Donepezil and memantine in moderate to severe Alzheimers disease - The DOMINO-AD Trial

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Alzheimer s disease is a devastating and progressive degenerative disorder for which there is no cure or treatment that can halt decline into a state of total dependence upon nursing care. A number of drug treatments have been shown to make small but significant and short-term improvements in some symptoms such as memory function or agitated or withdrawn behaviour in sufferers. Even when clear improvements are not seen with treatment, many studies have shown that those patients who are given these drugs do not decline as rapidly as those who were allocated placebo over a period of 6 months. Donepezil is a cholinesterase inhibitor - a drug which has been licensed for the treatment of patients with mild to moderate Alzheimer s disease. Memantine is a member of a different class of drugs and has a license for the treatment of patients with moderate to severe Alzheimer s disease. The two drugs work in different ways in the brain and there is some evidence that patients who are treated with both drugs together will decline less rapidly than those treated with just one drug. We want to see if this is correct and to see whether the benefits of drug treatments translate into real advantages in terms of preservation of activities of daily life and quality of life in patients. Because these drugs are relatively expensive, there is debate as to whether they are really cost-effective and therefore whether or not they should be available on the NHS. The DOMINO-AD Trial will provide information about the cost-effectiveness of these treatments to inform such a decision.