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The subheading “cognition-enhancing medications” in the article by Lee and colleagues is misleading (1). These drugs do not enhance cognition, at best they have minimal effects on cognition or marginally slow the decline in cognitive function.
A Cochrane review of memantine looked at the evidence in three different groups of patients with dementia. In those with moderate to severe Alzheimer’s Disease (AD) there was a small beneficial effect on cognition at 6 months (2.97 points on the 100-point Severe Impairment Battery). In mild to moderate AD, the effect on cognition was barely clinically detectable and for mild to moderate vascular dementia the effect on cognition was not supported by clinical global measures (2). After 26 weeks of treatment, rivastigmine only slowed the rate of cognitive decline, it did not enhance cognition (3). Donepezil versus placebo lead to a 2-3 point mean difference in the Alzheimer's Disease Assessment Scale (ADAS-cog) 70 point cognitive subscale. Galantamine at 16-24 mg/d changed the ADAS-cog score by ~ 3.4 points but led to more withdrawals due to adverse effects and caused cholinergic adverse effects in up to 20% of patients (4).
The independent French drug bulletin, La revue Prescrire, concluded that, “at best, drugs for Alzheimer’s disease can only stabilize or slightly improve cognitive function, in only a minority of patients” (5) reflecting the change in rating of medical benefit for these drugs by the French Pharamc...
Show MoreCompeting Interests: In 2015-2018, Joel Lexchin was a paid consultant on three projects: one looking at indication-based prescribing (United States Agency for Healthcare Research and Quality), a second to develop principles for conservative diagnosis (Gordon and Betty Moore Foundation) and a third deciding what drugs should be provided free of charge by general practitioners (Government of Canada, Ontario Supporting Patient Oriented Research Support Unit and the St Michael’s Hospital Foundation). He also received payment for being on a panel that discussed a pharmacare plan for Canada (Canadian Institute, a for-profit organization). He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare.