Overview of methodologic issues for pharmacologic trials in mild, moderate, and severe Alzheimer's disease

Barry Reisberg, Emile H. Franssen, Matthew Bobinski, Stefanie Auer, Isabel Monteiro, Istvan Boksay, Jerzy Wegiel, Emma Shulman, Gertrude Steinberg, Liduïn E M Souren, Alan Kluger, Carol Torossian, Elia Sinaiko, Henry M. Wisniewski, Steven H. Ferris

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


To address the issue of mild, moderate, and severe Alzheimer's disease (AD), it is necessary to initially establish some agreement on terminology. In recent decades, these terms have frequently been defined using screening instrument scores with measures such as the Mini-Mental State Examination (MMSE). There are many problems with this approach, perhaps the most salient of which is that it has contributed to the total and tragic neglect of patients with severe AD. An alternative approach to the classification of AD severity is staging. This approach has advanced to the point where moderately severe and severe AD can be described in detail. Procedures for describing this previously neglected latter portion of AD have recently been extensively validated. Staging is also uniquely useful at the other end of the severity spectrum, ill differentiating early aging brain/behavior changes, incipient AD, and mild AD. Temporally, with staging procedures, it is possible to track the course of AD approximately three times more accurately than with the MMSE. The net result of the advances in AD delineation is that issues such as prophylaxis, modification of course, treatment of behavioral disturbances, loss of ambulation, progressive rigidity, and the development of contractures in AD patients can now be addressed in a scientifically meaningful way that will hopefully bestow much benefit in AD patients and those who care for them.

Original languageEnglish (US)
Pages (from-to)159-193
Number of pages35
JournalInternational Psychogeriatrics
Issue number2
StatePublished - 1996
Externally publishedYes

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Aging
  • Psychiatry and Mental health
  • Psychology(all)
  • Clinical Psychology


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