title: Differential effects of current specific treatments on behavioral and psychological symptoms in patients with Alzheimer's disease: a 12-month, randomized, open-label trial.
abstract: BACKGROUND
  Behavioral and psychological symptoms of dementia (BPSD) occur in up to 80% of Alzheimer's disease (AD) patients and represent one of the most common reasons for early institutionalization and increase in management costs.
  
  
  OBJECTIVE
  This study evaluated the effects of four drugs (memantine, donepezil, rivastigmine, galantamine) in BPSD in AD patients.
  
  
  METHODS
  This was a prospective, longitudinal, randomized, open-label, 4-arm, parallel-group, 12-month clinical trial carried out in 177 AD patients. The severity of BPSD was evaluated at baseline and after treatment with memantine (n = 48), donepezil (n = 42), rivastigmine (n = 46), and galantamine (n = 41), by using the Neuropsychiatric Inventory (NPI) and the Behavioural Pathology in Alzheimer's Disease (BEHAVE-AD) scales.
  
  
  RESULTS
  The NPI and BEHAVE-AD total scores improved from baseline to month 12 in all groups. The improvements in both scales were statistically significant in the memantine, donepezil, and rivastigmine groups, but not in the galantamine group. Responder analyses showed that treatment with memantine and rivastigmine resulted in more patients improving on NPI and BEHAVE-AD score, respectively. Agitation/aggression was the NPI item with the highest improvements (significantly versus baseline in the memantine and in the rivastigmine groups), while aggression and anxiety/phobias were the mostly improved BEHAVE-AD items (significantly in the rivastigmine group for both and in the rivastigmine group only for anxiety/phobias). All treatments were well tolerated: most of adverse events reported were transient and of mild-to-moderate intensity.
  
  
  CONCLUSIONS
  This study suggests that specific drugs for AD, especially memantine and rivastigmine, may be effective in the improvement of BPSD in patients with mild to moderate AD, without major side effects.
authors.affiliation: Alzheimer and Dementia Unit, Neurodegenerative Disorders O. U., A.S.P. 2 Caltanissetta, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Cumbo
authors.affiliation: Alzheimer and Dementia Unit, Neurodegenerative Disorders O. U., A.S.P. 2 Caltanissetta, Italy.
authors.forename: Leonarda Domenica
authors.initials: LD
authors.lastname: Ligori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology; D001526:Behavioral Symptoms / Q000188:drug therapy* / Q000209:etiology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000188:drug therapy* / Q000209:etiology; D000077265:Donepezil; D018691:Excitatory Amino Acid Antagonists / Q000627:therapeutic use*; D005260:Female; D005702:Galantamine; D006801:Humans; D007189:Indans; D008137:Longitudinal Studies; D008297:Male; D008559:Memantine; D001523:Mental Disorders / Q000188:drug therapy* / Q000209:etiology; D048448:Phenylcarbamates; D010880:Piperidines; D011569:Psychiatric Status Rating Scales; D000068836:Rivastigmine
chemical_list: D002800:Cholinesterase Inhibitors; D018691:Excitatory Amino Acid Antagonists; D007189:Indans; D048448:Phenylcarbamates; D010880:Piperidines; D005702:Galantamine; D000077265:Donepezil; D000068836:Rivastigmine; D008559:Memantine
keywords: Alzheimer's disease; behavioral and psychological symptoms; donepezil; galantamine; memantine; rivastigmine