Abstract
Background
Alzheimer disease (AD) is a global health problem which afflicts millions of old age
population worldwide. Acetylcholinesterase inhibitors and memantine are recognized
drug treatments with limited clinical efficacy. It is uncertain if earlier initiation
of these drugs will result in better outcomes in the longer term.
Aim
To evaluate the benefit of early treatment among people with AD.
Methods
Prospective randomized controlled trials were systematically searched from the OVID
databases. The trials were eligible if study participants diagnosed with AD and were
randomized to have early or late treatment. Any clinical assessment scales on cognitive
function, physical function, behavioral problems, and the overall clinical status
were the primary outcomes, and any reported adverse events were the secondary outcomes.
Results
Ten randomized trials were identified between 2000 and 2010. A total of 3092 participants
with AD with mean age 75.8 years were randomly assigned to receive early treatment
or treatment delayed by placebo intervention for around 6 months. Compared with late
treatment, early AD drug treatment showed no significant benefit on cognitive function
[mean difference (MD) of Alzheimer's Disease Assessment Scale- Cognitive Subscale = −0.49,
95% CI = −1.67 to 0.69], physical function (MD of Alzheimer's Disease Cooperative
Study Activities of Daily Living Inventory = 0.47, 95% CI = −1.44 to 2.39), behavioral
problems (MD of Neuropsychiatric Inventory = −0.26, 95% CI = −2.70 to 2.18), and clinical
status (MD of Clinician's Interview-Based Impression of Change plus Caregiver Input = 0.02,
95% CI = −0.23 to 0.27). Nausea was the most common adverse events in acetylcholinesterase
inhibitor users, while memantine did not result in more side effects than the placebo
group. For both drugs, early treatment had comparable adverse events when compared
with late treatment.
Conclusions
Earlier AD drug treatment by around 6 months did not result in significant difference
in cognitive function, physical function, behavioral problems, and clinical status.
This study included relative high proportion of early AD with the follow-up less than
2 years. Future studies can be conducted to further investigate the long-term findings.
Keywords
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Article info
Publication history
Published online: September 18, 2015
Footnotes
The authors declare no conflicts of interest.
This is a self-initiated study without any financial support.
Identification
Copyright
© 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
