Effect of tacrine on language, praxis, and noncognitive behavioral problems in Alzheimer disease
M. A. Raskind, C. H. Sadowsky, W. R. Sigmund, P. J. Beitler and S. B. Auster
Veterans Affairs Puget Sound Health Care System, Seattle, USA.
OBJECTIVE: To examine the effects of tacrine hydrochloride in patients with
Alzheimer disease (AD) and detectable baseline deficits in discrete
cognitive and noncognitive parameters who are enrolled in a previously
reported multicenter, double-blind, 30-week trial. DESIGN: An exploratory
analysis using last observation carried forward. The study population
included a placebo group (n = 181) and all patients randomized to treatment
within 160 mg/d of tacrine hydrochloride (n = 234), regardless of highest
dose achieved or duration of tacrine therapy. STUDY POPULATION: Male and
female subjects, at least 50 years of age, with mild to moderate AD and
detectable baseline deficits in discrete cognitive and noncognitive
parameters. MAIN OUTCOME MEASURES: Change from baseline to last observation
carried forward in discrete subscale scores of the Alzheimer's Disease
Assessment Scale (ADAS): cognitive (memory, language, praxis) and
noncognitive (mood, behavior). Improvement was defined as a decrease of at
least 1 point from baseline; stabilization was defined as no change or a
decrease from baseline. RESULTS: Compared with the placebo group, the
percentage of patients receiving tacrine whose conditions improved or
stabilized was significantly greater for 8 of 11 ADAS-cognitive items (word
recall, word recognition, orientation, language production, comprehension,
word finding, following commands, ideational praxis) and for the
ADAS-noncognitive items: cooperation, delusions, and pacing. CONCLUSIONS:
Tacrine stabilizes or improves specific behavioral deficits and symptoms in
AD. The previous demonstration of tacrine's effect on global cognitive
function has been extended by suggesting an association between tacrine
therapy and improvements in individual cognitive and noncognitive items of
the ADAS. Effects of tacrine in clinical practice might be more accurately
and efficiently assessed by measuring individual ADAS cognitive and
noncognitive items relevant to individual patient pretreatment clinical
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