Abstract
Despite three decades of intensive research, the efforts of scientific society and industry and the expenditures, numerous attempts to develop effective treatments for Alzheimer's disease have failed. Currently, approved and widely used medications to treat cognitive deficits in Alzheimer's disease are symptomatic only and show at best modest efficacy. In this context, the need to develop a successful, disease-modifying treatment is loudly expressed. One way to achieve this goal is the use of add-on therapies or various combinations of existing ‘conventional’ drugs. Results of several clinical studies and post hoc analyses of combination therapy with all cholinesterase inhibitors and memantine are published. Moreover, there is a need for studies on long-term efficacy of combination therapy in Alzheimer's.
Papers of special note have been highlighted as: • of interest; •• of considerable interest
References
- 1 A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 382(9902), 1405–1412 (2013).• Demonstrates that the prevalence of dementia is decreasing in the developed countries.
- 2 . Epidemiology of dementias and Alzheimer's disease. Arch. Med. Res. 43(8), 600–608 (2012).
- 3 . The coming crisis: obtaining care for the growing burden of neurodegenerative conditions. Neurology 80(21), 1989–1996 (2013).
- 4 Comparison of informal care time and costs in different age-related dementias: a review. Biomed. Res. Int. 2013, 852368 (2013).
- 5 . Caregivers of Alzheimer's patients and factors influencing institutionalization of loved ones: some considerations on existing literature. Ann. Ig. 25(3), 235–246 (2013).
- 6 . Multivariate models of subjective caregiver burden in dementia: a systematic review. Ageing Res. Rev. 15, 76–93 (2014).
- 7 . Does pharmacological treatment of neuropsychiatric symptoms in Alzheimer's disease relieve caregiver burden? Drugs Aging 29(3), 167–179 (2012).
- 8 . Economic evaluation of treatment options in patients with Alzheimer's disease: a systematic review of cost-effectiveness analyses. Drugs 72(6), 789–802 (2012).
- 9 . Late-onset Alzheimer's disease genes and the potentially implicated pathways. Curr. Genet. Med. Rep. 2, 85–101 (2014).
- 10 . Alzheimer's disease risk genes and mechanisms of disease pathogenesis. Biol. Psychiatry. 77(1), 43–51 (2015).
- 11 Effects of multiple genetic loci on age at onset in late-onset alzheimer disease: a genome-wide association study. JAMA Neurol. 71(11), 1394–1404 (2014).
- 12 APOE genotype and neuroimaging markers of Alzheimer's disease: systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatry 86(2), 127–134 (2015).
- 13 Plasma and cerebrospinal fluid amyloid beta for the diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst. Rev. 6, CD008782 (2014).
- 14 . Alzheimer's disease – recent biomarker developments in relation to updated diagnostic criteria. Clin. Chim. Acta.
doi:10.1016/j.cca.2015.01.041 (2015) (Epub ahead of print).• Summarizes recent Alzheimer's disease biomarker developments in relation to updated diagnostic criteria. - 15 Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7(3), 280–292 (2011).
- 16 The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7(3), 270–279 (2011).
- 17 The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7(3), 263–269 (2011).•• Newest diagnostic guidelines of Alzheimer's disease.
- 18 Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 6(8), 734–746 (2007).
- 19 Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurol. 13(6), 614–629 (2014).•• Newest diagnostic criteria of Alzheimer's disease.
- 20 . Therapeutics of Alzheimer's disease: past, present and future. Neuropharmacology 76(Pt A), 27–50 (2014).
- 21 . Alzheimer's disease drug-development pipeline: few candidates, frequent failures. Alzheimers Res. Ther. 6(4), 37 (2014).
- 22 . Amyloid-based immunotherapy for Alzheimer's disease in the time of prevention trials: the way forward. Expert Rev. Clin. Immunol. 10(3), 405–419 (2014).
- 23 Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis. J. Alzheimers Dis. 41(2), 615–631 (2014).
