Pharmacological treatment in moderate-to-severe Alzheimer's disease.
BACKGROUND
Moderate-to-severe stage Alzheimer's disease (AD) is a clinically diagnosable entity that represents a substantial burden to our healthcare system in terms of its prevalence, symptomatology, caregiver stress and economics.


OBJECTIVE
In this paper, we review the data from currently available clinical trials aimed at treatment of this later stage of the disease.


METHODS
A literature search was performed and published randomized controlled trials (RCTs) in which the majority of the study population consisted of Alzheimer patients in the moderate-to-severe stage were selected for review.


RESULTS
A total of nine RCTs were identified in which the study population consisted of mainly moderate-to-severe AD patients. The results from these studies suggest that memantine and donepezil, individually or in combination, provide measurable global, cognitive and behavioral benefits in AD patients.


CONCLUSIONS
Pharmacological treatment of moderate-to-severe AD patients can be beneficial. However, cost-benefit data are limited, and the long-term effects and the optimal duration of treatment as patients continue to progress to more severe stages are unknown and require further investigation.
Hsiung
Ging-Yuek Robin
GY
University of British Columbia, Division of Neurology, Department of Medicine, S162 -2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada. hsiung@interchange.ubc.ca
Feldman
Howard H
HH
D000544:Alzheimer Disease / Q000188:drug therapy*; D000077265:Donepezil; D004311:Double-Blind Method; D006801:Humans; D007189:Indans / Q000009:adverse effects / Q000627:therapeutic use; D008559:Memantine / Q000009:adverse effects / Q000627:therapeutic use; D048448:Phenylcarbamates / Q000009:adverse effects / Q000627:therapeutic use; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use; D010919:Placebos; D016032:Randomized Controlled Trials as Topic; D000068836:Rivastigmine; D012642:Selegiline / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D014810:Vitamin E / Q000009:adverse effects / Q000627:therapeutic use
D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D010919:Placebos; D014810:Vitamin E; D012642:Selegiline; D000077265:Donepezil; D000068836:Rivastigmine; D008559:Memantine