Feb 2001

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IN THIS
ISSUE

INCIDENCE AND OUTCOMES OF DEMENTIA

  • Dementia incidence may be higher than previously believed
  • Simple variables are good predictors of dementia development
  • Vascular cognitive impairment without dementia is important to consider

TREATMENT OF ALZHEIMER'S DISEASE

  • Donepezil use for mild to moderate AD benefits a significant
  • proportion of patients
  • Galantamine slows the decline of function and cognition in AD
  • Donepezil slows functional deterioration in patients with moderate
  • to severe AD
  • Memantine improves patients with severe dementia

B12 DEFICIENCY AND DEMENTIA: TIME TO RE-EXAMINE?

  • Vitamin B12 may improve frontal lobe and language function
  • Low vitamin B12 levels in AD patients can affect behaviour

THE TREATMENT OF DEPRESSION IN DEMENTIA

  • Sertraline is effective in treating depression in AD patients
  • Citalopram and mianserin are equally effective

SUGGESTED OTHER ABSTRACTS AND WEBSITES

 

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EDITORIAL
COMMENT

INCIDENCE AND OUTCOMES OF DEMENTIA -- RESULTS OF THE CSHA
The main results of Phase II (five year follow-up) of the Canadian Study of Health and Aging (CSHA) have been published. The figures suggest a higher than anticipated rate of dementia incidence. (The CSHA Working Group). Simple baseline variables, such as lower scores on the Modified Mini Mental State Examination, advancing age and informants report of memory decline, are good predictors of progression to dementia (Hogan and Ebly). Persons fitting the criteria for Age Associated Cognitive decline were particularly at risk of progression to dementia, which was confirmed by Ritchie et al (FAX back section) in a population of seniors in France. Persons with vascular impairment without dementia were at the same higher risk of dying over the five year follow-up as patients with Alzheimer's disease (Rockwood et al ).

The incidence of dementia in Canada

(NEUROLOGY 2000;55:66-73)


THE CANADIAN SUDY OF HEALTH AND AGING WORKING GROUP,
OTTAWA, ON

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Predicting who will develop dementia in a cohort of Canadian seniors

(CAN. J. NEUROL. SCI. 2000;27:18-24)


DAVID B. HOGAN,
ERIKA M. EBLY,
CALGARY, AB

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Prevalence and outcomes of vascular cognitive impairment

(NEUROLOGY 2000;54:447-451)


K. ROCKWOOD, MD, FRCPC,
C. WENTZEL, PHD,
V. HACHINSKI, MD, FRCPC, DSCMED,
D.B. HOGAN, MD, FRCPC,
ET AL,
VARIOUS CENTRES, CANADA

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TREATMENT OF ALZHEIMER'S DISEASE
EDITORIAL
COMMENT

An audit of the assessment of patients and use of donepezil in routine clinical practice in the United Kingdom showed that 47% of patients had measurable improvement in cognition, activities of daily living (ADL), carer observation, or a combination thereof (Cameron et al). The last of the galantamine pivotal studies was published (Wilcock et al 2000) and, using the Canadian-designed ADL Disability Assessment in Dementia Scales showed a slower decline in patients with mild to moderate stages of AD on active treatment versus placebo over six months. Similar results were found in moderate to severe AD patients treated with donepezil (Gauthier et al). Memantine is an uncompetitive NMDA receptor antagonist which has shown promising results in European randomised studies involving moderate to severe stages of AD (Winblad and Poritis). Since it works through different mechanisms than cholinesterase inhibitors and has been shown to have no interactions in vitro with these drugs (Wend et al; FAX back section), it will likely be used in combination.

