AD Treatment Perspective #5

Contributed by: Dennis Fortier, President, Medical Care Corporation

Recent evidence from Harvard University and Massachusetts General Hospital shows that combination therapy of cholinesterase inhibition (Aricept, Exelon or Razadyne) plus Namenda is most effective in slowing disease progression. These combinations can preserve ADL's (Activities of Daily Living) and delay nursing home placement by several years in some patients.


  1. Whether or not drugs (e.g. Aricept) actually slow the progression of the disease has not really proven to be an an accurate observation for us in a traditional nursing home setting; but as you pointed out, our elders are most usually in the end stage by the time they are admitted to a nursing home.

  2. Regarding your skepticism about Aricept, there are several very common confounds that obscure the truth.

    First is the one you mentioned, patients are diagnosed late and the ultimate effect at end-stage is indeed small.

    Second, a significant percentage of patients taking Aricept for AD are either misdiagnosed or (very commonly) have mixed etiology including vascular disease, depression, or multiple strokes and only the AD is being treated.

    Finally, observers see ongoing decline and conclude "no efficacy" but for a valid conclusion, they would need to compare the rate of decline among Aricept takers to the rate of decline among the completely untreated. Such studies have been carefully administered in trial settings and there is a delaying effect, even if it is not obvious to most observers.