August 2001
international
abstracts:
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transplantation
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August 2001
international
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CHOLINESTERASE INHIBITORS IN VASCULAR DEMENTIA
MEMORY AND FUNCTIONAL DECLINE
TESTING FOR DISEASE MODIFICATION
BRAIN VOLUMETRY IN THE DIAGNOSIS OF AD
PREDICTORS OF NURSING HOME PLACEMENT
ANOTHER NEGATIVE VALPROATE TRIAL
AROMATHERAPY FOR BPSD
OUTCOME MEASURES FOR TREATMENT STUDIES
LINKS TO SUGGESTED WEBSITES
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alzheimer's issues: february 2003 november 2002 august 2002 may 2002 february 2002 november 2001 august 2001 may 2001 february 2001 november 2000 august 2000 june 2000 march 2000 november 1999 may 1999 february 1999 september 1998 june 1998 march 1998 december 1997 |
| EDITORIAL COMMENT |
CHOLINESTERASE
INHIBITORS IN VASCULAR DEMENTIA |
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(LANCET 2002;359:1283-1290) |
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| Donepezil improves cognition in patients with vascular dementia: results from study 307: a 24-week, randomized, double-blind, placebo-controlled trial (THE DONEPEZIL 307 STUDY GROUP USA) |
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G.C. ROMAN, R.D. PRATT, C.A. PERDOMO, SAN ANTONIO, TX, TEANECK, NJI |
Sorry, this abstract is not available |
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(THE DONEPEZIL 308 STUDY GROUP EISAI INC.) |
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Sorry, this abstract is not available |
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| EDITORIAL COMMENT |
There is a large body of evidence that the most reliable proof for early dementia comes from "informants," e.g. family and friends, who report on an individual decline in cognitive and functional abilities. This may also be true in predicting who among persons with mild cognitive impairment is more likely to progress to dementia. The study by Tabert et al suggests that informant-reported functional deficits compensate for the patient's lack of awareness of decline. In other words, any attempts at screening in an older population for early dementia should involve accompanying persons with a few targeted questions about cognitive and functional changes. |
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(NEUROLOGY 2002;58:758-764) |
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M.H. TABERT, PHD, S.M. ALBERT, PHD, L. BORUKHOVA-MILOV, BA, Y. CAMACHO, MS, et al, NEW YORK, NY |
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| EDITORIAL COMMENT |
Aisen et al published the
results from a pilot study comparing nimesulide, a preferential cyclooxygenase-2
inhibitor, to placebo over 12 weeks, followed by open-label treatment
up to two years. The drug was well tolerated but there was no significant
difference on any of the efficacy outcomes. This is not surprising considering
the expectation of a disease-modifying effect from that class of drug,
which would require at least 12 months of continuous treatment and a surrogate
outcome such as serial whole brain volumetric measurements by MRI. On
ethical and practical grounds, lengthy controlled studies will require
addition of the candidate drug or a placebo to "standard treatment"
for Alzheimer's in mild to moderate stages, e.g. a cholinesterase inhibitor.
A double-blind wash-out from the candidate drug at the end of the treatment
period could add some evidence for disease modification, if the actively
treated group remains different from the placebo group even off-drug.
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(NEUROLOGY 2002;58:1050-1054) |
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| EDITORIAL COMMENT |
The report by Gosche et al
from the Nun Study reinforces the many observations that MRI volumetric
measures of the hippocampus could lead to very early diagnosis of Alzheimer's.
This measurement has been built in two of the ongoing placebo-controlled
randomized studies in mild cognitive impairment, assessing the potential
effects of donepezil and galantamine on progressive whole brain atrophy.
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(NEUROLOGY 2002;58:1476-1482) |
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| EDITORIAL COMMENT |
In a large, well-designed,
prospective study, Yaffe et al determined the characteristics that predict
nursing home placement of patients with dementia. Both patient characteristics
(e.g. older age, more impairment, behavioural disturbances, etc.) and
caregiver characteristics (e.g. older age, higher caregiver burden, etc.)
predicted placement. Such data is helpful for designing interventions
that could decrease the risk for placement. |
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(JAMA 2002;287:2090-2097) |
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KRISTINE YAFFE, MD, PATRICK FOX, PHD, ROBERT NEWCOMER, PHD, LAURA SANDS, PHD, et al, SAN FRANCISCO, CA |
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| EDITORIAL COMMENT |
As reviewed previously in
International Abstracts in Alzheimer's Disease & Other Dementias
(August 2001), the available RCTs for the use of valproate for BPSD provided
little evidence of efficacy. In a new double-blind placebo-controlled
study, Sival et al found no efficacy on measures of aggression
when a fixed dose of 480 mg was used. With the publication of three negative
RCTs, clinicians should reconsider the use of valproate for the treatment
of BPSD. |
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(INT J GERIATR PSYCHIATRY 2002;17:579-585) |
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| EDITORIAL COMMENT |
Most
BPSD guidelines recommend the use of non-pharmacological interventions prior
to or concurrent with medications to treat BPSD. Two recent studies (Smallwood
et al 2001; Holmes et al 2002) suggest efficacy for aromatherapy with lavender
oil (Refer to FAXBACK). Both studies suffer from small numbers and weak
experimental designs, though this well-tolerated intervention deserves more
study.  |
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(INT J GERIATR PSYCHIATRY 2002;17:305-308) |
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OUTCOME
MEASURES FOR TREATMENT STUDIES
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| EDITORIAL COMMENT |
Given
the modest benefits that cognitive enhancers have in RCTs when cognitive
outcome measures are used, there has been a search for other measures that
might be more sensitive to change. In a prospective one year study, patients
with AD underwent PET scanning at baseline and follow-up. These patients
had significant reductions in glucose metabolism leading the investigators
to hypothesize that reductions in maximal glucose metabolism in the left
frontal cortex with PET might be used as a sensitive outcome measure for
clinical trials. |
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(AM J PSYCHIATRY 2002;159:738-745) |
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GENE E. ALEXANDER, PHD, KEWEI CHEN, PHD, PIETRO PIETRINI, MD, PHD, STANLEY I. RAPOPORT, MD, et al, TEMPE, ARIZONA |
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