- 24 Correlation of Alzheimer disease neuropathologic changes with cognitive status: a review of the literature. J. Neuropathol. Exp. Neurol. 71(5), 362–381 (2012).
- 25 . Glutamate system, amyloid ß peptides and tau protein: functional interrelationships and relevance to Alzheimer disease pathology. J. Psychiatry Neurosci. 38(1), 6–23 (2013).
- 26 . The intersection of amyloid β and tau in glutamatergic synaptic dysfunction and collapse in Alzheimer's disease. Ageing Res. Rev. 12(3), 757–763 (2013).
- 27 . The intersection of amyloid beta and tau at synapses in Alzheimer's disease. Neuron 82(4), 756–771 (2014).
- 28 Changes in CSF acetyl- and butyrylcholinesterase activity after long-term treatment with AChE inhibitors in Alzheimer's disease. Acta Neurol. Scand. 124(2), 122–129 (2011).
- 29 . Pharmacodynamics of cholinesterase inhibitors suggests add-on therapy with a low-dose carbamylating inhibitor in patients on long-term treatment with rapidly reversible inhibitors. J. Alzheimers Dis. 39(2), 423–440 (2014).
- 30 Clinical trials and late-stage drug development for Alzheimer's disease: an appraisal from 1984 to 2014. J. Intern. Med. 275(3), 251–283 (2014).
- 31 . Pharmacological management of behavioral symptoms associated with dementia. World J. Psychiatry 4(4), 72–79 (2014).
- 32 . Combination treatments in Alzheimer's disease: risks and benefits. Expert Rev. Neurother. 10(5), 693–702 (2010).
- 33 . Rationale for combining glutamatergic and cholinergic approaches in the symptomatic treatment of Alzheimer's disease. Expert Rev. Neurother. 12(11), 1351–1365 (2012).
- 34 . Benefits of combined cholinesterase inhibitor and memantine treatment in moderate-severe Alzheimer's disease. Alzheimers Dement. 9(3), 326–331 (2013).
- 35 . Memantine and cholinesterase inhibitors: complementary mechanisms in the treatment of Alzheimer's disease. Neurotox. Res. 24(3), 358–369 (2013).
- 36 Potential role of the combination of galantamine and memantine to improve cognition in schizophrenia. Schizophr. Res. 157(1–3), 84–89 (2014).
- 37 . Galantamine potentiates the neuroprotective effect of memantine against NMDA-induced excitotoxicity. Brain Behav. 3(2), 67–74 (2013).
- 38 . In vitro galantamine-memantine co-application: mechanism of beneficial action. Neuropharmacology 51(7–8), 1181–1191 (2006).
- 39 . Pharmacology of acetylcholinesterase inhibitors and N-methyl-D-aspartate receptors for combination therapy in the treatment of Alzheimer's disease. J. Clin. Pharmacol. 46(7 Suppl. 1), 8S–16S (2006).
- 40 . No interaction of memantine with acetylcholinesterase inhibitors approved for clinical use. Life Sci. 66(12), 1079–1083 (2000).
- 41 . Tolerability of memantine in combination with cholinesterase inhibitors in dementia therapy. Int. Clin. Psychopharmacol. 18(2), 81–85 (2003).
- 42 . Lack of pharmacokinetic or pharmacodynamic interaction between memantine and donepezil. Ann. Pharmacother. 38(9), 1389–1394 (2004).
- 43 . Clinical effectiveness of rivastigmine monotherapy and combination therapy in Alzheimer's patients. CNS Neurosci. Ther. 19(2), 91–97 (2013).
- 44 . Pharmacodynamic, pharmacokinetic and pharmacogenetic aspects of drugs used in the treatment of Alzheimer's disease. Clin. Pharmacokinet. 52(4), 225–241 (2013).
- 45 Comorbidity of dementia: a cross-sectional study of primary care older patients. BMC Psychiatry 14, 84 (2014).
