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Table 6 Outcomes of dementia/Alzheimer’s disease

From: Clinical Effectiveness of Muscarinic Receptor-Targeted Interventions in Neuropsychiatric Disorders: A Systematic Review

Lead author, year

Study design

Interventions and comparator (dose/route of administration)

Adverse effects

Main outcome measures

Key findings

Retention rate (%)

Bodick (1997) [99]

6-month, randomised, double-blind, placebo- controlled, parallel-group trial

Intervention:

Xanomeline Tartrate

25 mg (TID)

50 mg (TID)

75 mg (TID)

Oral,

24 weeks

Control: placebo

Syncope, nausea, vomiting, increased salivation, increased diaphoresis, mild to moderate increase in hepatic and biliary transaminase enzyme

ADAS-Cog

CIBIC+,

ADSS,

NOSGER

Xanomeline at highest dose of 75 mg significantly improved CIBIC+ (p = 0.01), NOSGER score (p = 0.03)

In ADSS score, higher improvement (p < 0.002) was evident for vocal outbursts, suspiciousness, delusions, agitations and hallucinations

No significant improvement was observed in ADAS-cog scale compared to placebo

<30

Bruno (1986) [101]

Double blind, placebo controlled, randomised

Intervention:

RS-86

Started at 0.5 mg/day

Titrated up to 5

mg/day

Maximum mean dose/day=4.6 mg

(4–5 mg)

4 times a day

8 days

oral

Control: placebo

Washout: 5 days

Diaphoresis, hypersalivation

Neuropsychological tests

Story recall for immediate memory

Word learning

Dichotic listening

Visual form of discrimination test

Pictorial memory

Recurring figures

Reaction time

No significant difference between RS-86 and placebo in any of the tasks

100

Hollander (1987) [100]

Double blind, cross-over, randomised, placebo-controlled

Intervention:

RS-86

Dose varies between patients till

Maximum tolerated

Dose range = 0.75–1.5 mg

Oral,

2 weeks

Control: placebo

Chills, excessive sweating, flushing, depressed mood, prolongation of P-R interval on EKG, tremor, hypersalivation, and confusion

Cognitive and noncognitive symptoms using ADAS

No statistical significance difference was observed in any of the ADAS symptomatic subscales

80

3 patients dropped out due to severe adverse events (syncope, abdominal distress, seizure)

Thal (2000) [102]

Multisite 6-month, randomised, double-blind, placebo-controlled, parallel group trial

Intervention:

Lu 25-109

25 mg (TID)

50 mg (TID)

100 mg (TID)

oral

24 weeks

Control: placebo

Dizziness, nausea, diarrhoea, fatigue, sweating, anorexia, increased salivation, vomiting, loss of weight, and asthenia

ADAS-Cog

ADCS-ADL

BEHAVE-AD

No significant differences in any of the outcome measures compared with placebo

61

Higher discontinuation rate in high dose group due to adverse effects

Veroff (1998) [98]

Multisite 6-month, randomized, double-blind, placebo- controlled, parallel-group trial

Intervention:

xanomeline tartrate

25 mg (TID)

50 mg (TID)

75 mg (TID)

Oral,

24 weeks

Control: placebo

Not reported

CNTB

ADAS

Xanomeline significantly improved CNTB summary score (p < 0.05), but not ADAS

61

  1. AD Alzheimer’s Disease, ADAS-Cog The Alzheimer's Disease Assessment Scale-Cognitive subscale, ADCS-ADL AD in basic and instrumental activities of daily living, ADSS AD symptomatology scale, BEHAVE-AD Behavioural Pathology in AD Rating Scale, CIBIC+ AD Cooperative Study-Clinical Global Impression of Change, CNTB Computerised Neuropsychological Test Battery, NOSGER Nurses' Observation Scale for Geriatric Patients