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The effect of long-term physostigmine administration in Alzheimer's disease

From the Department of Neurology, Veterans Administration, and University of Alabama Medical Center, Birmingham, AL.

We assessed the effect of chronic long-term physostigmine in 20 patients with probable Alzheimer's disease. Initially, all patients went through a dose-finding phase and a double-blind crossover period, and were subsequently classified as physostigmine responders or nonresponders based on an a priori classification system. We then offered all patients long-term treatment with physostigmine regardless of their initial classification. Results revealed that responders spent significantly (p < 0.0005) longer time periods on drug (36.1 ± 4.6 months) than nonresponders (10.8 ± 3.2). During a 2nd crossover period, 18 months into treatment, responders still demonstrated behavioral improvement, as assessed with the Sandoz Clinical Assessment-Geriatric Scale, whereas there were no behavioral changes observed in nonresponders. There were no effects on formal neuropsychological assessment. The results suggest that a subgroup of Alzheimer's patients benefits from long-term physostigmine therapy.

Address correspondence and reprint requests to Dr. Lindy E. Harrell, JT 1216, Department of Neurology, University of Alabama Medical Center, Birmingham, AL 35294.

Supported by grants from NU-P02-AG-06569 (L.E.H.) and the Alzheimer's Disease and Related Disorders Association (L.E.H.bt.

Received August 25, 1989. Accepted for publication in End form February 16, 1990.

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