- 46 . A claims data-based comparison of comorbidity in individuals with and without dementia. BMC Geriatr. 14, 10 (2014).
- 47 . Cardiovascular effects of drugs used to treat Alzheimer's disease. Drug Saf. 37(6), 391–395 (2014).
- 48 . Medication-related falls in the elderly: causative factors and preventive strategies. Drugs Aging 29(5), 359–376 (2012).
- 49 . Psychotropic drugs and falls in the elderly people: updated literature review and meta-analysis. J. Aging Health 23(2), 329–346 (2011).
- 50 . Effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and relevant pharmacological interventions on fall risk in elderly patients. Ther. Clin. Risk Manag. 10, 437–448 (2014).
- 51 . Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs. Ann. Pharmacother. 46(7–8), 917–928 (2012).
- 52 . The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 41(3), 299–308 (2012).
- 53 . Examining the relationship between specific cognitive processes and falls risk in older adults: a systematic review. Osteoporos. Int. 23(10), 2409–2424 (2012).
- 54 . The relationship between executive function and falls and gait abnormalities in older adults: a systematic review. Dement. Geriatr. Cogn. Disord. 36(1–2), 20–35 (2013).
- 55 Donepezil improves gait performance in older adults with mild Alzheimer's disease: a Phase II clinical trial. J. Alzheimers Dis. 43(1), 193–199 (2015).
- 56 Anti-dementia drugs and changes in gait: a pre-post quasi-experimental pilot study. BMC Neurol. 13, 184 (2013).
- 57 . Changes in gait variability with anti-dementia drugs: a systematic review and meta-analysis. CNS Drugs 28(6), 513–518 (2014).
- 58 . Medication for Alzheimer's disease and associated fall hazard: a retrospective cohort study from the Alzheimer's Disease Neuroimaging Initiative. Drugs Aging 31(2), 125–129 (2014).
- 59 . Dementia medications and risk of falls, syncope, and related adverse events: meta-analysis of randomized controlled trials. J. Am. Geriatr. Soc. 59(6), 1019–1031 (2011).
- 60 . Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: a randomized controlled trial. JAMA 291, 317–324 (2004).•• Fundamental paper on combination therapy with memantine and ChEI in the treatment of Alzheimer's disease.
- 61 . Cognitive response to memantine in moderate to severe Alzheimer disease patients already receiving donepezil: an exploratory reanalysis. Alzheimer Dis. Assoc. Disord. 20, 255–262 (2006).
- 62 . Activities of daily living in moderate-to-severe Alzheimer disease: an analysis of the treatment effects of memantine in patients receiving stable donepezil treatment. Alzheimer Dis. Assoc. Disord. 20, 263–268 (2006).
- 63 , Memantine MEM-MD-02 Study Group. A responder analysis of memantine treatment in patients with Alzheimer disease maintained on donepezil. Am. J. Geriatr. Psychiatry. 14(5), 428–437 (2006).
- 64 . Behavioral effects of memantine in Alzheimer disease patients receiving donepezil treatment. Neurology 67, 57–63 (2006).
- 65 The effects of combine treatment of memantine and donepezil on Alzheimer's disease patients and its relationship with cerebral blood flow in the prefrontal area. Int. J. Geriatr. Psychiatry 29(9), 881–889 (2014).
- 66 . P1–377 Safety, tolerability, and caregiver's impressions of combination therapy with rivastigmine and memantine for the treatment of Alzheimer's disease. Neurobiol. Aging 25(Suppl. 2), S205 (2004).
- 67 . Rivastigmine monotherapy and combination therapy with memantine in patients with moderately severe Alzheimer's disease who failed to benefit from previous cholinesterase inhibitor treatment. Int. J. Clin. Pract. 60(1), 110–118 (2006).
