Paper 4
Mayer M & Pulte I 2013 How safe is combination memantine/donepezil treatment in people with Alzheimers disease? Safety evaluation based on 23 clinical studies The Journal of the Alzheimers Association vol. 9 no. 4 p. 282.
In this article Mayer and Pultes purpose of study was to investigate the level of safety of using a combination of memantine and donepezil treatments in the management of Alzheimers disease. Donepezil has been widely used in many parts of the world in combination with memantine for Alzheimers disease patients and therefore the main concern of these authors was the safety of this combination on the patients. The study was based on review of data obtained from different clinical researches. Finally the results obtained from this study lead to the conclusion that the combination of memantine and donepezil is safe and does not compromise the overall health of Alzheimers disease patients. In addition the combination was found to be well tolerable by patients whether used on short term or long-term basis. This article is therefore very useful in answering my research question since it draws its evidence from many clinical studies and concentrates on establishing the safety of the combination therapy which is the core of this assignment.
Discussion (550 approx)
Compare and contrast the findings of each research paper. Ensure that your analysis explains why your research papers are relevant andhow the quality of the findings enables the stated research question to be answered. Identify any existing gaps in knowledge or practice. Discussion should be supported by additional relevant literature.
It is evident from majority of the studies that memantine and donepezil combination therapy is more effective in the alleviation of Alzheimers disease symptoms that each of the drugs used independent. Most of the articles used in this research support this claim and their findings are very viable in the effort to answer the research question. However they demonstrate some differences mainly in the research methods employed and thus the cause for the variations in their conclusions. The study samples in all the studies are similar as the authors used patients in the moderate to severe stages of Alzheimers disease. This makes them very reliable because these stages have the largest population of Alzheimers disease patients. The authors ensured that the patients population was well represent. The methodology applied varied from one study to the other. For instance in paper 1 the authors relied on analysing first hand data collected from the clinical trials carried out over a period of 24 weeks. In addition they used cognition function and global status measures to assess the efficacy of the combined therapy and this led them to the conclusion that the combined treatment is actually more efficient than a single treatment. Similarly the authors of the second article applied a systematic review and metaanalysis of randomized controlled trials on patients in the same stages of AD as the first paper. However their findings were different since they observed very minimal difference between the monotherapy and combined treatment. Although this article does not support the research question it is very useful as it gives a different t opinion on the subject prompting further research. The third article adopts a different methology as the authors rely on the review of past researches but its findings support the research question. The outcome of the forth research also supports the claim that combined treatment gives a better outcome that monotherapy. The two drugs have different mechanisms of action and this explains the improvement in effectiveness observed from the combination therapy. The two drugs have different effects on different transmitter systems with memantine mainly targeting natural neurotransmitters while donepezil selectively inhibits acetylcholinesterace (Tariot et al. 2005). Moreover the combination therapy improves the patients quality of life enabling them to sustain autonomy for a considerable period of time. In addition various studies have revealed that the safety and tolerability of the combination therapy is higher than the use of donepezil alone. Tariot et al. (2005) observed that using the two drugs together reduces the occurrence of such side effects as diarrhoea and faecalincontinence as well as constipation which are common in the independent use of either memantine or donepezil.
Conclusion (150 approx)
Summarize the major points in a synthesized non-repetitive manner clear future directions for research.
Alzheimers disease is one of the most common adult onset progressive mental disorders and has serious adverse effects on the affected patients higher cortical functions. It usually affects a persons thinking memory comprehension and orientation capacity thus affecting their day to day activities. The management of Alzheimers disease demands relatively high financial and emotional investment on the affected families and the society at large. This is because AD patients require very close attention and sometimes calling for hospitalization especially when the disease advances to severe levels. Although the established treatment options for this disease do not guarantee complete cure they go a long way in alleviating its symptoms as well as delaying disease progression thus improving the patients quality of life. Memantine and donepezil are the most widely licensed treatment options and have been found to significantly improve the condition. However their use in combination has attracted a lot of attention lately and various medical studies have found it to be more effective than when used individually. However the question of safety and tolerability of this combination therapy has attracted mixed opinions with majority of studies guaranteeing its safety and tolerability.