DOMINO

Donepezil and memantine in moderate to severe Alzheimer’s disease

Which drug can help slow the progress of Alzheimer’s disease?

What was this study about?

Alzheimer’s disease is the commonest cause of dementia. There are 750,000 living with dementia today in the UK and this number is expected to rise to over 1 million by 2021. There is no cure for Alzheimer’s disease.

Some drugs can help people who have a mild or moderate form of Alzheimer’s disease. Two drugs have been used to try to slow down the progress of Alzheimer’s disease once it becomes more severe - donepezil and memantine. But doctors weren’t sure which of these worked best, so they designed a randomised controlled trial called DOMINO.

DOMINO aimed to test whether it is better to give people with moderate or severe Alzheimer’s disease donepezil or memantine - or whether both should be given at once.

People who took part in this trial had been treated with donepezil for at least 3 months and had moderate or severe Alzheimer’s disease. These people were divided into four groups:

Patients in the 1st group carried on taking donepezil
Patients in the 2nd group stopped taking donepezil
Patients in the 3rd group stopped taking donepezil and started taking memantine instead
Patients in the 4th group carried on taking donepezil, and took memantine as well.

Results

We followed what happened to people who took part in this trial for one year. We then used two tests (called the Standardized Mini–Mental State Examination and the Bristol Activities of Daily Living Scale) to check how people’s brains were working and how they coped with daily activities.

We found that donepezil worked best to slow the progress of Alzheimer’s disease. However, as with memantine, it only slowed progress – it could not stop it.

What difference did this study make?

Results of this study were published very recently, so it’s too soon to say. We hope that it will encourage doctors to prescribe donepezil to people with moderate or severe Alzheimer’s disease in future, where this is appropriate.

Type of study

Randomised trial

Contact details

mrcctu.ctuenquiries@ucl.ac.uk

Who funded the study?

The Medical Research Council and the Alzheimer’s Society.

When did it take place?

This trial opened to recruitment in February 2008 and closed to recruitment in March 2010. The results of the trial were published in March 2012.

Where did it take place?

UK.

Who was included?

295 people with moderate or severe Alzheimer’s disease.