- 68 . Adding memantine to rivastigmine therapy in patients with mild-to-moderate alzheimer's disease: results of a 12-week, open-label pilot study. Prim. Care Companion J. Clin. Psychiatry. 8(5), 258–263 (2006).
- 69 . Domain-specific improvement of cognition on memantine in patients with Alzheimer's disease treated with rivastigmine. Dement. Geriatr. Cogn. Disord. 23(5), 301–306 (2007).
- 70 Steady-state pharmacokinetics of rivastigmine in patients with mild to moderate Alzheimer's disease not affected by co-administration of memantine: an open-label, crossover, single-centre study. Clin. Drug Investig. 28(6), 361–374 (2008).
- 71 . Safety and tolerability of rivastigmine capsule with memantine in patients with probable Alzheimer's disease: a 26-week, open-label, prospective trial (Study ENA713B US32). Int. J. Geriatr. Psychiatry. 25(4), 419–426 (2010).
- 72 . A 25-week, open-label trial investigating rivastigmine transdermal patches with concomitant memantine in mild-to-moderate Alzheimer's disease: a post hoc analysis. Curr. Med. Res. Opin. 26(2), 263–269 (2010).
- 73 Effect of rivastigmine or memantine add-on therapy is affected by butyrylcholinesterase genotype in patients with probable Alzheimer's disease. Eur. Neurol. 73(1–2), 23–28 (2015).
- 74 . Combination therapy with galantamine and memantine improves behavioral and psychological symptoms of dementia (BPSD) in patients with early-onset Alzheimer's disease. Aust. NZ J. Psychiatry 47(6), 583 (2013).
- 75 Combination therapy of cholinesterase inhibitor (donepezil or galantamine) plus memantine in the Okayama Memantine Study. J. Alzheimers Dis. 45(3), 771–780 (2015).
- 76 Clinically meaningful treatment responses after switching to galantamine and with addition of memantine in patients with Alzheimer's disease receiving donepezil. Neuropsychiatr. Dis. Treat. 9, 259–265 (2013).
- 77 The safety, tolerability, and efficacy of once-daily memantine (28 mg): a multinational, randomized, double-blind, placebo-controlled trial in patients with moderate-to-severe Alzheimer's disease taking cholinesterase inhibitors. CNS Drugs 27(6), 469–478 (2013).
- 78 Retrospective study on the benefits of combined Memantine and cholinEsterase inhibitor treatMent in AGEd Patients affected with Alzheimer's Disease: the MEMAGE study. J. Alzheimers Dis. 41(2), 633–640 (2014).
- 79 . Comparison of the efficacy of four cholinesterase inhibitors in combination with memantine for the treatment of Alzheimer's disease. Int. J. Clin. Exp. Med. 8(2), 2944–2948 (2015).
- 80 . Pharmacological modulation of cognitive and behavioral symptoms in patients with dementia due to Alzheimer's disease. J. Neurol. Sci. 336(1–2), 103–108 (2014).
- 81 A combination of galantamine and memantine modifies cognitive function in subjects with amnestic MCI. J. Nutr. Health Aging 16(6), 544–548 (2012).
- 82 Donepezil and memantine for moderate-to-severe Alzheimer's disease. N. Engl. J. Med. 366(10), 893–903 (2012).
- 83 . Efficacy and safety of donepezil 23 mg versus donepezil 10 mg for moderate-to-severe Alzheimer's disease: a subgroup analysis in patients already taking or not taking concomitant memantine. Dement. Geriatr. Cogn. Disord. 33(2–3), 164–173 (2012).
- 84 Tolerability and efficacy of memantine add-on therapy to rivastigmine transdermal patches in mild to moderate Alzheimer's disease: a multicenter, randomized, open-label, parallel-group study. Curr. Med. Res. Opin. 27(7), 1375–1383 (2011).
- 85 Response to rivastigmine transdermal patch or memantine plus rivastigmine patch is affected by apolipoprotein E genotype in Alzheimer patients. Dement. Geriatr. Cogn. Disord. 34(3–4), 167–173 (2012).
