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ALZHEIMER'S
DISEASE AND DEMENTIA |
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Forschungs-und Lehreinrichtung
des Birkmayer Instituts fur Parkinsontherapie Vienna,
Austria.
The Coenzyme nicotinamide adenine
dinucleotide (NADH) has been used as medication in 17
patients suffering from dementia of the Alzheimer type
in an open label trial. In all patients evaluated so
far, an improvement in their cognitive dysfunction was
observed. Based on the minimental state examination,
the minimum improvement was 6 points and the maximum
improvement 14 points with a mean value of 8.35 points.
The improvement on the basis of the global deterioration
scale (GDS) was a minimum of 1 point and a maximum of
2 points with a mean value of 1.82. The duration of
therapy was between 8 and 12 weeks. No side effects
or adverse effects have been reported from the patients
or their caregivers during the observation period which
is, in some patients, more than a year. This open label
trial represents a pilot study from which no definitive
conclusion can be drawn. A double-blind placebo controlled
study is necessary to demonstrate the clinical efficacy
of NADH. The planning and the fulfillment of all requirements
for such a study are in progress.
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Department of Neurology, St.
Josef-Hospital, Ruhr-University of Bochum, Federal
Republic of Germany.
The Coenzyme nicotinamide adenine
dinucleotide (NADH) has been used as medication in
17 patients suffering from dementia of the Alzheimer
type in an open label trial. In all patients evaluated
so far, an improvement in their cognitive dysfunction
was observed. Based on the minimental state examination,
the minimum improvement was 6 points and the maximum
improvement 14 points with a mean value of 8.35 points.
The improvement on the basis of the global deterioration
scale (GDS) was a minimum of 1 point and a maximum
of 2 points with a mean value of 1.82. The duration
of therapy was between 8 and 12 weeks. No side effects
or adverse effects have been reported from the patients
or their caregivers during the observation period
which is, in some patients, more than a year. This
open label trial represents a pilot study from which
no definitive conclusion can be drawn. A double-blind
placebo controlled study is necessary to demonstrate
the clinical efficacy of NADH. The planning and the
fulfillment of all requirements for such a study are
in progress.
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University of Southampton
OBJECTIVES: Systematic review
of the clinical and cost-effectiveness of donepezil,
rivastigmine, and galantamine for people suffering from
Alzheimer's disease. METHODS: Sixteen electronic databases
(including MEDLINE, the Cochrane Library, and Embase)
and bibliographies of related papers were searched for
published/unpublished English language studies, and
experts and pharmaceutical companies were consulted
for additional information. Randomized controlled trials
(RCTs) and economic studies were selected. Clinical
effectiveness was assessed on measurement scales assessing
progression of Alzheimer's disease on the person's global
health, cognition, functional ability, behavior and
mood, and quality of life. Cost-effectiveness was presented
as incremental cost per year spent in a nonsevere state
(by Mini Mental Health State Examination) or quality-adjusted
life-year. RESULTS: Twelve of 15 RCTs included were
judged to be of good quality. Although donepezil had
beneficial effects in Alzheimer's patients on global
health and cognition, rivastigmine on global health,
and galantamine on global health, cognition, and functional
scales, these improvements were small and may not be
clinically significant. Measures of quality of life
and behavior and mood were rarely assessed. Adverse
effects were usually mild and transient. Cost-effectiveness
base case estimates ranged from 2,415 Pounds savings
to 49,476 Pounds additional cost (1997 prices) per unit
of effect for donepezil and a small savings for rivastigmine.
Estimates were not considered robust or generalizable.
CONCLUSIONS: Donepezil, rivastigmine, and galantamine
appear to have some clinical effect for people with
Alzheimer's disease, although the extent to which these
translate into real differences in everyday life remains
unclear. Due to the nature of current economic studies,
cost-effectiveness remains uncertain and the impact
on different care sectors has been inadequately investigated.
Further research is needed to establish the actual benefits
of acetylcholinesterase inhibitors (AChEls) for people
with Alzheimer's disease and their caregivers, the relationship
of these changes to clinical management, and careful
prospective evaluation of resource and budgetary consequences.
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