Comprehensive approach of donepezil and psychosocial interventions on cognitive function and quality of life for Alzheimer's disease: the Osaki-Tajiri Project

There is a major need to develop an appropriate therapy for Alzheimer's disease (AD). Impairment of cholinergic transmission [1, 2] is important for the defects, and cholinesterase inhibitors (e.g. donepezil) [3, 4] cause symptomatic improvement. In Japan, only donepezil is available, and the drug has been reported to maintain cognitive function up to 6 months [5].Given the lack of a curative treatment for AD, psychosocial interventions have emerged over the years that are directed at optimising the function of patients and supporting their families. One of the most common approaches is reminiscence [6–9]. The primary goal is to facilitate recall of past experiences to promote intra/inter-personal functioning and improve quality of life (QOL). Relatively reserved remote memory [10] can provide a neurological basis to support the effectiveness. Reality orientation (RO) [6, 9, 11] is also used which stimulates time and place orientation. Reminiscence and RO are the most popular interventions [12, 13]. Lai et al. [14] performed a randomised controlled trial (RCT) to investigate whether a reminiscence program leads to higher levels of psychosocial well-being in dementia and found a significant improvement in QOL, although the intervention did not lead to significant cognitive improvement.Although the effect of donepezil in slowing cognitive decline in AD has been established, and psychosocial interventions were known to exhibit positive effects, a combined effect has not been fully investigated [11]. We hypothesized that donepezil has an effect in slowing cognitive deterioration, and that the additional psychosocial intervention would increase their QOL.