Alzheimer's Disease - Dementia

• Diagnosis, Imaging, Screening
• General Information
• Guidelines
• Internet Sites
• Risk Factors
• Risk Reduction
• Treatment

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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

Cognitive Effects of Treating Obstructive Sleep Apnea in Alzheimer's Disease: A Randomized Controlled Study (Journal of the American Geriatrics Society 2008) “CONCLUSION: OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present.”

Drug Side-Effects and Interactions

Doctors Say Medication Is Overused in Dementia “Nevertheless, many doctors say misuse of the drugs is widespread. “These antipsychotics can be overused and abused,” said Dr. Johnny Matson, a professor of psychology at Louisiana State University. “And there’s a lot of abuse going on in a lot of these places.” Dr. William D. Smucker, a member of the American Medical Directors Association, a group of health professionals who work in nursing homes, agreed. Though the group encourages doctors to conduct a thorough assessment and prescribe antipsychotics only as a last resort, he said, “Many physicians are absent without leave in the nursing home and don’t take an active role in the assessment of the patient.” Some nursing homes are trying a different approach, so-called environmental intervention. The strategies include reducing boredom, providing intellectual and physical stimulation, exercise, calming music, bringing in pets for therapy and improving how the staff approaches and talks to dementia patients. “

FDA Requires Conventional and Atypical Antipsychotics to Warn of Increased Death Risk in Elderly Dementia

Common Anti-psychotic Drugs Bad For Alzheimer's Patients, New Study Finds“A new UK study has found that anti-psychotic drugs, such as (Melleril), chlorpromazine (Largactil), haloperidol (Serenace), trifluoperazine (Stelazine) and risperidone (Risperdal), are bad for patients with Alzheimer's disease - the drugs were found to make their condition worse.”

How long can patients with mild or moderate Alzheimer's dementia maintain both the cognition and the therapy of cholinesterase inhibitors: a national population-based study. (Eur J Neurol. 2008)

Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial. (Lancet Neurol. 2008) "INTERPRETATION: 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."

Drugs

Effects of Cardiovascular Medications on Rate of Functional Decline in Alzheimer Disease (Am J Geriatr Psychiatry 2008) “Conclusions: In this population-based study of individuals with incident AD, use of statins and beta-blockers was associated with delay of functional decline. Further studies are needed to confirm these results and to determine whether treatment with these medications may help delay AD progression.”

Memantine therapy for Alzheimer disease in real-world practice: an observational study in a large representative sample of French patients. (Alzheimer Dis Assoc Disord. 2008)

Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline (Annals 2008) "Conclusions: Treatment of dementia with cholinesterase inhibitors and memantine can result in statistically significant but clinically marginal improvement in measures of cognition and global assessment of dementia."

Exercise

Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. (JAMA. 2008) “CONCLUSIONS: In this study of adults with subjective memory impairment, a 6-month program of physical activity provided a modest improvement in cognition over an 18-month follow-up period.”

Physical activity programs for persons with dementia. (Cochrane Database Syst Rev. 2008)

Exercise May Prevent Brain Shrinkage In Early Alzheimer's Disease “ "People with early Alzheimer's disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost. Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance," Burns said.”

Exercise training for depressed older adults with Alzheimer's disease. (Aging Ment Health. 2008)

General Information

Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia. (CMAJ. 2008)

Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia. (CMAJ. 2008)

Diagnosis and treatment of dementia: 4. Approach to management of mild to moderate dementia (CMAJ 2008)

Hippocampal volume change in the Alzheimer Disease Cholesterol-Lowering Treatment trial. (Cleve Clin J Med. 2008)

Anti-Inflammatories Should Not Be Used To Prevent Alzheimer's, Study “Results of a US study of elderly men and women with a family history of Alzheimer's suggest that the nonsteroidal anti-inflammatory drugs (NSAIDs) naproxen and celecoxib did not improve cognitive function and the investigators recommended against using them to prevent Alzheimer's. Previous research, based on observational studies, has suggested that risk of Alzheimer's is lower in people who use NSAIDs, supporting the idea that inflammatory processes are involved in the development of the neurodegenerative disease and in the decline of cognitive function such as thinking, memory and learning.”