- 86 Early and differential diagnosis of dementia and mild cognitive impairment: design and cohort baseline characteristics of the German Dementia Competence Network. Dement. Geriatr. Cogn. Disord. 27(5), 404–417 (2009).
- 87 . [Use of acetylcholinesterase inhibitors and memantine in Alzheimer-type dementia]. Rev. Esp. Salud. Publica. 79(6), 665–672 (2005).
- 88 , Memantine MEM-MD-12 Study Group. Memantine treatment in patients with mild to moderate Alzheimer's disease already receiving a cholinesterase inhibitor: a randomized, double-blind, placebo-controlled trial. Curr. Alzheimer Res. 5(1), 83–89 (2008).
- 89 , Alzheimer's Disease Neuroimaging Initiative. Treatment with cholinesterase inhibitors and memantine of patients in the Alzheimer's Disease Neuroimaging Initiative. Arch. Neurol. 68(1), 58–66 (2011).
- 90 . Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database Syst. Rev. 3, CD005593 (2006).
- 91 . Memantine for dementia. Cochrane Database Syst. Rev. CD003154 (2006).
- 92 . Antidementia drug use among community-dwelling individuals with Alzheimer's disease in Finland: a nationwide register-based study. Int. Clin. Psychopharmacol. 29(4), 216–223 (2014).
- 93 Memantine therapy for Alzheimer disease in real-world practice: an observational study in a large representative sample of French patients. Alzheimer Dis. Assoc. Disord. 22(2), 125–130 (2008).
- 94 . Mild cognitive impairment and anti-Alzheimer disease medications: a cross sectional study of the French National Alzheimer Databank (BNA). J. Alzheimers Dis. 38(3), 541–549 (2014).
- 95 . Treatment practices of mild cognitive impairment in California Alzheimer's Disease Centers. J. Am. Geriatr. Soc. 57(4), 686–690 (2009).
- 96 Efficacy and safety of cognitive enhancers for patients with mild cognitive impairment: a systematic review and meta-analysis. CMAJ 185(16), 1393–1401 (2013).
- 97 DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease – a multicentre RCT. Trials 10, 57 (2009).•• Fundamental paper on combination therapy with memantine and ChEI in the treatment of Alzheimer's disease.
- 98 Effectiveness and tolerability of high-dose (23 mg/d) versus standard-dose (10 mg/d) donepezil in moderate to severe Alzheimer's disease: a 24-week, randomized, double-blind study. Clin. Ther. 32, 1234–1251 (2010).
- 99 . Long-term course and effectiveness of combination therapy in Alzheimer disease. Alzheimer. Dis. Assoc. Disord. 22, 209–221 (2008).
- 100 Long-term effects of the concomitant use of memantine with cholinesterase inhibition in Alzheimer disease. J. Neurol. Neurosurg. Psychiatry 80, 600–607 (2009).
- 101 . Combination therapy with cholinesterase inhibitors and memantine for Alzheimer's disease: a systematic review and meta-analysis. Int. J. Neuropsychopharmacol. 18(5), pii: pyu115 (2014).•• Fundamental paper on efficacy of combination therapy with memantine and ChEIs in the treatment of Alzheimer's disease.
- 102 . Validity, significance, strengths, limitations, and evidentiary value of real-world clinical data for combination therapy in Alzheimer's disease: comparison of efficacy and effectiveness studies. Neurodegener. Dis. 10(1–4), 170–174 (2012).
- 103 . A population-based study of dosing and persistence with anti-dementia medications. Eur. J. Clin. Pharmacol. 69(7), 1467–1475 (2013).
- 104 . Continuous treatment with antidementia drugs in Germany 2003–2013: a retrospective database analysis. Int. Psychogeriatr. 27(8), 1335–1342 (2015).
