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Mayeux and Sano,
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Alan A. Mazurek, M.D.
Mercy Medical Center
Rockville Center, NY 11570
References
On the basis of anecdotal evidence, the efficacy of atypical neuroleptic drugs was evaluated for similar indications. In a 12-week multicenter trial of fixed doses of risperidone and placebo in 625 patients with dementia, 73 percent of whom had Alzheimer's disease, risperidone decreased the symptoms of psychotic behavior and aggressiveness.1 Furthermore, in a 13-week flexible-dose trial of risperidone, haloperidol, and placebo in 344 nursing home residents with severe dementia, 75 percent of whom had Alzheimer's disease, both risperidone and haloperidol reduced the total score and the aggression subscore on the Behavior Pathology in Alzheimer's Disease Rating Scale than did placebo.2 A post hoc analysis revealed significantly more improvement in aggressive symptoms with risperidone than with haloperidol, whereas the severity of extrapyramidal symptoms was greater in the haloperidol group than in the other two groups. In contrast to haloperidol, risperidone did not have important extrapyramidal side effects and did not induce cognitive impairment.
Peter Paul De Deyn, M.D., Ph.D.
University of Antwerp
2610 Wilrijk, Belgium
References
To the Editor: Dr. Mazurek was concerned that we did not mention several drugs, particularly huperzine A, that are being evaluated as treatments for Alzheimer's disease. We limited our discussion to "drugs given in clinical trials for at least six months," and we are unaware of any published studies of huperzine A that meet this criterion.
We thank Dr. De Deyn for his update and regret that because of the the timing of the article by him and his colleagues we were unable to include their results.1 They found no significant reduction in the total score for the primary measure of behavior in either the risperidone group or the haloperidol group, as compared with the placebo group. A post hoc analysis did reveal a reduction of 10 to 20 percent in the rating of aggressive behavior in those who received either drug, as compared with those who received placebo. The discontinuation rate of 41 percent in the risperidone group was also higher than the rate in either the haloperidol group (29 percent) or the placebo group (35 percent). Nevertheless, these comparative studies are critical in establishing the effectiveness of current treatments for Alzheimer's disease.
On page 1673 of our article, the first sentence in the section entitled "Metrifonate" should have read, "Metrifonate (trichlorfon), an anthelmintic drug with no anticholinesterase activity, undergoes nonenzymatic hydrolysis to dichlorvos, a pseudoirreversible inhibitor of cholinesterase," not anticholinesterase, as printed. Also on page 1673, the first sentence in the section entitled "Eptastigmine" should have read, "Eptastigmine is a carbamate derivative of physostigmine and a reversible inhibitor of cholinesterase," not anticholinesterase, as printed.
Richard Mayeux, M.D.
Mary Sano, Ph.D.
Columbia University
New York, NY 10032
References
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