Alzheimer’s: Two Drugs Better Than One
Study Shows Slowest Disease Progression With Combo Treatment
Longer Treatment Better
In an effort to address this issue, Atri and colleagues followed 382 Alzheimer's patients for an average of 2 1/2 years, assessing their mental and functional abilities every six months using standardized testing protocols.
A total of 144 patients received no drug treatment, 122 were treated with a cholinesterase inhibitor alone, and 116 took a cholinesterase inhibitor in combination with Namenda.
After controlling for factors associated with disease progression, including duration of illness and age, the researchers concluded that patients taking the combination of drugs had the smallest memory and functional declines.
Using a statistical model that they developed, they predicted that the longer patients stayed on the combination treatment, the smaller their rate of decline would be.
"Initial response when patients are put on these drugs is not really a good predictor of whether they are working," Atri says. "As time goes on the benefits become more apparent."
Other Approaches to Treatment
The researchers conclude that their study raises "the intriguing possibility that combination therapy modestly modifies the long-term clinical course of Alzheimer's disease."
But Alzheimer's researcher and clinician Constantine G. Lyketsos, MD, says the findings do little to change his opinion that the currently available drugs do not modify the course of the disease.
Lyketsos leads the psychiatry department at Baltimore's John's Hopkins Bayview Medical Center.
"This was not a randomized trial, and that is a problem," he says. "It may be that the patients on the combination treatment were healthier to begin with and could tolerate more aggressive treatment."
Lyketsos says there is now general agreement that the approved Alzheimer's drugs can have a "small to modest" impact on symptoms, but he adds that medication is just one component of treatment.
Counseling and respite for caregivers, providing activities for patients, treating psychiatric symptoms like depression, and getting patients off other medications that they may not need are also important aspects of a comprehensive treatment plan, he says.
"Good dementia care should include a conversation with the health provider about whether drugs are needed, but it certainly isn't limited to that," he says.