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Caregiver Acceptance of Adverse Effects and Use of Cholinesterase Inhibitors in Alzheimer's Disease*

  • Mark Oremus (a1) (a2), Christina Wolfson (a1) (a2), Alain C. Vandal (a1) (a3), Howard Bergman (a1) (a4) and Qihao Xie (a5)...


Caregivers play a determining role in choosing treatments for persons with Alzheimer's disease. The objective of this study was to examine caregivers' willingness to have persons with Alzheimer's disease continue taking cholinesterase inhibitors in the event that any 1 of 11 adverse effects was to occur. Data were gathered via postal questionnaire from 375 caregivers in Montreal. Sixty-four per cent of caregivers responded (n = 201), and most (≥59%) were willing to continue treatment if persons with Alzheimer's disease suffered from weight loss or loss of appetite. However, most (≥53%) were not willing to continue treatment in the event of headache, dizziness, nausea, diarrhea, vomiting, drop in blood pressure, insomnia, muscle cramps, or stomach bleeding. The use of cholinesterase inhibitors by persons with Alzheimer's disease was positively associated with caregivers' willingness to accept greater numbers of adverse effects (adjusted relative risk = 1.97; 95% CI = 1.11 to 3.61). Caregivers appear to make a risk–benefit assessment when they decide whether or not care-recipients should continue pharmacotherapy in the event of adverse effects.

Le personnel soignant joue un rôle déterminant dans le choix des traitements pour les personnes atteintes de la maladie d'Alzheimer. La présente étude vise à examiner la volonté du personnel soignant à ce que les personnes atteintes de cette maladie continuent à prendre des inhibiteurs de la cholinestérase advenant l'apparition de n'importe lequel des onze effets indésirables. Des données ont été recueillies par le truchement d'un questionnaire envoyé par la poste à 375 aidants naturels à Montréal. Soixante-quatre pour cent du personnel soignant a répondu au questionnaire (n = 201), et la plupart (≥59%) étaient d'accord pour continuer le traitement si les personnes souffrant de la maladie d'Alzheimer perdaient du poids ou n'avaient plus d'appétit. Toutefois, la plupart (≥53%) ne désiraient pas continuer le traitement si certains effets se manifestaient: maux de tête, étourdissements, nausée, diarrhée, vomissements, chute de la tension artérielle, insomnie, crampes musculaires, ou saignement de l'estomac. L'emploi d'inhibiteurs de cholinestérase par des personnes souffrant de cette maladie était positivement associé au désir du personnel soignant d'accepter un plus grand nombre d'effets indésirables (risque relatif = 1,97; intervalle de confiance de 95% = 1,11 à 3,61). Le personnel soignant semble faire une évaluation risque-avantage lorsqu'il décide si les bénéficiaires des soins devraient poursuivre la pharmacothérapie après manifestation d'effets indésirables.


Corresponding author

Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Mark Oremus, Ph.D., McMaster Evidence-Based Practice Centre—Room 326, Department of Clinical Epidemiology and Biostatistics, McMaster University DTC, 50 Main Street East, Hamilton, ON L8N 1E9. (


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We wish to thank the caregivers who participated in this study. We also wish to thank the Alzheimer Society of Montreal and the Alzheimer Groupe Incorporé for providing access to the caregivers, conducting the mailings, and lending their facilities for pre-testing. As well, we thank Fraser Moore, MD, for his helpful comments on an earlier draft of this manuscript.

This study was funded by a grant from the Consortium of Canadian Centres for Clinical Cognitive Research. Mark Oremus was the recipient of a doctoral training award from the Canadian Institutes of Health Research–Institute of Aging. He was also a recipient of a research award from the Scottish Rite Charitable Foundation of Canada. Howard Bergman has received grants from Janssen–Ortho, Novartis, and Pfizer to conduct clinical trials of cholinesterase inhibitors.



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