Effekten av donepezil vid mild-måttlig Alzheimers sjukdom mätt med Mini mental state exam

Sammanfattning: Alzheimer´s disease (AD) is today the world’s most common disease within dementia as it affects most number of people that are demented. There are no cure to AD, just symptomatic treatment are available. Scientists are still discussing the reason behind AD and many different theories exist. The most popular one is the amyloid cascade hypothesis. To diagnose AD many different types of scales are used to determine a person´s cognitive skills, also blood- and spinal cord samples are taken. One of the most popular scale that is used to diagnose AD is named mini mental state exam (MMSE). MMSE consists of several domains including: orientation, reading, mental arithmetic, writing and figure copying. The maximum of points are 30 and a score of 24 or less indicates some type of dementia. Today acetylcholinesteraseinhibitors like donepezil, rivastigmine and galantamine are used to treat people with mild to moderate AD. People with severe AD are recommended treatment with a NMDA-receptor-antagonist, memantine. The result from this study includes a summary of results from five studies. All of them studied the effect of donepezil over time and three of them also studied donepezils effect compared to placebo. Patients that were included had mild- moderate AD and in one study they measured a continued treatment with donepezil. All studies measured the results with scales and tests, including MMSE, that assessed patient’s cognitive ability. The results showed that patients treated with donepezil had significantly improved their scores on the scale MMSE at the end of the studies compared from baseline in three studies. When compared with placebo patients treated with donepezil got significantly better scores on MMSE. These changes were small even if significantly proven. The conclusion of this work was that MMSE is not optimal for measuring changes in AD if the patient is treated with donepezil because of the small changes. MMSE have difficulties to detect the small changes (a change of ≤ 3 points) and therefore other scales and tests are in need. Donepezil showed a significantly improvement in the beginning of the studies but after a few weeks that improvement had decreased or disappeared. It could be in everyone´s favor to start medication in an early stage of the disease and then after a while make a new assessment of the patient’s health.