A drug for Alzheimer’s seems to delay the point at which a person with the condition needs to be moved into a nursing home. Donepezil is usually given to people with moderate forms of the disease, but continuing to take the drug once the disease becomes more severe seems to prolong the period of time a person can remain in their own home.

Previously, the drug was not thought to benefit people once they had developed more severe forms of Alzheimer’s. But a study that followed 295 people with moderate to severe Alzheimer’s disease found that those who continued to take donepezil were nearly half as likely to end up in a care home within the next year.

“It could mean thousands of patients per year not going into care homes,” says Robert Howard of University College London, who led the study.


His team found that those who continued to take donepezil had a 20 per cent chance of being moved into a care home within the first year of the trial, compared to 37 per cent in those who stopped taking the drug.

However the effect didn’t last. The trial lasted for three years, and after the first year, those who taking donepezil were just as likely to be moved into a home than those who weren’t, suggesting that the drug does not have a longer-term effect on the care needs of those with Alzheimer’s.

“For every six patients treated with donepezil for 12 months, you would prevent one moving into a nursing home,” says Howard. “It’s a modest effect, but it’s important if it’s your mother or your wife.”

Not a cure

In the wake of the findings, Howard is hopeful that more family doctors will start people on donepezil while they still have moderate symptoms, and then continue to prescribe the drug once the disease has progressed.

As well as being less distressing for those with the disease, keeping people with Alzheimer’s in their own homes for longer could also save money. Generic versions of donepezil cost less than £22 a person a year, whereas it tends to cost between £30,000 and £34,000 a year for a person to live in a care home.

Donepezil does not slow down the damage that Alzheimer’s causes to the brain, but instead helps relieve symptoms. It works by boosting acetylcholine, a chemical used to send messages in the brain. As the disease progresses, less acetylcholine is produced, but donepezil protects the smaller amount that is made from being broken down, effectively allowing the brain to do more with less, despite the damage that has been caused.

Of the estimated 530,000 people in the UK who have Alzheimer’s, only 58,600 are currently taking donepezil, often because doctors have been told only those with mild to moderate disease benefit from it. But earlier work by Howard’s team showed that the drug may still alleviate symptoms when the disease has progressed to a more severe stage.

“With no new treatments for Alzheimer’s disease in over a decade, it is absolutely crucial that we make the most of the drugs we have available,” says Doug Brown, director of research and development at the UK Alzheimer’s Society. “It’s important we continue to find better ways to support people with dementia to remain in their own homes for longer.”

A number of new drugs are now coming forward that hold promise for actually slowing the rate at which the disease damages the brain, but Alzheimer’s remains one of the most difficult disorders to treat.

Journal reference: The Lancet Neurology, DOI: 10.1016/S1474-4422(15)00258-6

Image credit: Laura Kalcheff/Getty