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Overview of Methodologic Issues for Pharmacologic Trials in Mild, Moderate, and Severe Alzheimer's Disease

Published online by Cambridge University Press:  07 January 2005

Barry Reisberg
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Emile H. Franssen
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Maciej Bobinski
Affiliation:
Institute for Basic Research in Developmental Disabilities, Staten Island, New York.
Stefanie Auer
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Isabel Monteiro
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Istvan Boksay
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Jerzy Wegiel
Affiliation:
Institute for Basic Research in Developmental Disabilities, Staten Island, New York.
Emma Shulman
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Gertrude Steinberg
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Liduïn E. M. Souren
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Alan Kluger
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Carol Torossian
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Elia Sinaiko
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York
Henry M. Wisniewski
Affiliation:
Institute for Basic Research in Developmental Disabilities, Staten Island, New York.
Steven H. Ferris
Affiliation:
Aging and Dementia Research Center, New York University Medical Center, New York, New York

Abstract

To address the issue of mild, moderate, and severe Alzheimer's disease (AD), it is necessary to initially establish some agreement on terminology. In recent decades, these terms have frequently been defined using screening instrument scores with measures such as the Mini-Menal State Examination (MMSE). There are many problems with this approach, perhaps the most salient of which is that it has contributed to the total and tragic neglect of patients with severe AD. An alternative approach to the classification of AD severity is staging. This approach has advanced to the point where moderately severe and severe AD can be described in detail. Procedures for describing this previously neglected latter portion of AD have recently been extensively validated. Staging is also uniquely useful at the other end of the severity spectrum, in differentiating early aging brain/behavior changes, incipient AD, and mild AD. Temporally, with staging procedures, it is possible to track the course of AD approximately three times more accurately than with the MMSE. The net result of the advances in AD delineation is that issues such as prophylaxis, modification of course, treatment of behavioral distrubances, loss of ambulation, progressive rigidity, and the development of contractures in AD patients can now be addressed in a scientifically meaningful way that will hopefully bestow much benefit in AD patients and those who care for them.

Type
Other
Copyright
© 1996 International Psychogeriatric Association

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