Cholinesterase inhibitors (CI) remain the only drugs with a recognized efficacy in mild to moderate Alzheimer's disease (AD) in spite of enormous research efforts. However, these drugs presented as "symptomatic treatment" of AD are considered as having only a weak effect on the course of AD. The reimbursement of these drugs is regularly challenged due to the lack of evidence for the impact of these drugs on milestones stages of AD evolution (survival without severe dementia, restriction in Basic Activities of Daily Living - BADL) and on major consequences in public health (hospitalization and institutionalization). The great majority of previous randomized controlled trials conducted with CI have had a too short duration and the end points were limited to cognition (ADAS Cog scale), IADL (Instrumental Activities of Daily Living) function and Global Impression of Change. New evidences from the DOMINO trial (1) conducted in UK, independently of the pharmaceutical industry, showed that the true effect of CI might be more to avoid or to delay the cognitive or functional decline in AD than to improve patients; the institutionalisation (2) was also delayed. However, this trial was conducted in patients with moderate to severe AD, and the interest of the drugs at the mild to moderate stage remains questionable. The investigators have shown that a good surrogate marker of survival without severe dementia would be an increase of ADAS Cog scale of more than six points (3). A post hoc reanalysis of the pivotal RCT with two CI showed that in mild to moderate patients, CI was associated with a 15% decrease of patients with a deterioration of ADAS-Cog of more than six points in six months. Thus at the beginning of dementia the real effect of CI might be more of delaying the cognitive and functional decline, than to improve the patients. The main objective of the SOS trial is to demonstrate that the benefit of CI at the early phase of dementia is the same as at the later phase.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
1,205
The choice of the treatment will be done by the specialist according to his habits; the specialist will monitor the treatment as usual. All the recruited patients will be treated by CI according to the recommendations of the French HAS and the clinician's habits to choose the type of CI and adjust the dosage. After a 6-month period under CI treatment, patients will be classified according to the evolution of the Mini Mental State Examination (MMSE) as "non-responders" or responders. Responders patients will continue their treatment according to the habits of the clinician. Non-responder patients will be included in the RCT, with individual randomization in two groups: one group who stops the CI, one group who continues the CI. All randomized patients will then be followed-up for two years with regular assessment of judgment criteria every 6 months.
CHU d'Amiens Centre Mémoire Ressources Recherche
Amiens, France
CHU d'Angers Centre Mémoire Ressources Recherche
Angers, France
CHU de Bastia Centre Mémoire Ressources Recherche
Bastia, France
CHU de Besançon Centre Mémoire Ressources Recherche
Besançon, France
CHU de Bordeaux - Service de Neurologie - Centre Mémoire Ressources Recherche -
Bordeaux, France
The primary outcome is a combination of complete BADL dependency in bathing and dressing and/or institutionalization or death at 2 years after randomization.
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information. Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status. For dependency in bathing and dressing, although it could be considered as less objective, we choose a level of total dependency, easy to assess with very low risk of misinterpretation.
Time frame: at 30 months after patient's inclusion
BADL dependency will be evaluated by the clinician using the BADL scale from Katz [17].
Each of the components of the combined primary outcome, as defined above, analyzed separately. As previously demonstrated, bathing and dressing are the first ADL losses, also defined by Katz et al. as the thresholds of disability \[17\] \[18\]. A total limitation in bathing and dressing will be considered (each item is coded from 0 - no limitation, to 2 - total limitation).
Time frame: at inclusion
BADL dependency will be evaluated by the clinician using the BADL scale from Katz [17].
Each of the components of the combined primary outcome, as defined above, analyzed separately. As previously demonstrated, bathing and dressing are the first ADL losses, also defined by Katz et al. as the thresholds of disability \[17\] \[18\]. A total limitation in bathing and dressing will be considered (each item is coded from 0 - no limitation, to 2 - total limitation).
Time frame: at 6 months
BADL dependency will be evaluated by the clinician using the BADL scale from Katz [17].
Each of the components of the combined primary outcome, as defined above, analyzed separately As previously demonstrated, bathing and dressing are the first ADL losses, also defined by Katz et al. as the thresholds of disability \[17\] \[18\]. A total limitation in bathing and dressing will be considered (each item is coded from 0 - no limitation, to 2 - total limitation).