Diagnosis and treatment of dementia: 2. Diagnosis. (CMAJ. 2008)

Guidelines

NGC - Current pharmacologic treatment of dementia: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. (2008)

Current Pharmacologic Treatment of Dementia: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians (Annals 2008)

NGC - Practice guideline for the treatment of patients with Alzheimer's disease and other dementias. (2007)

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

Other

Other Treatments

Melatonin, light may aid people with Alzheimer's "A morning-time dose of bright light coupled with an evening dose of melatonin may help normalize the sleep-wake cycle in elderly adults with Alzheimer's disease, a study suggests. People with Alzheimer's commonly have disrupted sleep at night and nap frequently during the day, which can keep them from activities and social interactions that could alleviate some of the effects of the disease. The neurological damage inflicted by Alzheimer's disease appears to contribute to the problem. At the same time, many patients, especially those in nursing homes, have limited exposure to daylight, which further throws off natural sleep-wake rhythms."

Experimental

Garlic extract exhibits antiamyloidogenic activity on amyloid-beta fibrillogenesis: relevance to Alzheimer's disease. (Phytother Res. 2008)

Green tea epigallocatechin-3-gallate (EGCG) reduces beta-amyloid mediated cognitive impairment and modulates tau pathology in Alzheimer transgenic mice. (Brain Res. 2008)

Radiotherapy

Supplements-Vitamins-CAM

Ginkgo biloba for Prevention of Dementia (JAMA. 2008) “Conclusions In this study, G biloba at 120 mg twice a day was not effective in reducing either the overall incidence rate of dementia or AD incidence in elderly individuals with normal cognition or those with MCI.”

Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer's disease (Advanced Drug Delivery Reviews 2008)

High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial. (JAMA. 2008) “CONCLUSION: This regimen of high-dose B vitamin supplements does not slow cognitive decline in individuals with mild to moderate AD.”

B Vitamins No Help for Alzheimer's: Alzheimer's Patients Decline Despite High-Dose Folate, Vitamin B6/B12

Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer's disease. (Adv Drug Deliv Rev. 2008) “Data from cell culture and animal models suggest that LA could be combined with nutraceuticals such as curcumin, (-)-epigallocatechin gallate (from green tea) and docosahexaenoic acid (from fish oil) to synergistically decrease oxidative stress, inflammation, Abeta levels and Abeta plaque load and thus provide a combined benefit in the treatment of AD.”

High Doses of Vitamin E Lengthen Lives of Alzheimer's Patients

The effects of omega-3 fatty acids monotherapy in Alzheimer's disease and mild cognitive impairment: A preliminary randomized double-blind placebo-controlled study. (Prog Neuropsychopharmacol Biol Psychiatry. 2008)

Ginkgo biloba for mild to moderate dementia in a community setting: a pragmatic, randomised, parallel-group, double-blind, placebo-controlled trial. (Int J Geriatr Psychiatry. 2008)

Higher Serum Vitamin D(3) Levels Are Associated with Better Cognitive Test Performance in Patients with Alzheimer's Disease. (Dement Geriatr Cogn Disord. 2008) “Conclusions: These data support the idea that a relationship exists between vitamin D status and cognition in patients with probable AD. However, given the cross-sectional design of this study, no causality can be concluded. Further prospective studies are needed to specify the contribution of vitamin D status to the onset and course of cognitive decline and AD.”

The effect of curcumin (turmeric) on Alzheimer's disease: An overview (Annals of the Indian Academy of Neurology 2008) “Curcumin also has a potential role in the prevention and treatment of AD. Curcumin as an antioxidant, anti-inflammatory and lipophilic action improves the cognitive functions in patients with AD. A growing body of evidence indicates that oxidative stress, free radicals, beta amyloid, cerebral deregulation caused by bio-metal toxicity and abnormal inflammatory reactions contribute to the key event in Alzheimer's disease pathology. Due to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory, antioxidant and decreased microglia formation, the overall memory in patients with AD has improved.”

Alzheimer’s: Vitamin for Longer Life “After receiving 1,000 international units of vitamin E twice a day for five years, the patients were 26 percent less likely to die than those who did not take the vitamin. Whether they were also taking an Alzheimer’s drug (cholinesterase inhibitor) did not make a difference. Dr. Pavlik notes the dosage was much higher than what is currently recommended for the general public.”

Omega-3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms (International Journal of Geriatric Psychiatry 2008)

Surgery

Transplantation

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