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How effective are cholinesterase inhibitors and memantine for dementia?
Cognitive and global functioning, behaviour, and quality of life measures such as activities of daily living and caregiver burden. Secondary outcomes: mortality, rate of institutionalisation, and adverse events.
Systematic review with meta-analysis
MEDLINE, Pre-MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, CINAHL and AgeLine were searched from January 1986 to November 2006 for English language articles. Reference lists of identified studies were hand searched.
Study selection and analysis:
RCTs of cholinesterase inhibitors or memantine in people with major dementia (including Alzheimer’s, vascular and Parkinson’s dementia) compared to placebo or another drug. Measures of cognition were the Alzheimer’s Disease Assessment Scale (ADAS; cognitive and non-cognitive subscales), Severe Impairment Battery (SIB), and Mini-Mental State Examination. The validated measure of global functioning was the clinician-based impression of change with caregiver input (CIBIC-plus). Heterogeneity was investigated using the I2 statistic.
Fifty nine RCTs (96 publications) were identified which met inclusion criteria (donepezil vs …
Source of funding: Agency for Healthcare Research and Quality, US Department of Health and Human Service, Ontario Ministry of Health and Long-term Care and McMaster University Evidence-based Practice Center. The lead researcher holds a Canadian Institute of Health Research Investigator award and an Ontario Premier’s Research Excellence award.
A reference list is published online only at http://ebmh.bmj.com/content/vol11/issue4
Competing interests: None.
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