9 The CGIC measured by the clinician failed to detect a difference, but the self-rated impression of change from the subjects (PGA) showed a highly statistically significant difference between donepezil and placebo. Side effects were predominantly gastrointestinal (diarrhea, nausea, and vomiting) and nocturnal (abnormal dreams) at a higher frequency than patients with AD at a similar dose of 10 mg at bedtime.10 Results of conversion studies The 2-year galantamine studies showed no difference

in the primary analysis of conversion from amnestic MCI to AD.11 Analysis of secondary outcomes is under way, Inhibitors,research,lifescience,medical but it is apparent that a reduced rate of whole-brain atrophy has been found in patients treated with galantamine.12 Inhibitors,research,lifescience,medical Baseline demographics of the 3-year MIS have been reported4 and are listed in Table V. An annual conversion rate of the order of 13% was reached with this amnestic

MCI population, which most investigators would consider as prodromal AD.13 Table V. Baseline characteristics of the Memory Impairment Study (MIS). Values are means±SD. Inhibitors,research,lifescience,medical CDR, Clinical Dementia Rating; MMSE, MiniMental-State Examination; ADCS, Alzheimer Disease Cooperative Study; MCI, mild cognitive impairment; ADL, activities … Results of the primary analysis of MIS have been presented at the 9th International Conference on Alzheimer’s Disease and Related Disorders: there was no difference in the primary analysis of conversion from amnestic MCI to AD after 3 years.14 Analysis of secondary outcomes is under way, and it is already apparent that there is a statistically significant delay of conversion between subjects treated with donepezil and placebo at 6, 12, and Inhibitors,research,lifescience,medical 18 months into the study, with the conversion curves overlapping at 24, 30, and 36 months. Inhibitors,research,lifescience,medical Patients carrying the apolipoprotein E4 (APOE-4) mutation were at a much higher risk of converting to AD and had a statistically significant

protective effect from conversion on KPT-330 ic50 treatment with donepezil from month 6 until month 36. The results of the 4-year rivastigmine study should be available early 2005. Tolerability of AChEI in long-term amnestic MCI appears to be similar to patients with AD in terms of a predominance of gastrointestinal transient side effects. Their incidence and severity are slightly higher than in AD and lead to a higher rate of discontinuation, particularly in the first year of treatment. Lessons so far Although not Electron transport chain all the data are in and not all subanalyses on the available data have been performed, it is apparent that the AChEI class does not delay the conversion from amnestic MCI to AD beyond 18 months. This suggests that the AChEIs have a symptomatic and potentially clinically significant effect, but one that is transient. This is congruent with the AD2000 study, which demonstrated a sustained benefit of donepezil on cognition using the Mini-Mental-State Examination (MMSE) and an ADL measure over 2 years.