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• W2034506225 abstract "Accessible online at: www.karger.com/journals/dem A major goal in the pharmacological treatment of Alzheimer’s disease (AD) is to produce a clinically relevant benefit that is sustained in the long term. In order to meet this objective we have to ask two questions: How do we measure benefit, and what strategies can we use to prolong efficacy? To address these and other important issues in the management of AD, a panel of international experts gave presentations at a symposium, ‘The Modern Treatment of Alzheimer’s Disease’, which was held at the congress of the European Federation of Neurological Society (EFNS), in Lisbon, in September 1999. The articles that follow are based on these presentations. The central feature of AD is a progressive deterioration in a person’s cognitive functions, particularly in memory. The assessment of cognitive function is therefore essential in judging treatment outcome, as discussed by Professor Winblad in this supplement. To date, the cognitive subscale of the Alzheimer’s Disease Assessment Scale, ADAS-cog, which assesses memory, attention, orientation and language, is an internationally accepted standard measure of cognitive function in AD drug trials. In 6month studies, an improvement relative to placebo of at least 3–4 points on ADAS-cog is judged to be clinically relevant. Untreated patients with AD would be expected to deteriorate by 5–11 points per year. Therefore, in 12month studies, maintaining cognitive function at or near baseline values is considered to be a clinically significant outcome. However, this result in itself is not sufficient, as other dimensions in AD symptomatology are also very important for both the patient and the caregivers, namely the ability to perform activities of daily living (ADL) and patients’ global functioning, in which behavioural disturbances play an important role. Professor Winblad emphasized that treatment success should not be judged purely on cognitive function. AD is a devastating illness whose impact can and should be assessed beyond changes on a psychometric scale. As occurs with memory and other cognitive skills, there is a progressive decline in a patient’s ability to carry out first the more complex and then even basic activities of daily living. Once the ability to perform a daily activity is lost because of AD, it is rarely recovered. This has considerable implications for the patient, the carer and healthcare resources. A treatment that can preserve the patients’ functional ability will prolong their independence, and therefore reduce the burden on the caregiver. There are several contributing factors to caregiver burden, not least of which is time spent by the caregiver supervising and assisting a patient. Caregiver time, together with the use of hospital and physician services, forms a large part of resource utilization, which accounts for most of the economic cost of AD. Professor Winblad also highlighted other key aspects of AD such as behavioural and psychological symptoms, which can cause considerable distress to caregivers. As our understanding of the biochemical and pathological disturbances of AD grows, so does the number of dif-" @default.
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• W2034506225 title "New Millennium: New Expectations for Alzheimer’s Disease?" @default.
• W2034506225 doi "https://doi.org/10.1159/000051225" @default.
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