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Long-Term Effects of Rivastigmine Treatment on the Need for Psychotropic Medications in Nursing Home Patients with Alzheimer’s Disease

Results of a 52-Week Open-Label Study

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Abstract

Background and objective: Neuropsychiatric symptoms and behavioural disturbances occur in most patients with Alzheimer’s disease (AD), are a source of stress for caregivers, and are the primary cause of patient institutionalisation. These symptoms often are treated with psychotropic medications. However, adverse drug interactions, adverse effects and nursing home regulations make reducing the use of psychotropic medications in elderly AD patients an important goal of therapy. Fifty-two-week data including data from a 26-week prospective open-label, multicentre study and its 26-week open-label extension were analysed.

Patients and methods: 173 patients with moderate to severe AD residing in nursing homes were treated with rivastigmine 1.5–6mg twice daily. In the study, psychotropic drug use and behavioural symptoms were measured at baseline and at 52 weeks.

Results: Results showed that 40% of patients who were receiving psychotropic medications at baseline had discontinued use or reduced their dose of psychotropic medications at week 52. Furthermore, significant improvements were observed from baseline in 10 of the 12 behavioural domains of the Nursing Home version of the Neuropsychiatric Inventory, including delusions (mean change from baseline −2.0; p = 0.002), hallucinations (mean change −3.1; p < 0.001), anxiety (mean change −1.1; p = 0.014), and euphoria (mean change −3.2; p = 0.006).

Conclusion: These data suggest favourable tolerability, behavioural and pharmacoeconomic outcomes in nursing home residents with AD who are treated with rivastigmine.

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Acknowledgements

This research was sponsored by Novartis Pharmaceuticals Corp.

Keith Edwards has received research grant funds from Novartis for this study, he is on the Novartis Speakers’ bureau and he has been a Consultant to Novartis on various other studies for which he has received payment. He owns no stock or bonds nor does anyone in his family work for Novartis nor do they own any stock or bonds. The co-authors (Barbara Koumaras, Michael Chen, Ibrahim Gunay and Dario Mirski) are all employees of Novartis Pharmaceuticals Corporation.

* Rivastigmine Nursing Home Study Team: Ellen Binder, MD, Washington University School of Medicine, St Louis, MO; Jeffrey L. Cummings, MD, UCLA Department of Neurology, Los Angeles, CA; Marshal Folstein, MD, Department of Psychiatry, New England Medical Center, Boston, MA; Elsa M. Zayas, MD, St Louis University Medical Center, St Louis, MO; Raymond Ownby, MD, University of Miami School of Medicine, Miami, FL; Charles H. Merideth, MD, Affiliated Research Institute, San Diego, CA; Douglas W. Scharre, MD, Ohio State University Department of Neurology, Columbus, OH; Pierre Tariot, MD, Monroe Community Hospital, Rochester, NY; Keith Edwards, MD, Alzheimers Diagnostic Center, Bennington, VT; Peter M. Aupperle, MD, Comprehensive Services on Aging UMDNJ, Piscataway, NJ; Jay. M. Ellis, DO, Berkshire Neurological Associates, Pittsfield, MA; Jorg J. Pahl, MD, Pahl Brain Associates, Oklahoma City, OK; Ari Kiev, MD, Social Psychiatry Research Institute, Englewood, NJ and New York, NY.

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Authors and Affiliations

  1. Alzheimers Diagnostic Center, Bennington, Vermont, USA

    Keith Edwards

  2. Novartis Pharmaceuticals Corp., East Hanover, New Jersey, USA

    Barbara Koumaras, Michael Chen, Ibrahim Gunay &  Dario Mirski

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Edwards, K., Koumaras, B., Chen, M. et al. Long-Term Effects of Rivastigmine Treatment on the Need for Psychotropic Medications in Nursing Home Patients with Alzheimer’s Disease. Clin. Drug Investig. 25, 507–515 (2005). https://doi.org/10.2165/00044011-200525080-00003

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