Dementia

DOMINO: Howard et al, "Donepezil and Memantine for Moderate-to-severe Alzheimer's Disease." NEJM 2012;366:893-903. - N=295, treated with donepezil >=3 mo., moderate or severe Alzheimer's (MMSE 5 to 12 out of 30). Randomized to continue donepezil, discontinue donepezil, discontinue donepezil and start memantine, or continue donepezil and start memantine. Treated for 52 weeks. outcomes: MMSE and Bristol ADL Scale. - Donepezil group outperformed memantine group; no significant benefit to using both together. Authors recommend continued treatment with donepezil in patients with moderate to severe AD. - Notes: 4 small study groups, absolute benefit is small, conflicts of interest.

CASCADE: Mitchell SL, "The Clinical Course of Advanced Dementia." NEJM 2012. - Prospective observational study - Population: age>60, socre on Cognitive Performance Scale 5 or 6, length of stay in nursing home >30d - 18 months - n=323 - Over 18 months, 54.8% of pts died. Probability of PNA 41.1%, febrile episode 52.6%, eating problem 85.8%. 6-month mortality rate for residents who had PNA was 46.7%, febrile episode 44.5%, eating problem 38.6%. 46.7% had dyspnea and 39.1% had pain. In last 3 months of life, 40.7% underwent at least one burdensome intervention (hospitalization, ER visit, parenteral therapy, tube feeding). Patients much less likely to have burdensome interventions in last 3 months of life if their health care proxies understood poor prognosis and clinical complications expected in advanced dementia (OR 0.12, 95% CI 0.04-0.37).

Bexarotene: [|Science] [|NEJM] [|Perspective - NEJM]

IVIG: Relkin N, et al "Three-year follow-up on the IVIG for Alzheimer's phase II study" //AAIC// 2012; Abstract P3-381.

Crenezumab: [|Wikipedia]