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KCE reports 111C Interventions in Alzheimer’s Disease i
INTRODUCTION
Executive summary
No hard data exist, but experts estimate that in 2008 around 75 000 patients were
suffering from Alzheimer’s disease (AD) in Belgium. This is more than half of all patients
with dementia. Two-thirds of the AD patients are women and about 45% are
institutionalized. Clinical AD is preceded by a slowly progressing accumulation in the
brain of amyloid plaques and neurofibrillary tangles with hyperphosphorylated tau
protein. In many cases AD is present in combination with some degree of
cerebrovascular damage (mixed dementia). With the exception of some genetically welldefined
forms of AD, at present a definitive diagnosis of AD still requires
histopathological confirmation of a probabilistic clinical diagnosis.
Memory impairment is usually one of the first symptoms of AD. As the disease
progresses cognitive deficits start to interfere with activities of daily living (ADL) and
behavioural problems may appear. These behavioural and psychological signs and
symptoms in dementia (BPSD) commonly include depression, apathy, agitation,
disinhibition, psychosis, wandering, aggression, incontinence and altered eating habits.
They contribute significantly to caregiver burden, institutionalization (placement in an
elderly home), and decreased quality of life for patients with dementia.
The most frequently used cognitive test to assess the severity of AD is the 30 points
Mini Mental State Exam (MMSE). Severe AD is defined as a MMSE less than 10 points.
The life expectancy of AD patients is about half that of a person with the same age but
without AD. The overall goals of current interventions and care are to improve the
patient (and caregiver) quality of life and if needed, to “attenuate” the behavioural
disorder of the patient. It is expected that earlier intervention with disease-modifying
therapies will be more effective than current symptomatic therapies. If such diseasemodifying
therapies become available, an early accurate diagnosis will be more
important than it is now, even at the pre-dementia phase referred to as mild cognitive
impairment (MCI).
SCOPE AND METHODS
We studied the effectiveness and cost-effectiveness of the currently available
pharmaceutical and non-pharmaceutical interventions targeting AD patients. We limited
our search to HTA reports and systematic reviews that minimally covered the literature
published until 2003 for non-pharmacological interventions and mid 2004 for
pharmacological interventions. We did not perform any formal scoring of the quality of
the reviews, which can be considered a limitation of the study. With regard to costeffectiveness
analyses also original full economic evaluations were included if published
after 2004. Finally, we analysed Belgian drug prescription data for the 2002-2006 period.
The aim of this rapid assessment of interventions for AD was not to repeat the
numerous systematic reviews and health technology assessment reports which have
been published over the last years. The objective of this report was to summarize the
conclusions of these reviews and to focus on findings of relevance for the Belgian
decision makers. We have therefore tried to be complementary to other Belgian
research reports on AD.