Effects on caregiver burden of a donepezil hydrochloride dosage increase to 10 mg/day in patients with Alzheimer’s disease

Abstract

Kazuhito Nakamura,1,2 Norio Watanabe,1 Hiroshi Ohkawa,3 Michiyasu Ando,4 Yukio Ogura,5 Sumito Funabiki,6 Akito Kume,7 Kimihiko Urano,1 Takashi Osada,1 Keiko Yamamura1 1Department of Clinical Pharmacy, School of Pharmacy, Aichi Gakuin University, 2Koyo Pharmacy, 3Ohkawa Clinic, 4Ando Clinic, 5Total Support Clinic, 6Funabiki Clinic, 7Kume Clinic, Aichi, Japan Background: In this study, we evaluated changes in functioning and caregiver burden in Alzheimer’s disease (AD) patients after a dosage increase that was made based on pharmacists’ evaluation of AD patients’ behavior in daily life. Methods: Pharmacists used a checklist, a questionnaire, and the Repetitive Saliva ­Swallowing Test (RSST) to gather data on the daily life of AD patients taking donepezil 5 mg/day and their caregivers. In 27 cases, pharmacists suggested a dosage change to 10 mg/day to AD patients’ physicians. Pharmacists then evaluated these patients for 16 weeks after the increase to determine changes in functional assessment staging, caregiver burden, and swallowing function. Results: During the 16-week study, 20 of the 27 patients showed at least one-stage improvement in relation to the five assessed aspects of daily life (time/place, speech, bathing, dressing, and toileting). The mean score for caregiver burden due to personal strain was significantly lower after the dosage increase than before (5.15±3.76 at baseline; from 3.89±3.42 at week 4 to 3.59±3.90 at week 16; P<0.05), as was the mean score due to role strain (2.19±2.80 at baseline; 1.56±2.64 at week 8; P<0.05). After the dosage increase, the impaired swallowing function that accompanies AD was improved in the patients with swallowing problems, as indicated by a higher mean RSST score (1.22±0.67 at baseline; from 2.78±1.72 at week 4 to 2.78±1.79 at week 16; P<0.05). Conclusion: The dosage increase not only decreased caregiver burden, but also appeared to improve impaired swallowing function. Medication therapy management by pharmacists of AD patients, including the use of a checklist, contributed to the correct use of donepezil and improved quality of life for caregivers. Keywords: Alzheimer’s disease, caregiver burden, behavior in daily life, swallowing function, checklist, pharmacists