Treatment of apathy in Alzheimer's disease with transdermal rivastigmine: report of three cases.

Kehoe PG. Shifts in angotensin I converting enzyme insertion allele frequency across Europe: implications for Alzheimer's disease risk. Tratamento da apatia na doença de Alzheimer com rivastigmina transdérmica: relato de três casos Dear Editor, Apathy in Alzheimer's disease is one of the most difficult behavioral and psychological symptoms to treat. Anticholinesterasic drugs, dopaminergic agonists, and psychostimulants are treatment alternatives based on studies with contradictory results. 1 The use of transdermal rivastigmine has not been sufficiently studied in clinical trials, especially regarding the treatment of apathy. We report below 3 cases of dementia and apathy treated with transdermal rivastigmine, with behavioral symptoms analysis, cognitive testing and outcome measurement in the first, second, third and sixth months. Case reports: Three female patients were evaluated – MO (81 years old), ECN (74 years old) and DM (84 years old) – all of them meeting the criteria for Alzheimer's Disease (based on DSM-IV) and for apathy (based on the following criteria proposed by Robert P, 2009: 2 1) the core feature of apathy, diminished motivation, must be present for at least four weeks; 2) two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; 3) there should be identifiable functional impairments attributable to apathy; 4) exclusion criteria are specified to exclude symptoms and states that mimic apathy. After the diagnosis of Alzheimer's disease, the patients were treated with transdermal rivastigmine (4.6mg in the first month and 9.5mg after the second month). The improvement of apathy was observed after the introductions of anticholinesterasic treatment. The three cases are presented below: 1) DM presented at first meeting with: Mini Mental State Examination (MMSE) of 15/30, poor verbal contact, walking impairment, loss of manual abilities, and social isolation. After two months of treatment, the patient started to interact during the examination, returned to her manual and social activities, improved her walking balance and presented a MMSE of 21/30. After six months, the improvements were maintained. 2) ECN presented at first meeting with: MMSE of 20/30, difficulties in verbal contact, loss of instrumental activities of daily living (iADL), and social isolation. After two months of treatment, the patient returned with great improvement in verbal contact, returned to her iADL and presented a MMSE of 22/30. After six months, the improvements were maintained. 3) MO presented at first meeting with: MMSE of 13/30, poor verbal contact, loss of iADL and …