Time frame: at 12 months
BADL dependency will be evaluated by the clinician using the BADL scale from Katz [17].
Each of the components of the combined primary outcome, as defined above, analyzed separately As previously demonstrated, bathing and dressing are the first ADL losses, also defined by Katz et al. as the thresholds of disability \[17\] \[18\]. A total limitation in bathing and dressing will be considered (each item is coded from 0 - no limitation, to 2 - total limitation).
Time frame: at 18 months
BADL dependency will be evaluated by the clinician using the BADL scale from Katz [17].
Each of the components of the combined primary outcome, as defined above, analyzed separately As previously demonstrated, bathing and dressing are the first ADL losses, also defined by Katz et al. as the thresholds of disability \[17\] \[18\]. A total limitation in bathing and dressing will be considered (each item is coded from 0 - no limitation, to 2 - total limitation).
Time frame: at 24 months
BADL dependency will be evaluated by the clinician using the BADL scale from Katz [17].
Each of the components of the combined primary outcome, as defined above, analyzed separately As previously demonstrated, bathing and dressing are the first ADL losses, also defined by Katz et al. as the thresholds of disability \[17\] \[18\]. A total limitation in bathing and dressing will be considered (each item is coded from 0 - no limitation, to 2 - total limitation).
Time frame: at 30 months
Combination of complete BADL dependency in bathing and dressing and/or institutionalization or death
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information. Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status. For dependency in bathing and dressing, although it could be considered as less objective, we choose a level of total dependency, easy to assess with very low risk of misinterpretation.
Time frame: at inclusion
Combination of complete BADL dependency in bathing and dressing and/or institutionalization or death
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information. Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status. For dependency in bathing and dressing, although it could be considered as less objective, we choose a level of total dependency, easy to assess with very low risk of misinterpretation.
Time frame: at 6 months
Combination of complete BADL dependency in bathing and dressing and/or institutionalization or death
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information. Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status. For dependency in bathing and dressing, although it could be considered as less objective, we choose a level of total dependency, easy to assess with very low risk of misinterpretation.
Time frame: at 12 months
Combination of complete BADL dependency in bathing and dressing and/or institutionalization or death
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information. Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status. For dependency in bathing and dressing, although it could be considered as less objective, we choose a level of total dependency, easy to assess with very low risk of misinterpretation.
Time frame: at 18 months
Combination of complete BADL dependency in bathing and dressing and/or institutionalization or death
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information. Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status. For dependency in bathing and dressing, although it could be considered as less objective, we choose a level of total dependency, easy to assess with very low risk of misinterpretation.
Time frame: at 24 months
Combination of complete BADL dependency in bathing and dressing and/or institutionalization or death
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information. Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status. For dependency in bathing and dressing, although it could be considered as less objective, we choose a level of total dependency, easy to assess with very low risk of misinterpretation.
Time frame: at 30 months
Institutionalization with date of entry
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information.
Time frame: at inclusion
Institutionalization with date of entry
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information.
Time frame: at 6 months
Institutionalization with date of entry
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information.
Time frame: at 12 months
Institutionalization with date of entry
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information.
Time frame: at 18 months
Institutionalization with date of entry
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information.
Time frame: at 24 months
Institutionalization with date of entry
Institutionalization with date of entry will be assessed by specialist at each follow-up time every 6 months. For patients not coming to the memory consultation, caregiver (formal and/or informal) and/or the general practitioner will be systematically contacted to obtain the information.
Time frame: at 30 months
Death and date of death
Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status.
Time frame: at inclusion
Death and date of death
Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status.
Time frame: at 6 months
Death and date of death
Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status.
Time frame: at 12 months
Death and date of death
Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status.
Time frame: at 18 months
Death and date of death
Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status.
Time frame: at 24 months
Death and date of death
Death and date of death will be assessed by contacting proxy or general practitioner. In case of lack of information the birth City Hall will be contacted to assess the vital status.
