Dr. Mintzer and colleagues enrolled 60 patients with Alzheimer’s disease and apathy in a double-blind, placebo-controlled, multicenter trial (ADMET) to assess the safety and efficacy of methylphenidate for reducing these symptoms. The researchers defined apathy as lack of interest, reactivity severe enough to require treatment, and a score of 4 or higher on the Neuropsychiatric Inventory (NPI) apathy scale. Equal numbers of patients were randomized to 5 mg of methylphenidate or placebo twice per day for three days. For patients who had no adverse events, the dose was increased to 10 mg of methylphenidate twice per day, and the treatment lasted for six weeks.
At the end of the study, mean AES score decreased by 1.9 for patients taking methylphenidate, compared with a mean increase of 0.6 for controls. Approximately 21% of patients taking methylphenidate had moderate or marked clinical improvements, compared with 3% of patients receiving placebo. Improvement in mean NPI scores was 1.8 points greater for patients taking methylphenidate than for controls. Methylphenidate was associated with mild anxiety and loss of less than 2% of body weight.
—Erik Greb