Impact Of Rivastigmine And Memantine Alone Or Combined On Caregiver Burden Associated With Mild-to-moderate Alzheimer’s Disease

Objective: 1. Analysis of the correlation between the function of Alzheimer’s patients and the main caregiver burden associated with Alzheimer’s patients. 2. Observation the curative effect of rivastigmine and memantine alone or combined on mild-to-moderate Alzheimer’s patients and the influence of the caregiver burden associated with Alzheimer’s Disease(AD).Methods: This is a random, evaluator blind, prospective control study. Choose105 newly diagnosed AD patients as the research object, who come from Sichuan province people’s hospital of neurology and psychosomatic medicine outpatient and/or hospitalization in April 2014- December 2015, and met inclusion and exclusion criteria of Alzheimer’s patients and their caregiver.According to the principle of randomized study object, the patients were divided into memantine group, rivastigmine group, and combination group.Drug delivery methods: three stages: Screening stage, dose drop regularly and dose of maintenance period. The starting dose of memantine is 5mg/d, taking in the morning. Then added to 10mg/d in the second week, taking in the morning and evening twice a day. After that, added to 15mg/d in the third week,10 mg in the morning and the evening 5 mg. By the fourth week, dose is 20mg/d, taking in the morning and evening twice a day. The starting dose of rivastigmine is5mg/d, points taking twice in the morning and evening and with food. Without obvious adverse reaction or with good tolerance, then increase total daily dose3 mg/d every 2 weeks, maximum dose of 12 mg/d, taking in the morning and evening twice a day. During the titration process of dose, if patients with adverse reactions, we should adjust the dose for the original dose; if still cannot tolerate or with very serious adverse reactions, patients should be stopped the treatment and out of the treatment group. Evaluation method of curative effect:a mini-mental state examination(MMSE), Activity of Daily Living Scale(ADL), Alzheimer’s disease assessment scale-cognitive section(ADAS- cog),Neuropsychiatric inventory(NPI), Zarit Caregiver Burden Interview(ZBI)were used to evaluated patients and their caregiver at the 0th, 12 th, 24 th week respectively. Use score of each scale as evaluation indexes. Results:1.Comparing the baseline score of MMSE, ADL, ADAS-cog, NPI, ZBI and the patients’ age, duration, sex ratio of the three groups, there were no statistically significant difference(p>0.05). 2.Analyzing correlation use the scale data at the0 th week, the following results are obtained: The score of ZBI is correlated with ADL, ADAS-cog(r=0.498, P<0.001;r=0.543, P<0.001), significantly associated with NPI score(r=0.553,P<0.001).Analyzing correlation between each score of NPI and the score of ZBI, we can conclude the following results:behavior and mental symptoms(BPSD), such as delusion, illusion, the movement of the abnormal behavior, abnormal movement at night, vehement attack was associated with a significant burden on caregiver burden, and emotional indifference, disinhibition, elation had no significant correlation. After treatment, the MMSE score of three groups of patients was increased, the ADL,ADAS-cog, NPI, ZBI score is down before treatment. The MMSE, ADL,ADAS- cog, NPI, ZBI score of the three groups from baseline data at 24 weeks after treatment is improved significantly, the difference has statistical significance(p < 0.05). Compared the difference of MMSE, ADL, ADAS cog,NPI, ZBI score at the 24 th week after treatment between the baseline before treatment within the three groups, we find that: there was no statistically significant difference between memantine group and rivastigmine group(p>0.05), the improving score of each scale in the combination group was significantly superior to the simple medicine group, and the NPI and ZBI score improved significantly. Conclusion: memantine and rivastigmine alone or combined can improve the daily life ability, cognitive function,neural mental symptoms and the caregiver burden of patients with mild-to-moderate AD.Combination is better to improve the function of the patients condition and caregiver burden, especially in improving the caregiver burden associated with neuropsychological symptoms in patients. So according to the manifestation of patients, clinical reasonable individualized, the choice of targeted drugs scheme is beneficial to alleviate caregiver burden.