CHICAGO – Methylphenidate may be effective in the treatment of apathy associated with dementia of the Alzheimer type, Dr. Prasad Padala and associates reported in a poster at the annual meeting of the American Geriatrics Society.
Results from an open-label study in 13 patients suggest that methylphenidate (Ritalin) has a substantial effect on apathy, with smaller but significant positive effects on mood, cognition, and independent activities of daily living. The findings warrant further testing with a double-blind, placebo-controlled trial, he noted.
Apathy is the most common behavior problem reported in persons with Alzheimer's disease, affecting about 70%–90% of patients. All patients in the study had dementia of the Alzheimer type, Mini-Mental State Examination (MMSE) scores greater than 18, and Apathy Evaluation Scale (AES) scores greater than 30. Their mean age was 69 years.
All patients were started on methylphenidate 5 mg twice daily; the dose was titrated to 10 mg twice daily over a 2-week period. Follow-up visits were scheduled at 4, 8, and 12 weeks.
Significant improvement in apathy (AES 52.6 vs. 31.6) was reported from baseline over 12 weeks, reported Dr. Padala, of the department of psychiatry at the University of Nebraska, Omaha, and a psychiatrist at the Omaha division of the VA (Veterans Affairs) Nebraska Western Iowa Health Care System.
Less robust but significant improvement was noted at 12 weeks in Geriatric Depression Scale scores (93 vs. 63), MMSE scores (24.2 vs. 25.5), and Independent Activities of Daily Living criteria (13.7 vs. 16).
Subjective improvement was noted by caregivers. One caregiver reported that the patient was monitoring his medications better and started taking care of his finances again after a long hiatus.
None of the patients discontinued medication because of adverse events. In one patient, the dose of methylphenidate was reduced because of appetite loss, possibly related to treatment, Dr. Padala reported.
The study was funded by the Nancy and Ronald Reagan Alzheimer's Scholarship Fund, established at the University of Nebraska.