- 105 . Effectiveness of antidementia drugs in delaying Alzheimer's disease progression. Alzheimers Dement. 9(3), 338–345 (2013).
- 106 EFNS-ENS/EAN Guideline on concomitant use of cholinesterase inhibitors and memantine in moderate to severe Alzheimer's disease. Eur. J. Neurol. 22(6), 889–898 (2015).
- 107 Memantine in patients with Parkinson's disease dementia or dementia with Lewy bodies: a double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 8(7), 613–618 (2009).
- 108 Efficacy of memantine in PDD and DLB: an extension study including washout and open-label treatment. Int. J. Geriatr. Psychiatry 26(2), 206–213 (2011).
- 109 Memantine for patients with Parkinson's disease dementia or dementia with Lewy bodies: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 9(10), 969–977 (2010).
- 110 . Treatment effect of memantine on survival in dementia with Lewy bodies and Parkinson's disease with dementia: a prospective study. BMJ Open. 4(7), e005158 (2014).
- 111 . Cholinesterase inhibitors for dementia with Lewy bodies, Parkinson's disease dementia and cognitive impairment in Parkinson's disease. Cochrane Database Syst. Rev. 3, CD006504 (2012).
- 112 Efficacy and safety of cholinesterase inhibitors and memantine in cognitive impairment in Parkinson's disease, Parkinson's disease dementia, and dementia with Lewy bodies: systematic review with meta-analysis and trial sequential analysis. J. Neurol. Neurosurg. Psychiatry 86(2), 135–143 (2015).•• Meta-analysis on efficacy and safety of memantine and ChEIs in the treatment of Parkinson's disease, Parkinson's disease dementia and dementia with Lewy bodies.
- 113 . Donepezil in vascular dementia: combined analysis of two large-scale clinical trials. Dement. Geriatr. Cogn. Disord. 20(6), 338–344 (2005).
- 114 . Galantamine for vascular cognitive impairment. Cochrane Database Syst. Rev. 4, CD004746 (2013).
- 115 . Rivastigmine for vascular cognitive impairment. Cochrane Database Syst. Rev. 5, CD004744 (2013).
- 116 . Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomised controlled trials. Lancet Neurol. 6(9), 782–792 (2007).
- 117 . Effects of memantine and galantamine given separately or in association, on memory and hippocampal neuronal loss after transient global cerebral ischemia in gerbils. Brain Res. 1254, 128–137 (2009).
- 118 . Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimers. Res. Ther. 5(Suppl. 1), S5 (2013).
- 119 . Oxidative stress in Alzheimer's disease: why did antioxidant therapy fail? Oxid. Med. Cell. Longev. 2014, 427318 (2014).
- 120 Antioxidants for Alzheimer disease: a randomized clinical trial with cerebrospinal fluid biomarker measures. Arch. Neurol. 69(7), 836–841 (2012).
- 121 . Possibility of a new anti-alzheimer's disease pharmaceutical composition combining memantine and vitamin D. Drugs Aging 29(2), 81–91 (2012).
- 122 . Alzheimer's disease - input of vitamin D with mEmantine assay (AD-IDEA trial): study protocol for a randomized controlled trial. Trials 12, 230 (2011).
- 123 . Vitamin E for Alzheimer's dementia and mild cognitive impairment. Cochrane Database Syst. Rev. 11, CD002854 (2012).
- 124 Vitamin E and memantine in Alzheimer's disease: clinical trial methods and baseline data. Alzheimers Dement. 10(1), 36–44 (2014).
- 125 Effect of vitamin E and memantine on functional decline in Alzheimer disease: the TEAM-AD VA cooperative randomized trial. JAMA 311(1), 33–44 (2014).
- 126 Docosahexaenoic acid supplementation and cognitive decline in Alzheimer disease: a randomized trial. JAMA 304(17), 1903–1911 (2010).
