Search

Aim: Patients with dementia with Lewy bodies (DLB) are at a high risk for falls and fractures. Although cholinesterase inhibitors reportedly are effective in suppressing the progression of cognitive symptoms in DLB patients, their effects on fracture risk remain unclarified. This study aimed to evaluate the association between donepezil use and hip fracture risk in older patients with DLB. Methods: Using the Japanese insurance claim database, we collected the data of patients aged ≥65 years with DLB from April 2012 to March 2019. After propensity score matching, we compared the fracture rate over 3 years between DLB patients receiving donepezil and those not receiving antidementia drugs. Results: Altogether, 24 022 239 individuals aged ≥65 years were newly registered from April 2012 to March 2016 and had verifiable information from 6 months before to 3 years after the registration. We identified 6634 pure‐DLB patients and analyzed the data of 1182 propensity score‐matched pairs. The characteristics, including age, sex, fracture history, osteoporosis, and bone mineral density test rate, of the two groups were well balanced by propensity score matching. The incidence rate of hip fracture was significantly lower in DLB patients receiving donepezil than in those not receiving antidementia drugs (0.60 vs. 1.44/100 person‐years, P < 0.001), whereas that of vertebral fractures was the same. Conclusions: Donepezil administration in Japanese people aged ≥65 years with DLB was significantly associated with a decreased risk of hip fracture. Donepezil may provide new benefits to DLB patients. Geriatr Gerontol Int 2024; 24: 782–788. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to evaluate drug costs per resident at Japanese intermediate care facilities for older adults (called Roken) in relation to drug utilization after admission to these facilities. The payment, including coverage of drugs, is mainly determined by the resident's long‐term care needs. Methods: A nationwide drug utilization survey was carried out. The participants were 1324 residents of 350 Roken (up to five individuals per facility) who were admitted in 2015 and agreed to participate in this study. Drug costs per resident per month at admission and 2 months later were calculated for drugs prescribed for regular use. Associations between characteristics of the residents and drug costs were examined. Results: A wide variation in drug costs with a long right tail was observed. Median drug costs were $77 (interquartile range $34–147) at admission, and $46 (interquartile range $19–98) in month 2. There was no apparent association between the level of long‐term care needs and drug costs, adjusting for sex, age and main place of residence before admission. Anti‐dementia drugs accounted for the largest portion of total drug costs at admission (15.4%) and in month 2 (12.4%). The average drug cost per user was also the highest for anti‐dementia drugs ($90.2 per user per month), followed by drugs for Parkinson's disease ($70.3). The proportion of generic drugs across all drug classes examined increased after admission. Conclusions: These findings might suggest that implementation of the bundled payment scheme would be effective for the reduction of medication costs in institutional long‐term care. Geriatr Gerontol Int 2019; 19: 667–672. [ABSTRACT FROM AUTHOR]

Background: Donepezil is an established treatment for mild, moderate, and severe Alzheimer's disease (AD). An international study demonstrated superior efficacy of sustained release (SR) 23 mg/day donepezil over immediate release (IR) 10 mg/day donepezil for cognitive function, but not global function in moderate-to-severe AD.Objective: To demonstrate the superiority of SR 23 mg/day donepezil over IR 10 mg/day donepezil in Japanese patients with severe AD (SAD).Methods: In this multicenter, randomized, double-blind, parallel-group study, Japanese outpatients with SAD were randomly assigned to continue IR 10 mg/day or switch to SR 23 mg/day for 24 weeks. Endpoints included the Severe Impairment Battery (SIB), Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-plus), and safety.Results: Overall, 166 and 185 patients were randomized to receive IR 10 mg/day and SR 23 mg/day, respectively. SR 23 mg/day was not statistically superior to IR 10 mg/day by SIB (least squares mean difference [LSMD]: 0.0; 95% confidence interval [CI]: -1.7, 1.8; p = 0.981) or CIBIC-plus (LSMD: 0.2; 95% CI: 0.0, 0.4; p = 0.080). Common adverse events in the SR 23 mg group were decreased appetite, vomiting, diarrhea, and contusion. Safety findings were consistent with known safety profiles of donepezil.Conclusion: SR 23 mg/day donepezil was not superior to IR 10 mg/day donepezil regarding the efficacy endpoints for Japanese SAD. Considering that a 10 mg/day dose is approved for SAD in Japan, the present findings suggest that IR 10 mg/day donepezil is the optimal dosage for Japanese patients with SAD. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is one of the most significant diseases affecting an increasingly aging society.Objective: To determine the long-term efficacy of galantamine treatment in a Japanese population.Methods: We performed "Okayama Galantamine Study (OGS)" to retrospectively analyze the clinical effects of galantamine in 279 AD patients using 7 batteries for assessing dementia at baseline, 3, 6, 12, and 24 months. We further analyzed the effects of galantamine based on gender and the severity of their baseline cognitive, affective, and activity of daily living (ADL) functions.Results: In all 279 AD patients (80.6 ± 7.2 years old, MMSE 20.0 ± 4.5), cognitive functions were well preserved until 12 months and even frontal assessment battery improved after 12 months although Hasegawa dementia scale-revised finally worsened at 24 months ( *p <  0.05) with galantamine treatment. Affective and ADL functions were also well maintained after galantamine treatment with significant improvement of Geriatric Depression Scale scores at 3 months ( *p <  0.05). Subanalyses showed the better response to galantamine for male and lower baseline function subgroups.Conclusions: Our present study (OGS) revealed a long-term efficacy of galantamine in very elderly AD patients, and suggested a better efficacy for male and baseline lower cognitive, affective, and ADL functions. [ABSTRACT FROM AUTHOR]

