Alzheimer's Disease - Dementia

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Alzheimer's Disease - Dementia

NIH - Medical Encyclopedia Alzheimer's Disease

"Alzheimer's disease (AD), one form of dementia, is a progressive, degenerative brain disease. It affects memory, thinking, and behavior. Memory impairment is a necessary feature for the diagnosis of this or any type of dementia. Change in one of the following areas must also be present: language, decision-making ability, judgment, attention, and other areas of mental function and personality. The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course. There are two types of AD -- early onset and late onset. In early onset AD, symptoms first appear before age 60. Early onset AD is much less common, accounting for only 5-10% of cases. However, it tends to progress rapidly. The brain tissue shows "neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up the cell), "neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells, and protein), and "senile plaques" (areas where products of dying nerve cells have accumulated around protein). Although these changes occur to some extent in all brains with age, there are many more of them in the brains of people with AD."

Highlighted Articles

Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis. (Neurology. 2007)

"CONCLUSIONS: Regardless of the neuropathologic criteria used, education is predictive of dementia status among individuals with neuropathologic Alzheimer disease. These results support the theory that individuals with greater cognitive reserve, as reflected in years of education, are better able to cope with AD brain pathology without observable deficits in cognition."

Nutritional factors, cognitive decline, and dementia. (Brain Res Bull. 2006)

"Nutritional factors and nutritional deficiencies have been repeatedly associated with cognitive impairment. … Deficiencies of several B vitamins have been associated with cognitive dysfunction in many observational studies. More recently, deficiencies of folate (B(9)) and cobalamine (B(12)) have been studied in relation to hyperhomocysteinemia as potential determinants of cognitive impairment, dementia, and Alzheimer's disease (AD). A small number of studies assessed the association between intake of macronutrients and cognitive function or dementia. Among the others, the intake of fatty acids and cholesterol has received particular attention. Although the results are not always consistent, most studies have reported a protective role of dietary intakes of poly- and mono-unsaturated fatty acids against cognitive decline and AD."

Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older (Annals of Internal Medicine 2006)

"Conclusion: These results suggest that regular exercise is associated with a delay in onset of dementia and Alzheimer disease, further supporting its value for elderly persons."

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Alzheimer's Disease - Dementia

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Device Therapy

Drug Side-Effects and Interactions

Mortality Risk in Patients With Dementia Treated With Antipsychotics Versus Other Psychiatric Medications (Am J Psychiatry 2007) "CONCLUSIONS: Antipsychotic medications taken by patients with dementia were associated with higher mortality rates than were most other medications used for neuropsychiatric symptoms. The association between mortality and antipsychotics is not well understood and may be due to a direct medication effect or the pathophysiology underlying neuropsychiatric symptoms that prompt antipsychotic use."

Summaries for patients. Antipsychotic drug use and death in older adults with dementia. (Ann Intern Med. 2007) "Adults with antipsychotic prescriptions had a slightly higher risk for death than did adults without these prescriptions. The increased risk was in people living in the community and in people living in long-term care facilities. The use of conventional drugs seemed to be associated with a higher risk for death than did the use of atypical drugs. Excess risk was evident at 30 days and seemed to continue to 180 days."

[Galanthamine versus donepezil in the treatment of Alzheimer's disease.] (Rev Neurol. 2007) "The five most common side effects were, in order of frequency of presentation: nausea, agitation, vomiting, headache and fainting. In the long term, the most frequent side effects from anticholinesterases are, generally speaking, muscle cramps, tremors, nightmares, nausea, vomiting, fatigue, vertigo and loss of weight. The studies analysed show limitations in the design, duration, sample sizes and the titration schemes of the drugs."

Antipsychotic Drug Use and Mortality in Older Adults with Dementia (Ann Intern Med 2007) "Conclusions: Atypical antipsychotic use is associated with an increased risk for death compared with nonuse among older adults with dementia. The risk for death may be greater with conventional antipsychotics than with atypical antipsychotics."

Dementia patients dying early on sedatives: study "Alzheimer's patients prescribed antipyschotic drugs as sedatives are dying early because of the treatment, British researchers said on Friday. Although so-called neuroleptic drugs were originally developed for schizophrenia, they are frequently also used on an "off-label" basis to calm difficult or aggressive dementia patients. A five-year investigation found that the drugs, when given to Alzheimer's sufferers, were linked to a significant increase in long-term mortality -- with patients on the medicines dying an average six months earlier than those given placebo."

Drugs

Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial (The Lancet Neurology 2008) “Although aspirin is commonly used in dementia, in patients with typical AD 2 years of treatment with low-dose aspirin has no worthwhile benefit and increases the risk of serious bleeds.”

