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Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial

Published online by Cambridge University Press:  29 October 2013

Krista L. Lanctôt ,
Sarah A. Chau ,
Nathan Herrmann ,
Lea T. Drye ,
Paul B. Rosenberg ,
Roberta W. Scherer ,
Sandra E. Black ,
Vijay Vaidya ,
David L. Bachman  and
Jacobo E. Mintzer
Krista L. Lanctôt*
Affiliation:
Departments of Psychiatry and Medicine (Neurology), and Brain Sciences Research Program, Sunnybrook Research Institute, Departments of Psychiatry, Pharmacology/Toxicology and Medicine (Neurology), University of Toronto, Ontario, Canada
Sarah A. Chau
Affiliation:
Departments of Psychiatry and Medicine (Neurology), and Brain Sciences Research Program, Sunnybrook Research Institute, Departments of Psychiatry, Pharmacology/Toxicology and Medicine (Neurology), University of Toronto, Ontario, Canada
Nathan Herrmann
Affiliation:
Departments of Psychiatry and Medicine (Neurology), and Brain Sciences Research Program, Sunnybrook Research Institute, Departments of Psychiatry, Pharmacology/Toxicology and Medicine (Neurology), University of Toronto, Ontario, Canada
Lea T. Drye
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Paul B. Rosenberg
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Roberta W. Scherer
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Sandra E. Black
Affiliation:
Departments of Psychiatry and Medicine (Neurology), and Brain Sciences Research Program, Sunnybrook Research Institute, Departments of Psychiatry, Pharmacology/Toxicology and Medicine (Neurology), University of Toronto, Ontario, Canada
Vijay Vaidya
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
David L. Bachman
Affiliation:
Department of Neurosciences, Alzheimer's Research and Clinical Programs, Medical University of South Carolina, SC, USA Ralph H. Johnson VA Medical Center, SC, USA
Jacobo E. Mintzer
Affiliation:
Department of Neurosciences, Alzheimer's Research and Clinical Programs, Medical University of South Carolina, SC, USA Ralph H. Johnson VA Medical Center, SC, USA
*
Correspondence should be addressed to: Krista L. Lanctôt, 2075 Bayview Avenue Room FG-08, Toronto, Ontario M4N 3M5, Canada. Fax: (1)416-480-6022. Email: Krista.lanctot@sunnybrook.ca.
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Abstract

Background:

Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer's disease (AD). MPH has shown to improve apathy in AD, and both apathy and attention have been related to dopaminergic function. The goal was to investigate MPH effects on attention in AD and assess the relationship between attention and apathy responses.

Methods:

MPH (10 mg PO twice daily) or placebo was administered for six weeks in a randomized, double-blind trial in mild-to-moderate AD outpatients with apathy (Neuropsychiatric Inventory (NPI) Apathy ≥ 4). Attention was measured with the Wechsler Adult Intelligence Scale – Digit Span (DS) subtest (DS forward, selective attention) and apathy with the Apathy Evaluation Scale (AES). A mixed effects linear regression estimated the difference in change from baseline between treatment groups, defined as δ (MPH (DS week 6–DS baseline)) – (placebo (DS week 6–DS baseline)).

Results:

In 60 patients (37 females, age = 76 ± 8, Mini-Mental State Examination (MMSE) = 20 ± 5, NPI Apathy = 7 ± 2), the change in DS forward (δ = 0.87 (95% CI: 0.06–1.68), p = 0.03) and DS total (δ = 1.01 (95% CI: 0.09–1.93), p = 0.03) favored MPH over placebo. Of 57 completers, 17 patients had improved apathy (≥3.3 points on the AES from baseline to end point) and 40 did not. There were no significant associations between AES and NPI Apathy with DS change scores in the MPH, placebo, AES responder, or non-responder groups. DS scores did not predict apathy response to MPH treatment.

Conclusion:

These results suggest MPH can improve attention and apathy in AD; however, the effects appear independent in this population.

Keywords

Alzheimer's diseaseapathyneuropharmacologypsychopharmacologybehavioral and psychological symptoms of dementia (BPSD)
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 2 , February 2014 , pp. 239 - 246
Copyright
Copyright © International Psychogeriatric Association 2013 

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