Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials

Kaduszkiewicz, Hanna; Zimmermann, Thomas; Beck‐Bornholdt, Hans‐Peter; Bussche, Hendrik van den

doi:10.1136/bmj.331.7512.321

Cited by 442 publications

(293 citation statements)

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“…Los datos hallados sugieren que la DTA es una patología infratratada en nuestra comunidad. Esto puede ser debido a que existen dudas sobre el beneficio terapéu-tico real de la medicación antialzheimer 18 lo que puede inhibir a los médicos a su prescripción.…”

Section: Discussionunclassified

Utilización de los inhibidores de la acetilcolinesterasa y la memantinapara el tratamiento de la demencia tipo Alzheimer

Romero¹,

Romero²,

González³

et al. 2005

Rev. Esp. Salud Publica

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RESUMENFundamento: En los últimos años han aumentado las alternativas terapéuticas en el tratamiento de la demencia tipo Alzheimer (DTA), por lo que se hace necesario conocer el patrón de utilización de estos nuevos medicamentos.Métodos: Estudio observacional transversal de la población con DTA tratada con inhibidores de la acetilcolinesterasa y/o memantina en el Servicio Gallego de Salud. Se construyeron bases de datos con las variables demográficas y datos de utilización durante abril de 2005 de los referidos medicamentos.Resultados: De 5.110 pacientes con DTA, el 70,47% eran mujeres. La edad media de éstas fue de 80,12 y de 78,61 en los hombres, con desviaciones típicas de 6,66 y 7,03 respectivamente. El sexo femenino se mostró como un factor asociado a presentar DTA a tratamiento farmacológico (OR: 1,932 [IC 95%:1,819-2,052]). El medicamento más utilizado fue donepezilo (44,46% de los pacientes). Se hallaron diferencias significativas en el porcentaje de pacientes con memantina a favor de los pacientes ≤ 64 años (19,7% en ≤ 64 años vs. 14% en >64 años[p<0,05]), y de donepezilo a favor de los pacientes ≥ 95 años (75% en ³95 años vs. 46,9% en ≥ 95 años [p<0,03]). No se observaron diferencias significativas en la utilización de la terapéutica antidemencia, expresada en DDD/paciente/día entre sexos, grupos de edad, ni en la desagregación de los grupos de edad por sexos.Conclusiones: La utilización de memantina (en monoterapia o en combinación) es más frecuente en menores de 64 años. El sexo femenino se mostró como un factor asociado a presentar DTA a tratamiento farmacológico.Palabras clave: Enfermedad de Alzheimer. Galantamina. Memantina. Inhibidores de la Colinesterasa.

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Section: Discussionunclassified

Utilización de los inhibidores de la acetilcolinesterasa y la memantinapara el tratamiento de la demencia tipo Alzheimer

Romero¹,

Romero²,

González³

et al. 2005

Rev. Esp. Salud Publica

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“…The intervention of CST was routinely offered in the care setting. The aim of this study was to determine whether or not groups were running in practice and to determine if the positive findings for cognition and quality of life for the person with dementia found in previous CST research 5 could be demonstrated in practice. …”

Section: Observational Study Of Cognitive Stimulation Therapy In Pracmentioning

confidence: 99%

“…to our house, which is a bit of a worry. HOME TREATMENT PROGRAMME: DEVELOPMENT OF A HOME TREATMENT PACKAGE NIHR Journals Library www.journalslibrary.nihr.ac.uk (5) Too much activity/ stimulus in the home (2) Outdoor safety (1) Outdoor safety (6) Inability to identify potential risks (5) Changes in environment (3) Social isolation (2) Reluctance in calling for/refusing to call for help/assistance (2) Person with dementia is being abused ( Limited family carer awareness and understanding of dementia (6) Family carer is unable to access support services (4) Family carer absent (4) Family carer's physical health (2) Family carer is abusing person with dementia (2) Carer refusing help or assistance (1)…”

Section: Causes Of Crisismentioning

confidence: 99%

“…Drug treatments have an important role in dementia care, but in the UK they are limited to people with Alzheimer's disease, with mild to moderately severe dementia, have a limited impact on the illness, are not suitable for all patients and cost approximately £1000 per year. 5 There is increasing recognition that psychological and social interventions may have comparable value 6 and may be preferable (e.g. when medication may have intolerable side effects).…”

Section: Introductionmentioning

confidence: 99%

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Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

