August 2000
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August 2000 international |
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alzheimer's issues: |
IN THIS ISSUENOVEL TREATMENTS
FOR
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| EDITORIAL FOREWORD |
Patients and families
affected by Alzheimer's disease (AD) had high expectations of the recent
World Alzheimer's Congress, held in Washington, July 9-18, 2000. Schenk
et al gave an update on an autologous 'vaccine' against beta amyloid
peptide, currently in phase 1, after promising results in transgenic mice
(original report in Nature, 400, 173-7, 1999, abstract in FAX
back section), and Wieland et al summarized recent data on
Neotrofin, a stimulant of endogenous neurotropic factors, currently in phase
2b. These therapies would be useful additions to cholinesterase inhibitors
such as donepezil, rivastigmine and galantamine. Two of the phase 3 studies
on the latter drug were recently published (see FAX back section). |
| DALE B. SCHENK, FREDERIQUE BARD, ROBIN BARBOUR, KELLY JOHNSON-WOOD, ET AL, SAN FRANCISCO, CA |
sorry, this abstract is not available |
| SCOTT WIELAND, WILLIAM MOLLOY, STEVEN TARGUM, ERICH MOHR, ET AL, IRVINE, CA, HAMILTON, ON, PHILADELPHIA, PA, VICTORIA, BC |
sorry, this abstract is not available |
| EDITORIAL COMMENT |
Along with the major effort in understanding the pathophysiology
of AD in its presymptomatic stages, with potential reversibility of lesions
such as beta amyloid deposition and tau hyperphosphorylation (read the excellent
reviews by Rosenberg, Neurology, 54, 2045-54, 2000, Wolozin &
Behl, Arch Neurol 57, 793-6, 801-4, 2000), there are clinical studies
looking at the preclinical phases of AD. A 22-year prospective study by
Elias et al confirms that measures of retention of information
and abstract reasoning are strong predictors. The accompanying editorial
by Richard Mayeux (Arch Neurol 57, 783-4, 2000) highlights the
significance of this study. A shorter (three and six years) study is also
available in the FAX back section. Other reports are confirming the suspicion
that depression is a common prodrome of AD (FAX back
section). |
| MERRILL F. ELIAS, PHD, MPH, ALEXA BEISER, PHD, PHILIP A. WOLF, MD, RHODA AU, PHD, ET AL, BOSTON, MA, ORONO, ME, ODENSE, DENMARK |
| EDITORIAL COMMENT |
Two important documents on competency assessment were recently
published, and should be discussed in each province with the Alzheimer societies,
taking into account local laws and regulations. They are: financial capacity
(Marson et al) and driving ability (Dubinsky et al). These
issues are of great significance for patients with AD and their families,
and are part of the global management of a progressive illness in which
loss of capacity for instrumental tasks, such as driving and handling finances,
can be planned for ahead of time. |
| DANIEL C. MARSON, JD, PHD, STEPHEN M. SAWRIE, PHD, SCOTT SNYDER, PHD, BRONWYN MCINTURFF, MS, ET AL, BIRMINGHAM, AB, PHILADELPHIA, PA |
| RICHARD M. DUBINSKY, MD, ANTHONY C. STEIN, PHD, KELLY LYONS, PHD, ST. PAUL, MN |
| EDITORIAL COMMENT |
The later stages of dementia offer particular challenges to society,
as described by Winblad et al in a lead editorial (Int J Geriat
Psychiatry 14, 911-4, 1999). It is quite appropriate that recent studies
assess a variety of risk and protective factors towards institutionalization,
such as Smith et al. Costs analysis of AD taking into account the
nursing home stage are available in the FAX back section. |
| G.E. SMITH, PHD, E. KOKMEN, MD, P.C. O'BRIEN, PHD, ROCHESTER, MN |
| EDITORIAL COMMENT |
While cholinesterase inhibitors are marketed for the treatment
of Alzheimer's disease, recent case series by Lanctot et al and
McKeith et al suggest that these medications not only improve cognition
in patients with dementia with Lewy bodies, but may also have significant
effects on behavioural disturbances such as hallucinations, delusions, apathy
and agitation. |
| KRISTA L. LANCTOT, NATHAN HERRMANN, TORONTO, ON |
| IAN G. MCKEITH, JANET B. GRACE, ZUZANA WALKER, E. JANE BYRNE, ET AL, VARIOUS CENTRES, UK |
| EDITORIAL COMMENT |
Depressive symptoms and syndromes are one of the most common behavioural
disturbances noted in patients with a variety of dementias. This was recently
highlighted in a community study by Lyketsos et al of elderly patients
with dementia, approximately one-quarter of whom had significant depressive
symptoms. Depression is also frequently observed in patients with preclinical
AD, often confounding the diagnosis. Visser et al report on their
experience attempting to differentiate between the subjects with preclinical
AD and depression from subjects with depression-related cognitive impairment. |
| CONSTANTINE G.
LYKETSOS, MD, M.H.S., MARTIN STEINBERG, MD, JOANN T. TSCHANZ, PHD, MARIA C. NORTON, MS, ET AL, BALTIMORE, MD |
| PIETER JELLE VISSER, MD, FRANS R.J. VERHEY, MD, PHD, RUDOLF W.H.M. PONDS, PHD, ARNOLD KESTER, PHD, ET AL, MAASTRICHT, THE NETHERLANDS |
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