVAMC) and UCSF.

The study, an analysis of data from multiple small studies, appears in the January 8, 2003 issue of the Journal of the American Medical Association. Known as a meta-analysis, the study applied sophisticated statistical methods to data from 29 trials that involved the treatment of Alzheimer’s disease (AD) with cholinesterase inhibitors (ChIs).

People with AD can suffer cognitive, behavioral or functional difficulties. ChIs have been previously shown to effectively treat cognitive difficulties such as memory loss, disorientation and loss of language skills, said Kristine Yaffe, MD, Chief of Geriatric Psychiatry at the SFVAMC and UCSF assistant professor of psychiatry, neurology and epidemiology and biostatistics.

“Until now, the jury has been out on whether these drugs really worked for behavioral and functional symptoms,” said Yaffe, senior author of the JAMA article.

The current analysis revealed that patients treated with ChIs scored slightly higher on standard tests used to assess behavioral and functional status in patients with mild to moderate AD. These kinds of small, statistically significant increases in scores often translate into large impacts on behavior-related health problems, Yaffe said.

Approximately 4 million Americans have Alzheimer’s disease, a progressive disorder that leads to varying degrees of dementia and for which there is currently no cure. The deterioration of the brain characteristic of Alzheimer’s disease most often results in cognitive difficulties, such as memory loss.

About half the people suffering from the disease experience behavioral problems that can include changes in their personality, agitation, anxiety, delusions or hallucinations. Functional difficulties—such as the ability to balance a checkbook, shop for groceries or perform simple domestic tasks—are key features of Alzheimer’s disease and other dementias. The noted improvement may or may not be the result of improved cognitive function, Yaffe said.

According to Yaffe, participants in the studies done to date didn’t necessarily exhibit symptoms in all three categories of problems associated with AD. She said clinical trials that specifically enroll people with behavioral problems are needed to further resolve the issues associated with the use of the drugs.

Long-term research is also needed to determine the effects of these drugs on both patients and their caregivers during the progression of the disease. “We need to know how the small effects of the drugs translate into long-term benefits, such as improvements in quality of life for patients and decreases in burdens to caregivers,” Yaffe said.