Common cholinesterase inhibitor eases behavioral symptoms like agitation, depression, and psychosis in patients

The so-called "memory drugs" used to treat Alzheimer's disease and other causes of dementia also ease or prevent a barrage of troublesome behaviors that affect the majority of patients, ultimately lightening the burden on caregivers, researchers have found. They report their results in the March issue of the American Journal of Psychiatry.

The current first wave of medications that doctors turn to in treating Alzheimer's disease – medicines known as cholinesterase inhibitors – are aimed at treating the confusion and memory loss of dementia by helping the brain cope with a deficiency of the brain chemical acetylcholine.

Now, in a new analysis of a previous study involving 978 patients and their families, scientists have shown that, as many patients and doctors have suspected, the medicines are much more than "memory drugs." Scientists found that a common cholinesterase inhibitor eases behavioral symptoms like agitation, depression, and psychosis in patients who already have those symptoms, and that the medication delays the onset of those behaviors in patients not yet displaying them.

Doctors also found that the medications ultimately ease distress among caregivers whose role is made easier when the patient's symptoms improve. While that may not come as a surprise to caregivers, it's an important distinction that hasn't been shown before, say the researchers, who point out that previous studies have focused on patients' cognition, not their behavior or its effects on caregivers.

"To our knowledge, this is the first time that it's been shown that the caregiver's stress level is less because the patient's behavior has improved," says Pierre Tariot, M.D., one of the authors and a professor of psychiatry, medicine, and neurology at the University of Rochester Medical Center.

"Over time, it's become clearer and clearer that it's not just the patient who is distressed by his or her behavior, but the family as well. We decided maybe we should look at the indirect impact of the medications on the family as well as the direct impact on the patient."

Patients who were already experiencing behavioral symptoms when they entered the five-month study experienced a 29 to 48 percent drop in symptoms while on galantamine (Reminyl), according to reports by their caregivers, who did not know whether their loved ones were taking a real medication or a placebo. Behaviors like losing one's temper over minor matters, shouting or using coarse language in an uncharacteristic way, snapping at family members, not enjoying previously pleasurable activities like reading or visiting with one's grandchildren – such behaviors were reduced markedly in the group on galantamine, but not in the group taking a placebo medication.

"These are a major reason that people go into nursing homes," says Tariot. "Such behaviors are a major cause of distress, and a major driver of institutionalization, which in addition to being so sad for families, also costs billions of dollars each year. When people think of Alzheimer's disease, they think of memory loss and confusion. But it's often the other behaviors, such as yelling and becoming angry or agitated, that drives a family to seek nursing-home care for their loved one."

While the study published in the Journal of American Psychiatry followed patients for approximately five months, subsequent study by the team has found that, for patients not already exhibiting behavioral problems, treatment with galantamine delayed their symptoms for more than three years on average. This is added impetus to treat patients with dementia with cholinesterase inhibitors as early as possible, says Tariot, who adds that there is often a gap of years between when patients first have symptoms that would benefit from treatment and when doctors put those patients on medicine.

"If treating earlier means delaying the emergence of very distressing behavioral symptoms, that's huge, in terms of the health of patients, and also the well-being of their caregivers, many of whom are older themselves."


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