Time frame: at 30 months
the ADL scale
ADL DE KATZ BATHING :└-┘/2 0 bathes self completely 1. needs help in bathing only one part of the body 2. needs help with bathing more than one part of the body or not bathed DRESSING :└-┘ /2 0 gets clothes and gets completely dressed without assistance 1 gets clothes and gets dressed without assistance, except for assistance in tying shoes 2 receives assistance in getting clothes or in getting dressed, or stays partly or completely undressed TOILETING :└-┘/2 0 toileting without assistance (may use cane, walker, or wheelchair) 1 receives assistance 2 doesn't go to room termed " toilet ". TRANSFER:└-┘/2 0 transfer without assistance (may be using cane or walker) 1. transfer with assistance 2. doesn't get out of bed. FEEDING :└-┘/2 0 feeding without help 1. need help cutting meat or buttering bread 2. needs total help or requires parenteral feeding. TOTAL : └-┴-┘/10 If the patient has a result of 2 at bathing and or dressing he can't be included at T0.
Time frame: at inclusion
the ADL scale
ADL DE KATZ BATHING :└-┘/2 0 bathes self completely 1. needs help in bathing only one part of the body 2. needs help with bathing more than one part of the body or not bathed DRESSING :└-┘ /2 0 gets clothes and gets completely dressed without assistance 1 gets clothes and gets dressed without assistance, except for assistance in tying shoes 2 receives assistance in getting clothes or in getting dressed, or stays partly or completely undressed TOILETING :└-┘/2 0 toileting without assistance (may use cane, walker, or wheelchair) 1 receives assistance 2 doesn't go to room termed " toilet ". TRANSFER:└-┘/2 0 transfer without assistance (may be using cane or walker) 1. transfer with assistance 2. doesn't get out of bed. FEEDING :└-┘/2 0 feeding without help 1. need help cutting meat or buttering bread 2. needs total help or requires parenteral feeding. TOTAL : └-┴-┘/10 If the patient has a result of 2 at bathing and or dressing he can't be randomized at T6M
Time frame: at 6 months
the ADL scale
ADL DE KATZ BATHING :└-┘/2 0 bathes self completely 1. needs help in bathing only one part of the body 2. needs help with bathing more than one part of the body or not bathed DRESSING :└-┘ /2 0 gets clothes and gets completely dressed without assistance 1 gets clothes and gets dressed without assistance, except for assistance in tying shoes 2 receives assistance in getting clothes or in getting dressed, or stays partly or completely undressed TOILETING :└-┘/2 0 toileting without assistance (may use cane, walker, or wheelchair) 1 receives assistance 2 doesn't go to room termed " toilet ". TRANSFER:└-┘/2 0 transfer without assistance (may be using cane or walker) 1. transfer with assistance 2. doesn't get out of bed. FEEDING :└-┘/2 0 feeding without help 1. need help cutting meat or buttering bread 2. needs total help or requires parenteral feeding. TOTAL : └-┴-┘/10
Time frame: at 12 months
the ADL scale
ADL DE KATZ BATHING :└-┘/2 0 bathes self completely 1. needs help in bathing only one part of the body 2. needs help with bathing more than one part of the body or not bathed DRESSING :└-┘ /2 0 gets clothes and gets completely dressed without assistance 1 gets clothes and gets dressed without assistance, except for assistance in tying shoes 2 receives assistance in getting clothes or in getting dressed, or stays partly or completely undressed TOILETING :└-┘/2 0 toileting without assistance (may use cane, walker, or wheelchair) 1 receives assistance 2 doesn't go to room termed " toilet ". TRANSFER:└-┘/2 0 transfer without assistance (may be using cane or walker) 1. transfer with assistance 2. doesn't get out of bed. FEEDING :└-┘/2 0 feeding without help 1. need help cutting meat or buttering bread 2. needs total help or requires parenteral feeding. TOTAL : └-┴-┘/10
Time frame: at 18 months
the ADL scale
ADL DE KATZ BATHING :└-┘/2 0 bathes self completely 1. needs help in bathing only one part of the body 2. needs help with bathing more than one part of the body or not bathed DRESSING :└-┘ /2 0 gets clothes and gets completely dressed without assistance 1 gets clothes and gets dressed without assistance, except for assistance in tying shoes 2 receives assistance in getting clothes or in getting dressed, or stays partly or completely undressed TOILETING :└-┘/2 0 toileting without assistance (may use cane, walker, or wheelchair) 1 receives assistance 2 doesn't go to room termed " toilet ". TRANSFER:└-┘/2 0 transfer without assistance (may be using cane or walker) 1. transfer with assistance 2. doesn't get out of bed. FEEDING :└-┘/2 0 feeding without help 1. need help cutting meat or buttering bread 2. needs total help or requires parenteral feeding. TOTAL : └-┴-┘/10
