Disease stage in Alzheimer disease and treatment effects of rivastigmine.
The efficacy and tolerability of the cholinesterase inhibitor rivastigmine in the treatment of Alzheimer disease (AD) have been demonstrated in several clinical trials, which included patients with a wide range of dementia severities. To investigate the association between severity of disease and treatment response, the combined data from three large randomized, placebo-controlled trials were analyzed. The pooled patient population was stratified into three cohorts showing moderately severe (Mini-Mental State Examination score [MMSE] < or = 15), moderate (MMSE 16-22), and mild (MMSE > or = 22) dementia. In each cohort, the effects of rivastigmine 6 to 12 mg/day versus placebo were evaluated using the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) and the Progressive Deterioration Scale. Rivastigmine 6 to 12 mg/day maintained ADAS-cog scores at or above placebo levels in all cohorts, while cognitive deterioration with placebo was progressive and severity dependent. Activities of daily living showed statistically significant benefits with rivastigmine across all severity cohorts.
Kurz
Alexander
A
Technische Universität München, Munich, Germany. alexander.kurz@lrz.tu.muenchen.de
Farlow
Martin
M
Quarg
Peter
P
Spiegel
René
R
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000145:classification* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D018696:Neuroprotective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D048448:Phenylcarbamates / Q000494:pharmacology* / Q000627:therapeutic use; D010919:Placebos; D012189:Retrospective Studies; D000068836:Rivastigmine; D012720:Severity of Illness Index
D018696:Neuroprotective Agents; D048448:Phenylcarbamates; D010919:Placebos; D000068836:Rivastigmine