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DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer’s disease – a multicentre RCT


Jones, Rob, Sheehan, Bart, Phillips, Patrick, Juszczak, Ed, Adams, Jessica, Baldwin, Ashley, Ballard, Clive, Banerjee, Sube, Barber, Bob, Bentham, Peter, Brown, Richard, Burns, Alistair, Dening, Tom, Findlay, David, Gray, Richard, Griffin, Mary, Holmes, Clive, Hughes, Alan, Jacoby, Robin, Johnson, Tony, Jones, Roy, Knapp, Martin, Lindesay, James, McKeith, Ian, McShane, Rupert, Macharouthu, Ajay, O'Brien, John, Onions, Caroline, Passmore, Peter, Raftery, James, Ritchie, Craig, Howard, Rob


Trials, Volume: 10, Pages.: 57-57

Year of Publication



Background: Alzheimer’s disease (AD) is the commonest cause of dementia. Cholinesterase inhibitors, such as donepezil, are the drug class with the best evidence of efficacy, licensed for mild to moderate AD, while the glutamate antagonist memantine has been widely prescribed, often in the later stages of AD. Memantine is licensed for moderate to severe dementia in AD but is not recommended by the England and Wales National Institute for Health and Clinical Excellence. However, there is little evidence to guide clinicians as to what to prescribe as AD advances; in particular, what to do as the condition progresses from moderate to severe. Options include continuing cholinesterase inhibitors irrespective of decline, adding memantine to cholinesterase inhibitors, or prescribing memantine instead of cholinesterase inhibitors. The aim of this trial is to establish the most effective drug option for people with AD who are progressing from moderate to severe dementia despite treatment with donepezil.; Method: DOMINO-AD is a pragmatic, 15 centre, double-blind, randomized, placebo controlled trial. Patients with AD, currently living at home, receiving donepezil 10 mg daily, and with Standardized Mini-Mental State Examination (SMMSE) scores between 5 and 13 are being recruited. Each is randomized to one of four treatment options: continuation of donepezil with memantine placebo added; switch to memantine with donepezil placebo added; donepezil and memantine together; or donepezil placebo with memantine placebo. 800 participants are being recruited and treatment continues for one year. Primary outcome measures are cognition (SMMSE) and activities of daily living (Bristol Activities of Daily Living Scale). Secondary outcomes are non-cognitive dementia symptoms (Neuropsychiatric Inventory), health related quality of life (EQ-5D and DEMQOL-proxy), carer burden (General Health Questionnaire-12), cost effectiveness (using Client Service Receipt Inventory) and institutionalization. These outcomes are assessed at baseline, 6, 18, 30 and 52 weeks. All participants will be subsequently followed for 3 years by telephone interview to record institutionalization.; Discussion: There is considerable debate about the clinical and cost effectiveness of anti-dementia drugs. DOMINO-AD seeks to provide clear evidence on the best treatment strategies for those managing patients at a particularly important clinical transition point.; Trial Registration: Current controlled trials ISRCTN49545035.;

Bibtex Citation

@article{Jones_2009, doi = {10.1186/1745-6215-10-57}, url = {}, year = 2009, month = {jul}, publisher = {Springer Nature}, volume = {10}, number = {1}, author = {Rob Jones and Bart Sheehan and Patrick Phillips and Ed Juszczak and Jessica Adams and Ashley Baldwin and Clive Ballard and Sube Banerjee and Bob Barber and Peter Bentham and Richard Brown and Alistair Burns and Tom Dening and David Findlay and Richard Gray and Mary Griffin and Clive Holmes and Alan Hughes and Robin Jacoby and Tony Johnson and Roy Jones and Martin Knapp and James Lindesay and Ian McKeith and Rupert McShane and Ajay Macharouthu and John O{textquotesingle}Brien and Caroline Onions and Peter Passmore and James Raftery and Craig Ritchie and Rob Howard}, title = {{DOMINO}-{AD} protocol: donepezil and memantine in moderate to severe Alzheimer{textquotesingle}s disease {textendash} a multicentre {RCT}}, journal = {Trials} }


alzheimer disease, donezepil, dopamine agents, drug therapy, humans, indans, memantine, nootropic agents, piperidines, research design, severity of illness index, therapeutic use

Countries of Study


Types of Dementia

Alzheimer’s Disease

Types of Study

Economic evaluation, Randomised Controlled Trial

Type of Outcomes

ADLs/IADLs, Behaviour, Carer Burden (instruments measuring burden), Cognition, Quality of Life of Person With Dementia, Service use or cost reductions (incl. hospital use reduction, care home admission delay)

Type of Interventions

Pharmaceutical Interventions

Pharmaceutical Interventions

Anti-Alzheimer medications, e.g.: donezepil, galantamine, rivastigmine, memantime