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4 Interventions in Alzheimer’s Disease KCE Reports 111 NMDA N-methyl-D-aspartate NNT Number-needed-to-treat NOSGER Nurses’ Observation Scale for Geriatric Patients NPI Neuropsychiatric Inventory NPI-D Neuropsychiatric Inventory, distress subscale PDS Progressive Deterioration Scale PLST Progressively Lowered Stress Threshold QALY Quality adjusted life-year QoL Quality of life RCT Randomised controlled trial ROB Rustoord voor Bejaarden RVT Rust- en Verzorgingstehuis SBU Swedish Council on Technology Assessment in Health Care SD Standard deviation SIB Severe Impairment Battery TENS Transcutaneous Electrical Nerve Stimulation VaD Vascular dementia WMD Weighted mean difference
KCE Reports 111 Interventions in Alzheimer’s Disease 5 1 INTRODUCTION AND RESEARCH QUESTIONS 1.1 INTRODUCTION 1.1.1 Project scope Many studies have been published over the last two decades on the subject of Alzheimer’s disease or Alzheimer’s dementia (AD). They have been summarized and analyzed as systematic reviews and health technology assessment (HTA) reports. Our ambition with this short HTA was not to repeat these enormous tasks but to list the conclusions drawn of the most recently published reviews and to focus on findings that might be of relevance for the Belgian decision makers. We included original research studies only for the health-economic chapter. Alzheimer’s disease or Alzheimer’s dementia (AD) accounts for more than half of the cases of dementia (around 60%). 1 In many cases AD is present together with some degree of cerebrovascular damage (mixed dementia). The prevalence of dementia and AD increases with age, and the most common form of AD is Senile Dementia of the Alzheimer Type (SDAT). With the exception of some genetically well-defined forms of AD, a definitive diagnosis of AD still requires histopathological confirmation of a probabilistic clinical diagnosis. Interventions targeting AD and dementia care in general constitute a vast domain of research. Especially the manpower needed to care for a growing number of AD patients poses a challenge for societies with increasing proportions of elderly people. In this report we limited the research questions to an evaluation of the effectiveness and costeffectiveness of the pharmaceutical and non-pharmaceutical interventions targeting AD patients. For the topics organisation of care, including care for the (presenile) smaller patient groups with AD, patient rights and legal aspects, obtaining patient consent, we refer to a project concerning these topics conducted in parallel to the KCE project by the Koning Boudewijnstichting and mentioned below under the local initiatives section. The overall goals of interventions and care are to improve the patient quality of life (and that of the caregiver) and to to “attenuate” the behaviourial disorder of the patient. We do not cover in this report the financing of care, and the appropriateness of funding based on functions lost by the patient rather than the efforts needed to maintain or stimulate the remaining functions. We also briefly look into advances in technology which are aimed at expanding the possibilities to maintain independency or facilitate care giving. Care for AD patients at home or in an elderly home requires the input of a dedicated “coordinator” (can be a family member) to assess the needs for care to schedule the care interventions, as well as a dedicated “caregiver” (can be the same family member), who “fills the gaps” and assures continuity of care. Patient care is provided in various forms, often on a volunteer basis. AD patients are mainly elderly, and may be suffering from a large number of concomitant diseases for which they may receive medication or other forms of treatment. Avoiding drug interactions in elderly patients is another challenge. Avoiding toxicity and adverse outcomes may even prove impossible when multiple drugs all have to be metabolized using competing systems in an ageing body. The study of drug interactions is not within the project scope, but we analyse the medication prescribed for AD patients in Belgium.
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KCE reports 33 Effects and costs of
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