Time frame: at 24 months
the ADL scale
ADL DE KATZ BATHING :└-┘/2 0 bathes self completely 1. needs help in bathing only one part of the body 2. needs help with bathing more than one part of the body or not bathed DRESSING :└-┘ /2 0 gets clothes and gets completely dressed without assistance 1 gets clothes and gets dressed without assistance, except for assistance in tying shoes 2 receives assistance in getting clothes or in getting dressed, or stays partly or completely undressed TOILETING :└-┘/2 0 toileting without assistance (may use cane, walker, or wheelchair) 1 receives assistance 2 doesn't go to room termed " toilet ". TRANSFER:└-┘/2 0 transfer without assistance (may be using cane or walker) 1. transfer with assistance 2. doesn't get out of bed. FEEDING :└-┘/2 0 feeding without help 1. need help cutting meat or buttering bread 2. needs total help or requires parenteral feeding. TOTAL : └-┴-┘/10
Time frame: at 30 months
the MMSE score
The MMSE score will be assessed by the clinician, the psychologist or the speech therapist according to the habits of the center, using the French version of the MMSE (GRECO version)
Time frame: at inclusion
the MMSE score
The MMSE score will be assessed by the clinician, the psychologist or the speech therapist according to the habits of the center, using the French version of the MMSE (GRECO version)
Time frame: at 6 months
the MMSE score
The MMSE score will be assessed by the clinician, the psychologist or the speech therapist according to the habits of the center, using the French version of the MMSE (GRECO version)
Time frame: at 12 months
the MMSE score
The MMSE score will be assessed by the clinician, the psychologist or the speech therapist according to the habits of the center, using the French version of the MMSE (GRECO version)
Time frame: at 18 months
the MMSE score
The MMSE score will be assessed by the clinician, the psychologist or the speech therapist according to the habits of the center, using the French version of the MMSE (GRECO version)
Time frame: at 24 months
the MMSE score
The MMSE score will be assessed by the clinician, the psychologist or the speech therapist according to the habits of the center, using the French version of the MMSE (GRECO version)
Time frame: at 30 months
the number of hospitalizations
The number of hospitalizations will be assessed using standardized questionnaire, with date (month/year) and duration of hospitalization;
Time frame: at inclusion
the number of hospitalizations
The number of hospitalizations will be assessed using standardized questionnaire, with date (month/year) and duration of hospitalization;
Time frame: at 6 months
the number of hospitalizations
The number of hospitalizations will be assessed using standardized questionnaire, with date (month/year) and duration of hospitalization;
Time frame: at 12 months
the number of hospitalizations
The number of hospitalizations will be assessed using standardized questionnaire, with date (month/year) and duration of hospitalization;
Time frame: at 18 months
the number of hospitalizations
The number of hospitalizations will be assessed using standardized questionnaire, with date (month/year) and duration of hospitalization;
Time frame: at 24 months
the number of hospitalizations
The number of hospitalizations will be assessed using standardized questionnaire, with date (month/year) and duration of hospitalization;
Time frame: at 30 months
Pharmacologie treatments consumed by the patient
All the pharmacologie treatments consumed by the patient will be assessed, allowing to assess psychotropic drug consumption.
Time frame: at inclusion
Pharmacologie treatments consumed by the patient
All the pharmacologie treatments consumed by the patient will be assessed, allowing to assess psychotropic drug consumption.
Time frame: at 6 months
Pharmacologie treatments consumed by the patient
All the pharmacologie treatments consumed by the patient will be assessed, allowing to assess psychotropic drug consumption.
Time frame: at 12 months
Pharmacologie treatments consumed by the patient
All the pharmacologie treatments consumed by the patient will be assessed, allowing to assess psychotropic drug consumption.
Time frame: at 18 months
Pharmacologie treatments consumed by the patient
All the pharmacologie treatments consumed by the patient will be assessed, allowing to assess psychotropic drug consumption.
Time frame: at 24 months
Pharmacologie treatments consumed by the patient
All the pharmacologie treatments consumed by the patient will be assessed, allowing to assess psychotropic drug consumption.
Time frame: at 30 months
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