Oral Physostigmine as Treatment for Primary Degenerative Dementia: A Double-Blind Placebo-Controlled Inpatient Trial

Twenty-three patients with primary degenerative dementia (Alzheimer's disease) were administered an optimal dose of oral physostigmine and placebo, each for a 1-week period, under double-blind conditions on a research unit of a general hospital. Each patient served as his or her own control. The optimal dose of physostigmine for each patient was determined previously by a dose-finding phase. There were no significant group differences on a number of neuropsychological tests. Along with other studies in the literature, this study casts serious doubt on the efficacy of short-term administration of oral physostigmine when used alone in an attempt to ameliorate cognitive dysfunction in Alzheimer's disease patients. The possibilities that physostigmine may slow the course of the disease or may acutely improve symptoms when combined with other agents are discussed. (J Geriatr Psychiatry Neurol 1990;3:13-17).