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Methylphenidate for Treating Apathy in Alzheimer Disease

10/23/2016 2:55:00 PM

Information sourced from NEJM Journal Watch: Treating Apathy in Alzheimer Disease Methylphenidate improved motivation, cognition, mood, functioning, and caregiver burden in community-dwelling men with mild disease. Apathy, a prominent feature of Alzheimer disease, impairs motivation, reduces spontaneous behavior, and has been associated with a heavier caregiver burden. In a 12-week trial, investigators randomized 60 community-dwelling male veterans with mild Alzheimer disease and apathy to methylphenidate (target dose, 10 mg twice daily) or placebo (mean age, 77; mean Mini-Mental State Exam [MMSE] score, 24; >90% white). Participants did not have active psychosis, frontotemporal dementia, or current major depression, although 58% had depressive symptoms. About 85% had hypertension, and 47% had coronary artery disease. Polypharmacy was common (cholinesterase inhibitors, 63%; antidepressants, 55%; memantine, 30%). Significant improvements for methylphenidate vs. placebo were first seen at 4 weeks for overall apathy scores; at 8 weeks for the behavior, cognition, and motivation domains of apathy; and at 12 weeks for depression and emotion scores, MMSE scores, activities of daily living, and caregiver burden. Adverse events and serious adverse events were similar in the groups, with only one serious event possibly attributable to medication. COMMENT These results bear replication in larger samples and both sexes. Still, the study suggests several clinically important points. First, treating apathy might help to reduce depressive symptoms, but apathy and depression should be distinguished from each other and warrant separate attention. Second, in these elderly patients with hypertension and cardiovascular disease, adverse effects were no more frequent for modestly dosed methylphenidate than for placebo. Third, improvements occurred within 4 weeks for apathy but more gradually in other psychological and functional areas. Fourth, cognitive improvements at 12 weeks were comparable to those reported for cholinesterase inhibitors. Overall, treating apathy with methylphenidate may benefit both patients with mild Alzheimer disease and their caregivers. Joel Yager, MD reviewing Padala PR et al. Am J Psychiatry 2017 Sep 15. CITATION(S): Padala PR et al. Methylphenidate for apathy in community-dwelling older veterans with mild Alzheimer’s disease: A double-blind, randomized, placebo-controlled trial. Am J Psychiatry 2017 Sep 15; [e-pub]. [PubMed® abstract] NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright ©2017 Massachusetts Medical Society. All rights reserved. The above message comes from NEJM Journal Watch, who is solely responsible for its content.

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