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

阿尔茨海默病S病是一种破坏性和进行性的退行性疾病，没有治愈或治疗方法可以阻止衰退进入完全依赖护理的状态。一些药物治疗已被证明在一些症状上取得了微小但显著的短期改善，如记忆功能或患者的烦躁或孤僻行为。即使在治疗中没有看到明显的改善，许多研究也表明，在6个月的时间里，服用这些药物的患者的病情下降速度没有那些服用安慰剂的患者那么快。多奈哌齐是一种胆碱酯酶抑制剂，是一种已被批准用于治疗轻至中度阿尔茨海默病患者的药物S。美金刚是另一类药物的成员，拥有治疗中重度阿尔茨海默病患者S的许可证。这两种药物在大脑中的作用方式不同，有一些证据表明，同时使用两种药物的患者比只使用一种药物的患者下降速度要慢。我们想看看这是否正确，并想看看药物治疗的好处是否转化为在保留患者日常生活活动和生活质量方面的真正优势。由于这些药物相对昂贵，因此关于它们是否真的具有成本效益以及是否应该在NHS上提供这些药物存在争议。Domino-AD试验将提供有关这些治疗的成本效益的信息，以便做出这样的决定。

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shown to make small but significant and short-term improvements in some symptoms such as memory function or agitated or withdrawn behaviour in sufferers.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.