Maintaining functional and behavioral abilities in Alzheimer disease
Winblad B
Karolinska Institutet,
Alzheimer Disease Research Center
Huddinge Hospital, Sweden.
bengt.winblad@neurotec.ki.se
Alzheimer Dis Assoc Disord 2001 Aug;15 Suppl 1:S34-40
ABSTRACT
Limitations associated with conventional
acetylcholinesterase inhibitors have led to interest in therapies with
more than one mode of action. Galantamine is a novel treatment for
Alzheimer disease with a dual mode of action. The mechanisms involved
may result in better long-term cognitive function, and may specifically
affect behavioral symptoms. Three acetylcholinesterase inhibitors
available in the USA, donepezil, rivastigmine and tacrine, have
demonstrated improvements in activities of daily living. However, data
are mixed and much is questionable because of the outcome measures used.
Galantamine showed evidence of functional benefit in three pivotal Phase
III studies of up to 6 months' duration. Furthermore, galantamine
stabilized instrumental and basic activities of daily living in an
open-label 12-month study. This long-term maintenance of functional
ability would be expected to be an important benefit for patients and
carers. Open-label studies have suggested that donepezil and tacrine
might have beneficial effects on behavioral symptoms. In a 5-month
pivotal study, galantamine significantly slowed the progression of
behavioral symptoms in patients with mild-to-moderate Alzheimer disease.
These behavioral benefits were associated with reduced caregiver
distress and translated into reduced caregiver time. These benefits
would be expected to make an important difference to the quality of life
of patients and caregivers.
