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. 2006;8(3):158-9.
doi: 10.4088/pcc.v08n0306.

A systematic review of assessment and treatment of moderate to severe Alzheimer's disease

Frederick A Schmitt  1 , Christine H Wichems
Affiliations

A systematic review of assessment and treatment of moderate to severe Alzheimer's disease

Frederick A Schmitt et al. Prim Care Companion J Clin Psychiatry. 2006.

Abstract

Objective: The systematic, large-scale study of therapies for moderate to severe Alzheimer's disease (AD) is a relatively recent advancement in the field. This review describes for the general practitioner the characterization of moderate to severe AD, discusses the development of metrics sensitive to the constellation of symptoms in these patients, and critically evaluates the use of those measures in moderate to severe AD clinical trials.

Data sources: Published clinical trials obtained by MEDLINE searches used the following key words: moderate AD, severe AD, donepezil, rivastigmine, galantamine, memantine, and anti-dementia agents. Clinical trials were limited by language (English), study type (clinical trial), and publication dates (1990-2005).

Study selection: Nine clinical trials comprise the studies conducted to date in moderate to severe AD and include 5 prospective randomized clinical trials (3 for memantine, 2 for donepezil) and 4 retrospective subanalyses (2 for galantamine, 2 for rivastigmine) of primary datasets.

Data extraction: Clinical trials are summarized and major findings are reviewed.

Data synthesis: The data reviewed support the decision to initiate and maintain treatment in moderate to severe AD patients.

Conclusions: The development and implementation of improved metrics for moderate to severe AD patients has revealed that meaningful benefits are attainable in this patient population by treatment with the N-methyl-D-aspartate receptor antagonist memantine. Evidence also indicates a benefit from cholinesterase inhibitor treatment, although further study of these agents in this patient population is warranted.

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Figures

Figure 1.
Figure 1.
Mean and Range of MMSE Scores (box plot) for Levels of Impairment Defined by CDR Stages of Dementia Severitya
Figure 2.
Figure 2.
Impact of Baseline MMSE Scores on SIB Score Decline in Placebo Patients
See this image and copyright information in PMC

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References

    1. Hebert LE, Scherr PA, and Bienias JL. et al. Alzheimer's disease in the US population. Arch Neurol. 2003 60:1119–1122. - PubMed
    1. Canadian Study of Health and Aging Working Group. Patterns of caring for people with dementia in Canada. Can J Aging. 1994;12:470–487.
    1. Feldman H, Gauthier S, and Hecker J. et al. A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer's disease. Neurology. 2001 57:613–620. - PubMed
    1. Reisberg B, Doody R, and Stöffler A. et al. Memantine in moderate-to-severe Alzheimer's disease. N Engl J Med. 2003 348:1333–1341. - PubMed
    1. Tariot PN, Farlow MR, and Grossberg GT. et al. Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA. 2004 291:317–324. - PubMed