Use of donepezil for the treatment of mild-moderate Alzheimer's disease: an audit of the assessment and treatment of patients in routine clinical practice

(INT. J. GERIATR. PSYCHIATRY 2000;15:887-891)


IAN CAMERON
STEPHEN CURRAN,
PAUL NEWTON,
DUNCAN PETTY,
ET AL,
LEEDS, UK
WAKEFIELD, UK

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Efficacy and safety of galantamine in patients with mild to moderate Alzheimer's disease: multicentre randomised controlled trial

(BMJ 2000;321:1-7)


GORDON K. WILCOCK,
SEAN LILIENFELD,
ELS GAENS,
ON BEHALF OF THE GALANTAMINE INTERNATIONAL-1 STUDY GROUP
BRISTOL, UK,
BEERSE, BELGIUM

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Benefits of donepezil on performance of basic and instrumental. Activities of daily living in moderate to severe Alzheimer's disease

(NEUROBIOLOGY OF AGING 2000;[21]S161)


SERGE GAUTHIER,
HOWARD FELDMAN,
JANE HECKER,
BRUNO VELLAS,
ET AL,
MONTREAL, QC,
VANCOUVER, BC,
DAW PARK, AUSTRALIA,
ALBUQUERQUE, NM,
NEW YORK, NY

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Memantine in severe dementia: results of the 9M-BEST study (benefit and efficacy in severely demented patients during treatment with memantine)

(NEUROLOGY 2001;56: SUPPL. 3 - A128)

B. WINBLAD,
N. PORITIS,
HUDDINGE, SWEDEN,
RIGA, LATVIA

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B12 DEFICIENCY AND DEMENTIA: TIME TO RE-EXAMINE?

EDITORIAL
COMMENT 		While The Canadian Consensus Conference on Dementia suggested measurement of serum B12 was only optional ("...if proprioceptive loss, peripheral neuropathy or a macrocytic anemia accompany cognitive decline..."), two recent studies appear to challenge this. Eastley et al suggest that B12 supplementation in cognitively impaired individuals without anemia may improve certain cognitive functions (e.g. verbal fluency) but without reversing the dementia. Meins et al note that low serum B12 levels may also be associated with behavioural disturbances such as irritability.

Vitamin B12 deficiency in dementia and cognitive impairment: the effects of treatment of neuropsychological function

(INT. J. GERIAT. PSYCHIATRY 2000;15:226-233)


REBECCA EASTLEY,
GORDON K. WILCOCK,
ROMOLA S. BUCKS,
BRISTOL, UK

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Subnormal serum vitamin B12 and behavioural and psychological symptoms in Alzheimer's disease

(INT. J. GERIAT. PSYCHIATRY 2000;15:415-418)


PIERRE N. TARIOT, MD,
LON S. SCHNEIDER, MD,
JACOBO E. MINTZER, MD,
ANDREW J. CUTLER, MD,
ET AL,
VARIOUS CENTRES, USA
FOR THE DEPAKOTE ELDERLY MANIA STUDY GROUP

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THE TREATMENT OF DEPRESSION IN DEMENTIA
EDITORIAL
COMMENT

Depression is a common behavioural complication of dementia which can impair quality of life. It is increasingly recognized that patients with dementia can respond favourably to antidepressant therapy. In a randomized placebo-controlled study of sertraline for depression in AD (Lyketsos et al, significantly greater improvements in mood were noted in the sertraline-treated group, and most of the benefits were documented early (within 3 weeks). Similarly, in a large randomized controlled trial of citalopram vs Mianserin (not available in Canada), both antidepressants were effective and well tolerated (Karlsson et al).


Randomized, placebo-controlled, double-blind clinical trial of sertraline in the treatment of depression complicating Alzheimer's disease: Initial results from the depression in Alzheimer's disease study

(AM J PSYCHIATRY 2000;157:1686-1689)


CONSTANTINE G. LYKETSOS, MD, MHS,
JEANNIE-MARIE E. SHEPPARD, BA,
CYNTHIA D. STEELE, RN, MPH,
SUSAN KOPUNEK, RN,
ET AL,
BALTIMORE, MD

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A randomised, double-blind comparison of the efficacy and safety of citalopram compared to mianserin in elderly, depressed patients with or without milk to moderate dementia

(INT. J. GERIAT. PSYCHIATRY 2000;15:295-305)


INGVAR KARLSSON,
JAN GODDERIS,
CARLOS AUGUSTO DE MENDONCA LIMA,
HARALD NYGAARD,
ET AL,
VARIOUS CENTRES, EUROPE

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THE FOLLOWING PAPERS and websites were judged by the editors to also be of interest.

NO INTERACTION OF MEMANTINE WITH ACETYLCHOLINESTERASE INHIBITORS APPROVED FOR CLINICAL USE

WEBSITES