A Systematic Review of Assessment and Treatment of Moderate to Severe Alzheimer's Disease

Wichems, Frederick A. Schmitt Christine H.

doi:10.4088/pcc.v08n0306

Cited by 45 publications

(34 citation statements)

References 59 publications

(60 reference statements)

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“…As expected, SMMSE scores correlated inversely with the amount of time from dementia diagnosis, marking the deterioration of cognitive functions common in all types of dementia [19,20]. An interesting finding was the negative influence of multiple diseases on SMMSE scores, suggesting an interaction between comorbidities and cognitive functions in advanced dementia.…”

Section: Discussionmentioning

confidence: 68%

“…The incorporation of such tools into clinical practice can help physicians to understand better the particular group of patients they are caring for, as well as the set of symptoms that can be expected in the advanced stages. Moreover, the use of standardized cognitive instruments, such as the SMMSE, can provide quantifiable data in randomized clinical trials, and can make it possible to select and follow patients with moderate and severe dementia [20,22]. …”

Section: Discussionmentioning

confidence: 99%

“…Careful monitoring of these patients must include an assessment of cognition, function, and behavior during every clinical appointment [20]. …”

Section: Discussionmentioning

confidence: 99%

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A Useful and Brief Cognitive Assessment for Advanced Dementia in a Population with Low Levels of Education

Sales

Suemoto²,

Nitrini³

et al. 2011

Dement Geriatr Cogn Disord

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Background/Aims: Almost half of community-dwelling patients and 59.6% of institutionalized residents with dementia are in moderate or severe stages of this disease. The Mini-Mental State Examination (MMSE) has limited applicability to these patients due to floor effects. We aimed to determine the correlation between the MMSE and the Severe Mini-Mental State Examination (SMMSE), as well as SMMSE association with functional scales in patients having moderate to severe dementia and low levels of education. Methods: A cross-sectional study of patients 60 years or older attending an outpatient clinic was conducted. The MMSE, SMMSE and functional scales were applied. Clinical and demographic data from medical records were reviewed. Results: Seventy-five patients with a mean of 4.1 ± 3.6 years of education were analyzed. The mean scores on the MMSE and SMMSE were 7.8 ± 7.0 and 17.8 ± 9.4, respectively. The results indicated that the MMSE and SMMSE correlated only in patients who had an MMSE score of less than 10 (r = 0.87; p < 0.001). In addition, significant correlations were found between the SMMSE and functional scales (p < 0.001). It was observed that educational level did not interact with SMMSE performance. Conclusion: The SMMSE is a useful and reliable tool for a brief cognitive assessment of advanced dementia patients with low educational levels.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Useful and Brief Cognitive Assessment for Advanced Dementia in a Population with Low Levels of Education

Sales

Suemoto²,

Nitrini³

et al. 2011

Dement Geriatr Cogn Disord

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show abstract

“…When patients inevitably continue to decline despite therapeutic intervention, frustration is understandable; however, studies suggest that the benefits of therapy can be rapidly lost if treatment is discontinued [170] , and in most cases even modest therapeutic effects provide justification for therapy maintenance [155] . Open-label extension trials have suggested continued benefits for up to 1 year with memantine [171] and for at least 3 years with each of the ChEIs [172][173][174] .…”

Section: Managing Expectationsmentioning

confidence: 99%

“…These lines are beginning to blur, however. The recent approval of donepezil for severe AD [154] will likely lead to increased ChEI use in late-stage AD, and current practice suggests that patients should not discontinue ChEI therapy even after they progress to a more severe stage [155] . Additional studies involving patients with mild-to-moderate AD may also help clarify whether memantine can be effective in treating patients (or a subset of patients) in earlier stages of the disease [9,41,42] .…”

Section: Optimizing Pharmacotherapy: Monotherapymentioning

confidence: 99%

Treatment Options in Alzheimer’s Disease: Maximizing Benefit, Managing Expectations

Farlow

Miller

Pejovic

2008

Dement Geriatr Cogn Disord

112

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Alzheimer’s disease (AD) is becoming an increasingly heavy burden on the society of developed countries, and physicians now face the challenge of providing efficient treatment regimens to an ever-higher number of individuals affected by the disease. Currently approved anti-AD therapies – the cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine – offer modest symptomatic relief, which can be enhanced using combination therapy with both classes of drugs. Additionally, alternative therapies such as nonsteroidal anti-inflammatory drugs, vitamin E, selegiline, Ginkgo biloba extracts, estrogens, and statins, as well as behavioral and lifestyle changes, have been explored as therapeutic options. Until a therapy is developed that can prevent or reverse the disease, the optimal goal for effective AD management is to develop a treatment regimen that will yield maximum benefits for individual patients across multiple domains, including cognition, daily functioning, and behavior, and to provide realistic expectations for patients and caregivers throughout the course of the disease. This review provides a basic overview of approved AD therapies, discusses some pharmacologic and nonpharmacologic treatment strategies that are currently being investigated, and offers suggestions for optimizing treatment to fit the needs of individual patients.

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Withdrawal or continuation of cholinesterase inhibitors and/or memantine in patients with dementia.

Parsons

Hughes

Passmore

2011

Cochrane Database of Systematic Reviews

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A Systematic Review of Assessment and Treatment of Moderate to Severe Alzheimer's Disease

Cited by 45 publications

References 59 publications

A Useful and Brief Cognitive Assessment for Advanced Dementia in a Population with Low Levels of Education

A Useful and Brief Cognitive Assessment for Advanced Dementia in a Population with Low Levels of Education

Treatment Options in Alzheimer’s Disease: Maximizing Benefit, Managing Expectations

Withdrawal or continuation of cholinesterase inhibitors and/or memantine in patients with dementia.

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