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Review: donepezil, metrifonate, rivastigmine, and Ginkgo biloba are more effective than placebo in Alzheimer's disease

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 QUESTION: Which drugs are most effective for adults with Alzheimer's disease (AD)?

Data sources

Studies were identified by searching Medline, CINAHL, Applied Science and Technology, Core Biomedical Collection, Core Biomedical Collection III, PsycINFO, HealthSTAR, the Cochrane Library, references of review articles, and personal files.

Study selection

Randomised controlled trials (RCTs) were selected if they were full reports published from 1986 to 1999 on drugs that were on the market or in phase III clinical trials; had a quality score ≥5 on the 8 item Jadad scale (maximum score 8); and used the US National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria to diagnose AD.

Data extraction

Data were extracted on RCT methods and duration, patients, type of drug, completion rates, adverse effects, and outcomes.

Main results

26 RCTs met the selection criteria. Donepezil: 4 RCTs compared donepezil with placebo for 12 weeks (2 RCTs) or 24 weeks (2 RCTs). A benefit on the Alzheimer Disease Assessment-cognitive subscale (ADAS-cog) was seen for donepezil, 5 mg/day, in 4 RCTs (difference in …

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