An aspirin a day for Alzheimer's disease

Donepezil for the treatment of agitation in Alzheimer's disease. (N Engl J Med. 2007) "CONCLUSIONS: In this 12-week trial, donepezil was not more effective than placebo in treating agitation in patients with Alzheimer's disease."

Donepezil preserves cognition and global function in patients with severe Alzheimer disease (NEUROLOGY 2007) "Conclusion: Patients with severe AD demonstrated greater efficacy compared to placebo on measures of cognition and global function."

A randomised double-blind placebo-controlled trial of folic acid supplementation of cholinesterase inhibitors in Alzheimer's disease. (Int J Geriatr Psychiatry. 2007)

Meta-analysis of the effectiveness of atypical antipsychotics for the treatment of behavioural problems in persons with dementia. (Psychother Psychosom. 2007) "Conclusions: In general, effect sizes of atypical antipsychotics for behavioural problems are medium, and there are no statistically or clinically significant differences between atypical antipsychotics and placebo."

The use of a cholinesterase inhibitor review committee in long-term care. (J Am Med Dir Assoc. 2007) "CONCLUSIONS: Through the review process, almost one third of ChE-I users were recommended for discontinuation because of insufficient benefit; the majority of these were discontinued. Fewer than one third were subsequently restarted. A ChE-I Review Committee seemed to be an effective and acceptable model for decision making regarding ChE-I use in LTC."

Donepezil: an update. (Expert Opin Pharmacother. 2007) "The pharmacokinetics, pharmacodynamics, safety/tolerability profile and drug interaction properties of donepezil make it an easy and safe agent to use. However, in general, the efficacy of donepezil is limited, and ongoing studies are investigating other agents that may ultimately overtake its present position as the mainstay of anti-AD therapy."

Cerebral white matter changes and rate of progression of dementia during cholinesterase inhibitor treatment: a retrospective cohort study. (Int J Geriatr Psychiatry. 2007)

Memantine in the treatment of mild-to-moderate Alzheimer's disease. (Expert Opin Pharmacother. 2007)

Functional outcomes of drug treatment in Alzheimer's disease : a systematic review and meta-analysis. (Drugs Aging. 2007) "CONCLUSIONS: Standardised estimates of effect size across diverse functional outcome measures for drug treatment in patients with Alzheimer's disease were small and the data reflect only a modest trend favouring active treatment over placebo. However, given the current lack of other effective treatments for Alzheimer's disease, this trend supports the clinical benefits of these treatments with regard to this important health outcome."

Pharmacological Treatment of the Psychosis of Alzheimer's Disease : What Is the Best Approach? (CNS Drugs. 2007) " . until an effective and safe medication is approved by the regulatory agencies for PAD, clinicians do not have a better choice than atypical antipsychotics for the management of the serious symptoms of this condition."

Memantine in the treatment of mild-to-moderate Alzheimer's disease. (Expert Opin Pharmacother. 2007)

Prevention and Treatment of Dementia or Alzheimer's Disease by Statins: A Meta-Analysis. (Dement Geriatr Cogn Disord. 2007) " Conclusions: Statin use did not show a beneficial effect on the risk of dementia or Alzheimer's disease."

Consumer Reports Best Buy Drugs: Evaluating the drugs used to treat Alzheimer's disease

Clock Drawing and Frontal Lobe Behavioral Effects of Memantine in Alzheimer's Disease: A Rater-Blinded Study (American Journal of Alzheimer's Disease and Other Dementias 2007) " The current findings suggest that memantine improves frontal lobe behavior in some Alzheimer's disease patients and that clock drawing to command may be sensitive to these improvements."

Donepezil in Alzheimer's Disease: What to Expect after 3 Years of Treatment in a Routine Clinical Setting (Dementia and Geriatric Cognitive Disorders 2007) "Conclusion: Three-year donepezil treatment showed a positive global and cognitive outcome in the routine clinical setting."

A Placebo-Controlled Trial of Valproate for Agitation and Aggression in Alzheimer's Disease (Dementia and Geriatric Cognitive Disorders 2007) "Conclusion: Valproate is not effective for the management of agitation in moderate-to-severe AD, and may be poorly tolerated in this population."

Exercise

Effect of Regular Exercise on Senile Dementia Patients. (Int J Sports Med. 2007) "Our findings showed that regular exercise can enhance cognitive and functional activity scores in dementia patients, suggesting that senile dementia may improve by participating in a regular exercise program."

