Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Methylphenidate for Apathy in Alzheimer’s Disease

Am J Psychiatry; ePub 2017 Sep 15; Padala, et al

Among a group of community-dwelling older veterans with mild Alzheimer’s disease, methylphenidate improved apathy, as well as cognition, functional status, and depression, a recent study found. The 12-week, double-blind, randomized, placebo-controlled trial included 60 community-dwelling veterans (all male, mean age 77 years) with mild Alzheimer’s disease who were randomized to either methylphenidate for placebo. Researchers found:

  • After adjusting for baseline, the methylphenidate group had significantly greater improvement in apathy than the placebo group at 4, 8, and 12 weeks.
  • At 12 weeks, greater improvement was also observed in cognition, functional status, caregiver burden, Clinical Global Impressions Scale (CGI) scores, and depression in the methylphenidate group vs the placebo group.
Citation:

Padala PR, Padala KP, Lensing SY, et al. Methylphenidate for apathy in community-dwelling older veterans with mild Alzheimer’s disease: A double-blind, randomized, placebo-controlled trial. [Published online ahead of print September 15, 2017]. Am J Psychiatry. doi:10.1176/appi.ajp.2017.17030316.

Commentary:

We are used to seeing and treating agitated dementia, since it is difficult to ignore. Apathy, however, is a more common behavioral manifestation of dementia than either agitation or depression, but is often not given as much attention because it does not seem as pressing of a problem. It is problematic nonetheless, as it is associated with significant functional impairment. Individuals with dementia and apathy are approximately 2.5 times more likely to have deficits in activities of daily living than those without apathy.1 This study shows that for patients with dementia and apathy, methylphenidate may help decrease apathy and caregiver burden, as well as improve cognition and functional status. It is important to note, though, that methylphenidate is not FDA approved for this indication and while there were not large differences in this study in adverse events, methylphenidate can cause an increase in heart rate, blood pressure, and agitation, as well as worsened axienty. Therefore, any decision to use methylphenidate must be balanced with the risk of side effects and is best done with the informed consent of the patient’s family. —Neil Skolnik, MD

  1. Okura T, Plassman BL, Steffens DC, Llewellyn DJ, Potter GG, Langa KM. Prevalence of neuropsychiatric symptoms and their association with functional limitations in older adults in the United States: The aging, demographics, and memory study. J Am Geriatr Soc. 2010;58(2):330–337. doi:10.1111/j.1532-5415.2009.02680.x. 

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