- 127 . Statins for the treatment of dementia. Cochrane Database Syst. Rev. 7, CD007514 (2014).
- 128 . Nutrition and prevention of Alzheimer's dementia. Front. Aging Neurosci. 6, 282 (2014).
- 129 . Nutraceuticals: a novel concept in prevention and treatment of Alzheimer's disease and related disorders. J. Alzheimers Dis. 42(2), 357–367 (2014).
- 130 . Nutraceuticals in cognitive impairment and Alzheimer's disease. Front. Pharmacol. 5, 147 (2014).
- 131 . Nutritional supplementation for Alzheimer's disease? Curr. Opin. Psychiatry 28(2), 141–147 (2015).
- 132 Effects of Gingko biloba supplementation in Alzheimer's disease patients receiving cholinesterase inhibitors: data from the ICTUS study. Phytomedicine 21(6), 888–892 (2014).
- 133 Add-on prolonged-release melatonin for cognitive function and sleep in mild to moderate Alzheimer's disease: a 6-month, randomized, placebo-controlled, multicenter trial. Clin. Interv. Aging 9, 947–961 (2014).
- 134 . Cognitive stimulation for dementia: a systematic review of the evidence of effectiveness from randomised controlled trials. Ageing Res. Rev. 12(1), 253–262 (2013).
- 135 Cognitive and affective benefits of combination therapy with galantamine plus cognitive rehabilitation for Alzheimer's disease. Geriatr. Gerontol. Int.
doi:10.1111/ggi.12488 (2015) (Epub ahead of print). - 136 Combination benefit of cognitive rehabilitation plus donepezil for Alzheimer's disease patients. Geriatr. Gerontol. Int.
doi:10.1111/ggi.12455 (2015) (Epub ahead of print). - 137 . Addressing the challenges to successful recruitment and retention in Alzheimer's disease clinical trials. Alzheimers Res. Ther. 2(6), 34 (2010).
- 138 . Improving recruitment of older people to clinical trials: use of the cohort multiple randomised controlled trial design. Age Ageing 44(4), 547–550 (2015).
- 139 . A conceptual framework and ethics analysis for prevention trials of Alzheimer Disease. Prog. Neurobiol. 110, 114–123 (2013).
- 140 Regional variability of imaging biomarkers in autosomal dominant Alzheimer's disease. Proc. Natl Acad. Sci. USA 110(47), E4502–E4509 (2013).
- 141 Dominantly Inherited Alzheimer Network: facilitating research and clinical trials. Alzheimers Res. Ther. 5(5), 48 (2013).
- 142 Preclinical trials in autosomal dominant AD: implementation of the DIAN-TU trial. Rev. Neurol. (Paris) 169(10), 737–743 (2013).
- 143 . Integrating ADNI results into Alzheimer's disease drug development programs. Neurobiol. Aging 31(8), 1481–1492 (2010).
- 144 . Neuroimaging and other biomarkers for Alzheimer's disease: the changing landscape of early detection. Annu. Rev. Clin. Psychol. 9, 621–648 (2013).
- 145 . Molecular imaging in Alzheimer's disease: new perspectives on biomarkers for early diagnosis and drug development. Alzheimers Res. Ther. 3(6), 34 (2011).
- 146 . Imaging endpoints for clinical trials in Alzheimer's disease. Alzheimers Res. Ther. 6(9), 87 (2014).
- 147 Imaging as a biomarker in drug discovery for Alzheimer's disease: is MRI a suitable technology? Alzheimers Res. Ther. 6(4), 51 (2014).
- 148 . Multi-target design strategies in the context of Alzheimer's disease: acetylcholinesterase inhibition and NMDA receptor antagonism as the driving forces. Neurochem. Res. 39(10), 1914–1923 (2014).
- 149 Combining galantamine and memantine in multitargeted, new chemical entities potentially useful in Alzheimer's disease. J. Med. Chem. 55(22), 9708–9721 (2012).