The Evidence for Long-Term Benefits in the Treatment of Dementia

Serge Gauthier, MCSA Alzheimer's Disease Research Unit, MCSA Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, Verdun, QC, Canada

Alzheimer’s disease (AD), vascular dementia (VaD), or mixed presentations of the two are the most common forms of dementia; all have a progressive and deteriorating course, which can last anything up to 10 years. In treating all of these severe neurodegenerative conditions, the aim is to stabilize cognitive and behavioral symptoms, and allow patients to live safely and independently for as long as possible.

Galantamine is a novel treatment for dementia with a dual mode of action. Pivotal phase III studies have confirmed the substantial short-term benefits of galantamine in the treatment of AD, VaD and mixed dementia, and, through open-label extensions to these pivotal studies, provide valuable evidence for the long-term benefits of galantamine treatment.

A long-term, open-label extension study in patients with mild-to-moderate AD has shown that galantamine 24 mg/day can maintain baseline levels of cognition for at least 4 years, with many patients showing an early improvement in cognitive function, as measured by ADAS-Cog. A separate, long-term extension study also demonstrated that galantamine can reduce the severity of, or prevent the emergence of, many of the commonly encountered behavioral symptoms associated with AD.

A 6-month, double-blind study in patients with VaD or mixed dementia has confirmed that galantamine can also enhance cognition, activities of daily living, global function and behavior compared with placebo. Long-term, open-label extensions of this study show that galantamine 24 mg/day can prevent a deterioration in behavior over 12 months, and maintain cognition at or above baseline for at least 2 years in many patients.
Treatment with galantamine for up to 4 years has been well tolerated in these elderly patients. The incidence of cholinergic adverse events associated with galantamine treatment has been low.

Long-term studies with galantamine in the most common forms of dementia have therefore demonstrated that the treatment offers broad and sustained clinical benefits. Many patients who would deteriorate rapidly without treatment can now be maintained at or above their own baselines with galantamine, providing a clear incentive for early initiation of treatment and a robust rationale for its long-term use.