Exercise slows decline in Alzheimer's patients "Nursing home residents with Alzheimer's disease who participate in a moderate exercise program have a significantly slower deterioration than those who receive routine medical care, researchers have shown"

Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial. (J Am Geriatr Soc. 2007) "CONCLUSION: A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care."

General Information

Efficacy and safety of antidepressants for treatment of depression in Alzheimer's disease: a metaanalysis. (Can J Psychiatry. 2007)

[Cognitive rehabilitation--the learning therapy for the senile dementia] (Brain Nerve. 2007)

Non-pharmacological interventions for wandering of people with dementia in the domestic setting. (Cochrane Database Syst Rev. 2007)

Family Physicians' Recommendations for the Treatment of Alzheimer's Disease (American Journal of Alzheimer's Disease and Other Dementias 2007) " Engagement in social activities and participation in support groups were the interventions most recommended by the physicians. Isolation and physical restraints were the least recommended. Recommendations about AD treatments were associated with the severity of the disease and the extent to which the person described in the vignette was perceived as dangerous."

Guidelines

Trials and Tribulations of Evidence-Based Medicine: The Case of Alzheimer Disease Therapeutics

NGC - (1) Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer's disease (2) 2007 addendum. (2007)

NGC - Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer's disease. (2006)

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

The importance of fish and docosahexaenoic acid in Alzheimer disease "In each of these studies, the n-3 fatty acids retarded the decline in cognition over time. One mechanism for the positive effect could be the antithrombotic and antiinflammatory properties of EPA (9). Moreover, the entrance of DHA into the brain could correct DHA deficiency in membrane phospholipids in the cerebral cortex in patients with Alzheimer disease (5), and EPA would counter the proinflammatory action of arachidonic acid, which is a precursor of cytokine and proinflammatory eicosanoids that may be associated with greater cognitive decline."

Other

Other Treatments

Experimental

Oxidative stress and oxidative DNA damage is characteristic for mixed Alzheimer disease/vascular dementia. (J Neurol Sci. 2007) "Oxidative stress/DNA damage is an important factor that may be involved in pathogenesis of mixed dementia. It is likely that treatment of these patients with antioxidants may slow down the progression of the disease."

Common spice may help Alzheimer's patients "If laboratory findings hold true in people, treatment with one of the active chemicals in turmeric, the main spice found curry, may boost the immune system of patients with Alzheimer's disease and, thereby, increase the clearance of amyloid plaques in the brain, the primary abnormality seen in patients with the disease, researchers in the United States report. In their study, Dr. Milan Fiala, from the Greater Los Angeles Veteran's Affairs Medical Center, and colleagues first show that immune cells called macrophages taken from patients with Alzheimer's disease cannot efficiently eliminate amyloid and that this may be related to the abnormal regulation of certain genes. Treating these cells with an active substance found in turmeric, called bisdemethoxycurcumin, increases the production of some of the genes and enhances macrophage function, according to the team's report, published in the Early Edition of the Proceedings of the National Academy of Sciences. "

Radiotherapy

Supplements-Vitamins-CAM

Alpha-lipoic acid as a new treatment option for Alzheimer's disease--a 48 months follow-up analysis. (J Neural Transm Suppl. 2007)

Omega-3 supplements affect Alzheimer's symptoms "Omega-3 supplements can, in certain cases, help combat the depression and agitation symptoms associated with Alzheimer's disease, according to a clinical study conducted at the Swedish medical university Karolinska Institutet. A number of epidemiological studies have shown that eating fatty fish provides a certain degree of protection against Alzheimer's and other dementia diseases-an effect often thought attributable to the omega-3 fatty acids it contains. Some studies also suggest that omega-3 can have a therapeutic effect on some psychiatric conditions. . The team points out that no general therapeutic recommendations can be made from the results until larger studies on individuals with more pronounced neuropsychiatric symptoms are conducted."

Omega-3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms. (Int J Geriatr Psychiatry. 2007)

Vitamin B12 supplementation did not improve cognition but reduced delirium in demented patients with vitamin B12 deficiency (Archives of Gerontology and Geriatrics 2007) "Cognitive function of mild to moderately demented older people with vitamin B12 deficiency did not significantly change with vitamin B12 supplementation over a 10-month period. The supplementation reduced delirium associated with dementia."

Ginkgo biloba for cognitive impairment and dementia. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: Ginkgo biloba appears to be safe in use with no excess side effects compared with placebo. Many of the early trials used unsatisfactory methods, were small, and we cannot exclude publication bias. The evidence that Ginkgo has predictable and clinically significant benefit for people with dementia or cognitive impairment is inconsistent and unconvincing."

Surgery

Transplantation

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