The clinical benefits of memantine, depending on the baseline cognitive and affective conditions in real world dementia clinics, have not been completely examined. We performed the "Okayama Memantine Study II (OMS II)" to retrospectively evaluate the clinical effects of memantine monotherapy (n = 38) in Alzheimer's disease (AD) patients using seven batteries to assess dementia at the baseline, at 3, 6, and 12 months. Additionally, we divided 163 AD patients treated with memantine into two subgroups depending on the baseline cognitive score of the Mini-Mental State Examination (MMSE): the MMSE <15 group (n = 36) and the baseline MMSE ≥15 group (n = 127). We also analyzed 71 AD patients based on the baseline behavioral and psychological symptoms of dementia (BPSD) severity using Abe's BPSD score (ABS). Memantine monotherapy maintained cognitive functions until 6 months of treatment, but showed a decrease at 12 months ( *p <  0.05 versus baseline). However, memantine monotherapy greatly improved BPSD symptoms until 12 months ( *p <  0.05,  **p <  0.01) and maintained other affective functions as well as the activity of daily living. Memantine treatment showed similar effects, regardless of the baseline cognitive functions, but showed better effects on ABS for higher baseline cognitive functions. Memantine treatment greatly improved ABS depending on baseline BPSD severity. Our present OMS II showed that memantine monotherapy improved BPSD until 12 months. The higher baseline cognitive subgroup (MMSE ≥15) and the worse baseline BPSD subgroup were expected to show better effects with memantine. [ABSTRACT FROM AUTHOR]

Recently, there is a great social problem that geriatric disorders, especially senile dementia, are growing rapidly with the increasing percentage of aged individuals in the total population. However, there is yet no drug that has reliable effects on senile dementia on the market. Therefore, society requires the development of new drugs that can support patients so that they can smoothly live their daily lives by themselves. In this study, we attempted to investigate the 1998 domestic state of development of cognitive enhancers by summarizing many publications and by gathering questionnaires from pharmaceutical, food, synthetic fiber and chemical manufacturing companies. There were 40 currently investigated cognitive enhancers in Japan as of the end of March, 1999 including 37 newly synthesized compounds and 3 new dosage forms or applications of additional effects. On the classification according to the mechanism of drug action, 12 of the investigated drugs are cholinomimetic agents, 12 are ameliorators of neuronal transmission, 1 is an intracellular mediative substance, 3 are neuropeptides, 2 are cerebral metabolic activators, 2 are cerebral circulation enhancers and 7 are neuronal cell protectors, and 1 is another type. For dementia of the Alzheimer's type, there are 1, 3, 10 and 2 drugs in prerecognition, phase late II, early II and I of clinical trials, respectively. For cerebrovascular dementia and cerebrovascular disease, there are 19 drugs being investigated. Seven of these compounds such as E2020 (donepedil HCl), DM-9384 (nefiracetam), TA-0910 (taltirelin), NS-3 (montirelin), TTC-909 (clinprost), DR-3305 (ebselen) and AVS (nicaraven) are at the prerecognition stage for marketing. It is important that effective cognitive enhancers will be supplied for clinical stage use as soon as possible.