Brief Report
Methylphenidate for Apathy and Functional Status in Dementia of the Alzheimer Type

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Objective

Apathy is the most common behavioral problem in persons with dementia of the Alzheimer type (DAT). Treatment of apathy in DAT is not systematically studied. The purpose of this study was to evaluate the response of apathy to methylphenidate treatment and to examine whether functional status improved.

Methods

The authors conducted a 12-week open-labeled study with immediate release formulation of methylphenidate. Twenty-three patients with DAT scoring >40 on the Apathy Evaluation Scale (AES) were recruited. Repeated measures analysis of variance and correlation analysis were performed.

Results

None of the patients dropped out of the study because of adverse events. Significant improvement in apathy was noted during 12 weeks. Significant improvement was also noted in depression, Mini-Mental State Examination score, and functional status. There was no correlation between changes in the AES and depression scores.

Conclusions

Methylphenidate was well tolerated in these patients with DAT. Apathy improved with the use of methylphenidate.

Section snippets

METHODS

We conducted a 12-week open-labeled study with immediate release formulation of methylphenidate. This study was approved by local institutional review boards. Informed consent was obtained from the patient after evaluation of competency. If they were found to be incompetent to consent, their legal surrogates signed the consent in addition to the assent from the patient. All patients had a diagnosis of DAT by Diagnostic and Statistical Manual IV-Text Revision criteria, Mini-Mental State

RESULTS

Twenty-one of the 23 subjects were white, one was African American, and one was Hispanic. Only one subject was woman. All patients were community dwelling, and their mean age was 70.4 years (±9.5), other baseline variables are presented in Table 1. Apathy was confirmed in all patients by the NPI. Other behavioral problems endorsed on the NPI include irritability (96%), agitation (78%), depression (78%), appetite disturbance (65%), sleep disturbance (57%), anxiety (57%), disinhibition (43%),

CONCLUSION

Apathy is a significant problem in patients with dementia. Treatments for apathy could have positive impact on caregiver burden and functional status. In this report, we found significant improvement in apathy during the 12-week trial of methylphenidate. This is in keeping with the previous reports with methylphenidate. Significant improvement was also noted in IADL. This finding could have significant impact on the quality of life of patients with DAT and could translate to decreased caregiver

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    Citation Excerpt :

    A large placebo response and small sample size limit its interpretability. Methylphenidate has been studied in two RCTs and one open-label trial (Herrmann et al., 2008; Padala et al., 2010; Rosenberg et al., 2013). Apathy in Dementia Methylphenidate Trial (ADMET) was the first parallel group, multicenter, RCT of a medication intervention specifically designed to assess apathy in AD (Drye et al., 2013).

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This work was supported by MXH/99-925-1314 grant from the Clinical Research Center at University of Nebraska Medical Center (to PRP) and the Nancy & Ronald Reagan Alzheimer's Scholarship Fund Award (to PRP).

This article was presented at the Annual meetings of the American Geriatrics Society and the International Conference on Alzheimer's Disease.

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