Donepezil for severe Alzheimer's disease.

摘要

Bengt Winblad and co-workers (April 1, p 1057)1 conclude that donepezil improves cognition and preserves function in nursing home patients with severe Alzheimer's disease. Some points should be discussed before accepting this conclusion.Although Winblad and colleagues mention that a CT or MRI scan consistent with Alzheimer's disease was required for entry into the study, such imaging is insufficient to distinguish Alzheimer's disease from other types of dementia, especially vascular dementia resulting from cerebral ischaemia. It has been reported that applied fiuorodeoxyglucose positron emission tomography accurately separates vascular dementia from Alzheimer's disease.Additionally, abnormal levels ofp-amyloid,tau,andaphosphorylated version of tau in cerebrospinal fluid can distinguish Alzheimer's disease from other types of dementia.Since donepezil is ineffective in dementias other than Alzheimer's disease, the precise diagnosis is essential.Winblad and colleagues report that eligible patients in bothgroups took concomitant drugs for rheumatic diseases. They did not mention the proportion of eligible patients taking non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs protect against Alzheimer's disease and its progression by suppressing chronic inflammation and reducing p-amyloid formation in the brain. Winblad and co-workers need to show that use of NSAIDs did not affect their conclusion.