Orrell

Hoe

Charlesworth

et al. 2017

Programme Grants Appl Res

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BackgroundDementia is a national priority and this research addresses the Prime Minister’s commitment to dementia research as demonstrated by his 2020 challenge and the new UK Dementia Research Institute. In the UK > 800,000 older people have dementia. It has a major impact on the lives of people with dementia themselves, on the lives of their family carers and on services, and costs the nation £26B per year. Pharmacological cures for dementias such as Alzheimer’s disease are not expected before 2025. If no cure can be found, the ageing demographic will result in 2 million people living with dementia by 2050. People with dementia lose much more than just their memory and their daily living skills; they can also lose their independence, their dignity and status, their confidence and morale, and their roles both within the family and beyond. They can be seen as a burden by society, by their families and even by themselves, and may feel unable to contribute to society. This programme of research aims to find useful interventions to improve the quality of life of people with dementia and their carers, and to better understand how people with dementia can be supported at home and avoid being admitted to hospital.Objectives(1) To develop and evaluate the maintenance cognitive stimulation therapy (MCST) for people with dementia; (2) to develop the Carer Supporter Programme (CSP), and to evaluate the CSP and Remembering Yesterday, Caring Today (RYCT) for people with dementia both separately and together in comparison with usual care; and (3) to develop a home treatment package (HTP) for dementia, to field test the HTP in practice and to conduct an exploratory trial.Methods(1) The MCST programme was developed for people with dementia based on evidence and qualitative work. A randomised controlled trial (RCT) [with a pilot study of MCST plus acetylcholinesterase inhibitors (AChEIs)] compared MCST with cognitive stimulation therapy (CST) only. The MCST implementation study conducted a trial of outreach compared with usual care, and assessed implementation in practice. (2) The CSP was developed based on existing evidence and the engagement of carers of people with dementia. The RCT (with internal pilot) compared the CSP and reminiscence (RYCT), both separately and in combination, with usual care. (3) A HTP for dementia, including the most promising interventions and components, was developed by systematically reviewing the literature and qualitative studies including consensus approaches. The HTP for dementia was evaluated in practice by conducting in-depth field testing.Results(1) Continuing MCST improved quality of life and improved cognition for those taking AChEIs. It was also cost-effective. The CST implementation studies indicated that many staff will run CST groups following a 1-day training course, but that outreach support helps staff go on to run maintenance groups and may also improve staff sense of competence in dementia care. The study of CST in practice found no change in cognition or quality of life at 8-month follow-up. (2) The CSP/RYCT study found no benefits for family carers but improved quality of life for people with dementia. RYCT appeared beneficial for the quality of life of people with dementia but at an excessively high cost. (3) Case management for people with dementia reduces admissions to long-term care and reduces behavioural problems. In terms of managing crises, staff suggested more costly interventions, carers liked education and support, and people with dementia wanted family support, home adaptations and technology. The easy-to-use home treatment manual was feasible in practice to help staff working in crisis teams to prevent hospital admissions for people with dementia.LimitationsGiven constraints on time and funding, we were unable to compete the exploratory trial of the HTP package or to conduct an economic evaluation.Future researchTo improve the care of people with dementia experiencing crises, a large-scale clinical trial of the home treatment manual is needed.ConclusionThere is an urgent need for effective psychosocial interventions for dementia. MCST improved quality of life and was cost-effective, with benefits to cognition for those on AChEIs. MCST was feasible in practice. Both CSP and RYCT improved the quality of life of people with dementia, but the overall costs may be too high. The HTP was useful in practice but requires evaluation in a full trial. Dementia care research may improve the lives of millions of people across the world.Trial registrationsCurrent Controlled Trials ISRCTN26286067 (MCST), ISRCTN28793457 (MCST implementation) and ISRCTN37956201 (CSP/RYCT).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 5. See the NIHR Journals Library website for further project information.

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“…5 Audits of practice suggest compliance with the original NICE guidelines and drug efficacy (in terms of MMSE scores) in the short term. 6,7 More recently, however, other trials 8 and systematic reviews 9 have questioned the efficacy and cost ef fectiveness of ChEIs.…”

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confidence: 99%

Do cholinesterase inhibitors alter the course of dementia?

Larner¹

2007

Prog Neurol Psychiatry

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Cholinesterase inhibitors are generally believed to have solely symptomatic effects – the benefit being lost on termination of the drug. Dr Larner describes an audit carried out at his cognitive function clinic between 2001 and 2005 to investigate whether cholinesterase inhibitors can alter the natural history of dementia, by observing the number of patients entering nursing homes during the study period. Copyright © 2007 Wiley Interface Ltd

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Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials

Cited by 442 publications

References 42 publications

Utilización de los inhibidores de la acetilcolinesterasa y la memantinapara el tratamiento de la demencia tipo Alzheimer

Utilización de los inhibidores de la acetilcolinesterasa y la memantinapara el tratamiento de la demencia tipo Alzheimer

Support at Home: Interventions to Enhance Life in Dementia (SHIELD) – evidence, development and evaluation of complex interventions

Do cholinesterase inhibitors alter the course of dementia?

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