Aricept

[mjl1717]

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I know Aricept 5mg should be given in the evening for mild to moderate dementia. But do neurologist often say take it in the am and why? Thank you.

 

[Thama]

I wouldn't worry too much about what time of day to take a placebo.

 

[mjl1717]

Are you saying that inhibiting the enzyme acetylcholinesterase is not helpful to the elderly?

 

[DrSatan]

Causes freaky dreams, less so if taken in the AM. Also is possibly no better than placebo. If tolerated, may as well take it.

 

[Telamir]

I honestly don't think any of the "dementia drugs" work particularly well.

 

[Thama]

Are you saying that inhibiting the enzyme acetylcholinesterase is not helpful to the elderly?

I'm saying that the drug is slightly superior to placebo in particular cognitive tests, but is basically a placebo in actual patient-relevant outcomes such as self-reported and caregiver-reported performance and quality of life. The idea that you are going to significantly affect a disease that causes widespread neurodegeneration by tweaking synaptic acetylcholine is also pretty dumbfounding.

People give it because a) drug companies tell them to, and b) doctors often don't deal well with the conversation that "no, this disease really is incurable and there really isn't anything you can do to slow it down".

 

[Telamir]

Interestingly enough I always caught flack during residency for not placing a lot of these patients on any meds. They cause a lot of side effects and they don't really help all that much if at all like you say. A lot of docs put people on it just to feel like they're doing something, I guess. Worse is when they start combining dementia drugs/treatments.

 

[mjl1717]

Thanks guys!! The entire topic decreased cognition and dementia. And how corona virus typically and atypically effects the elderly is morbid and sad.

 

[Neurologo]

I have not yet seen a patient or family reporting any improvement with donepezil, memantine or rivastigmine short or long term, low or high doses. But my sample size may be small.

 

[Telamir]

Aricept is a real funny way of spelling placebo.