Optimization of the Inclusion of Alzheimer's Disease Patients in International Multicenter Randomized Trials: Results of a National Survey Conducted in Memory Research Centers in France

Abstract

Introduction: Since 2002, with the creation of Centers of Memory Resources and Research (CMRR), considerable progress has been made in France regarding the administrative and institutional framework within which Alzheimer's disease (AD) is managed. In this study, we explore three approaches that can help optimize the inclusion of patients in clinical trials related to AD. They are as follows: to assess communication concerning clinical trials on AD in French CMRR, to analyze the internal organization of these centers concerning the dynamics of inclusion, and to evaluate screening tools used. Methods: A national, descriptive, cross-sectional survey was conducted in all CMRR in France between May 1 and July 31, 2011, using a self-administered questionnaire. All investigators, subinvestigators and the relevant CMRR personnel were involved. Results: A total of 75% of the CMRR participated, and about 30% of the physicians contacted responded positively to the survey. Only 50% reported having communicated with health care professionals at least once in the previous 3 months, and less than 50% had communicated occasionally with the general public. A total of 75% of those surveyed had a research group but only half of the groups were active, 50% of the physicians did not have a consultation time dedicated to study recruitment, and 75% of the respondents had a screening tool in their CMRR but over half of them were not satisfied with it. Conclusion: This investigation provides a basis for improving the screening of patients by both internal organizational development and adaptation of tools already available. Improvement requires promoting regular communication that is appropriate and targeted to health care professionals, smaller memory centers, associations and the public, and therefore, familiarizing the whole population with clinical research on AD.

Predictors of Rapid Cognitive Decline in Patients with Mild-to-Moderate Alzheimer Disease: A Prospective Cohort Study with 12-Month Follow-Up Performed in Memory Clinics

“…Then, preventative strategies involving home-based technologies may slow RCD [44]. Such variables constitute important parameters when clinical studies including dementia subjects are planned [45]. Anticipation of the needs of such patients could include: (1) a broader, differential diagnosis of dementia that develops within a 12-month period (such patients should consult doctors with dementia experience working in hospitals with diagnostic facilities [46]); (2) in patients with dementia caused by AD, delirium attributable to infection and toxic metabolites, and comorbidities such as stroke, depression, and misuse of drugs with adverse anticholinergic effects should be ruled out [46]; (3) current symptomatically prescribed drugs, including cholinesterase inhibitors and the N-methyl-D-aspartate receptor antagonist memantine, should be used at optimally individualised therapeutic doses; (4) rivastigmine should be considered as potentially affording additive benefits to rapid decliners [47]; (5) the combination of cholinesterase inhibitor and memantine therapy is both rational and safe, but evidence of the utility of the combination is equivocal [46]; (6) a more frequent follow-up is required to plan for the rapid loss of autonomy and the increased burden on the caregiver; and (7) as RCD patients have poor outcomes, a high disease burden, and limited treatment options, more systematic control of risk factors, particularly vascular risk factors, is needed.…”

Effectiveness of a Geriatric Emergency Medicine Unit for the Management of Neurocognitive Disorders in Older Patients: Results of the MUPACog Study

“…Readmission is often linked to hospitalization. While hospitalization provides the opportunity to treat acute pathologies, it is associated with several adverse effects including disorientation, anxiety, and incontinence, and increases the risk of dependence, particularly in patients with NCD [32-34].…”