#Domino meme template trial#
#Domino meme template license#

4 The findings of a study showing that combination therapy with memantine and a cholinesterase inhibitor was more effective than treatment with a cholinesterase inhibitor alone 5 have not been replicated. 3 Evidence of the efficacy of memantine has been shown primarily in patients with moderate or severe Alzheimer's disease. Despite questions about the methods used in the trials 1 and about the clinical significance of reported benefits, 1,2 guidelines advocate treatment with a cholinesterase inhibitor, although some recommend discontinuation when Alzheimer's disease becomes severe. Most studies evaluating cholinesterase inhibitors for the treatment of Alzheimer's disease have focused on patients with mild-to-moderate disease. Alzheimer's Society Current Controlled Trials number, ISRCTN49545035.) Introduction In patients with moderate or severe Alzheimer's disease, continued treatment with donepezil was associated with cognitive benefits that exceeded the minimum clinically important difference and with significant functional benefits over the course of 12 months. There were no significant benefits of the combination of donepezil and memantine over donepezil alone.

The efficacy of donepezil and of memantine did not differ significantly in the presence or absence of the other. Patients assigned to receive memantine, as compared with those assigned to receive memantine placebo, had a score on the SMMSE that was an average of 1.2 points higher (95% CI, 0.6 to 1.8 P<0.001) and a score on the BADLS that was 1.5 points lower (95% CI, 0.3 to 2.8 P=0.02). Patients assigned to continue donepezil, as compared with those assigned to discontinue donepezil, had a score on the SMMSE that was higher by an average of 1.9 points (95% confidence interval, 1.3 to 2.5) and a score on the BADLS that was lower (indicating less impairment) by 3.0 points (95% CI, 1.8 to 4.3) (P<0.001 for both comparisons).

The minimum clinically important differences were 1.4 points on the SMMSE and 3.5 points on the BADLS. The coprimary outcomes were scores on the SMMSE and on the Bristol Activities of Daily Living Scale (BADLS, on which scores range from 0 to 60, with higher scores indicating greater impairment). Patients received the study treatment for 52 weeks. We assigned 295 community-dwelling patients who had been treated with donepezil for at least 3 months and who had moderate or severe Alzheimer's disease (a score of 5 to 13 on the Standardized Mini–Mental State Examination ) to continue donepezil, discontinue donepezil, discontinue donepezil and start memantine, or continue donepezil and start memantine. It is not known whether treatment benefits continue after the progression to moderate-to-severe disease. The most trusted, influential source of new medical knowledge and clinical best practices in the world.Ĭlinical trials have shown the benefits of cholinesterase inhibitors for the treatment of mild-to-moderate Alzheimer's disease.

#Domino meme template license#

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#Domino meme template trial#

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