Feb 2003

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IN THIS
ISSUE

BEHAVIOURAL SYMPTOMS OF
ALZHEIMER'S DISEASE

  • Donepezil is effective in patients with moderate to severe AD
  • The apathy inventory is a reliable method for assessing elderly patients
  • Behavioural symptoms in AD patients increase costs of care

PARKINSON ASSOCIATED DEMENTIA

  • Dementia is associated with an increased risk of death in PD

  • Attention impairments are comparable in various types of PD patients

NEW GENETIC ASSOCIATION
WITH LATE-ONSET AD

  • The CYP46 gene influences late-onset sporadic AD

NON-CONVENTIONAL
THERAPIES FOR DEMENTIA

  • Two weeks of melatonin did not improve sleep in people with dementia
  • Physicians should be acquainted with possible herb-drug interactions

NEUROPSYCHIATRIC SYMPTOMS IN MCI

  • There is a high prevalence of neuropsychiatric symptoms in MCI

VAGUS NERVE STIMULATION

  • Patients with AD may benefit from VNS

EXECUTIVE CONTROL FUNCTION

  • The prevalence of ECF in many disorders has not been determined

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EDITORIAL
COMMENT

BEHAVIOURAL SYMPTOMS OF
ALZHEIMER'S DISEASE

A sub-analysis of the Moderate to Severe Alzheimer Disease (MSAD) study has confirmed the efficacy of donepezil against placebo in later stages of AD, using the Neuro-Psychiatric Inventory (NPI; Gauthier et al 2002). This analysis of the NPI (total score, individual item analysis, emerging symptoms) will be useful in other studies, such as the combination of memantine and donepezil versus placebo and donepezil. The Apathy Inventory is another interesting measurement scale (Robert et al 2002). Finally, the expected high correlation between behavioural symptoms and costs in AD was demonstrated by Murman et al.

Efficacy of donepezil on behavioral symptoms in
patients with moderate to severe Alzheimer's disease

(INT PSYCHOGERIATRICS 2002;14[4]:389-404)


SERGE GAUTHIER,
HOWARD FELDMAN,
JANE HECKER,
BRUNO VELLAS,
ET AL,
VANCOUVER, VERDUN, CANADA,
DAW PARK, AUSTRALIA,
TOULOUSE, FRANCE

To view this abstract at www.ipa-online.org

click here!


The apathy inventory: assessment of apathy and awareness in
Alzheimer's disease, Parkinson's disease and mild cognitive impairment

(INT J GERIATR PSYCHIATRY 2002;17:1099-1105)


P.H. ROBERT,
S. CLAIRET,
M. BENOIT,
J. KOUTAICH,
ET AL,
NICE, FRANCE

To view this abstract in
PubMed

click here!


The incremental direct costs associated with behavioral symptoms in AD

(NEUROLOGY 2002;59:1721-1729)


D.L. MURMAN, MD, MS,
Q. CHEN, MS,
M.C. POWELL, BS,
S.B. KUO, BS,
ET AL,
EAST LANSING, M
I

To view this abstract in
PubMed

click here!

 


PARKINSON ASSOCIATED DEMENTIA


EDITORIAL
COMMENT

The association between mortality and incident dementia has been confirmed by Levy et al. There is thus a great interest to follow-up on observations that cholinesterase inhibitors, such as donepezil and rivastigmine, may be safe and effective in Parkinson's disease (PD) associated dementia. Measurement tools such as the Cognitive Drug Research computerized battery have been found to be useful even in patients with MMSE scores below 10 (Ballard et al). A number of randomized placebo-controlled studies in PD dementia are being initiated and will include such measurements as outcome variables.

 

The association of incident dementia with mortality in PD

(NEUROLOGY 2002;59:1708-1713)


G. LEVY, MD,
M.-X. TANG, PHD,
E.D. LOUIS, MD, MS,
L.J. CÔTÉ, MD,
ET AL,
NEW YORK, NY

To view this abstract in
PubMed

click here!


Fluctuations in attention: PD dementia vs DLB with parkinsonism

(NEUROLOGY 2002;59:1714-1720)


C.G. BALLARD, MRCPSYCH, MD,
D. AARSLAND, MD,
I. MCKEITH, FRCPSYCH, MD,
J. O'BRIEN, MRCPSYCH,
ET AL,
LONDON, NEWCASTLE, UK,
STAVANGER, NORWAY

To view this abstract in
PubMed

click here!


NEW GENETIC ASSOCIATION WITH LATE-ONSET AD


EDITORIAL
COMMENT

Papassotiropoulos et al have reported evidence that a polymorphism of the gene CYP46, which regulates the hydroxylation of cholesterol and its removal from the brain, doubles the risk for late-onset AD. Furthermore, subjects with both CYP46 and apoE mutations have an increased risk as high as 9.6. As discussed in the excellent accompanying editorial by B. Wolozin, these data suggest an important role for lipid metabolism in the pathophysiology of AD, and support the need for clinical trials attempting to modify cholesterol metabolism in the brain.


Increased brain beta-amyloid load, phosphorylated tau, and risk of Alzheimer disease associated with an intronic CYP46 polymorphism

(ARCH NEUROL 2003;60:29-35)


ANDREAS PAPASSOTIROPOULOS, MD,
JOHANNES R. STREFFER, MD,
MAGDALINI TSOLAKI, MD,
SIMON SCHMID, MD,
ET AL,
BERN, SWITZERLAND

To view this abstract in
PubMed

click here!


NON-CONVENTIONAL THERAPIES FOR DEMENTIA


EDITORIAL
COMMENT

There is on-going debate about the role of herbal and non-conventional therapies for the treatment of dementia. What is not controversial is the need for more research and continuing medical education for physicians whose patients are already using these therapies. In an RCT with melantonin, Serfaty et al were unable to demonstrate any benefit for sleep in 25 dementia patients with significant sleep disturbances using actigraphy. Besides questions about efficacy, Dergal et al raised concerns about the safety of herbal preparations as well. In this study from a Memory Disorders Clinic in Toronto, investigators identified 11 potential herb-drug interactions in 195 patients over a six-week period. Finally, please consider reading an excellent review article on herbal remedies (De Smet. NEJM 2002;347[25]:2046-2056 -- refer to FAXBACK section. p. 12).

 

Double blind randomised placebo controlled trial of low dose melatonin for sleep disorders in dementia

(INT J GERIATR PSYCHIATRY 2002;117:1120-1127)


MARC SERFATY,
SANDRA KENNELL-WEBB,
JAMES WARNER,
ROBERT BLIZARD,
ET AL,
LONDON, UK

To view this abstract in
PubMed

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Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic

(DRUGS AGING 2002;19[11]:879-886)


JULIE M. KERGAL,
JENNIEFER L. GOLD,
DARA A. LAXER,
MONICA S.W. LEE,
ET AL,
TORONTO, ON

To view this abstract in
PubMed

click here!


NEUROPSYCHIATRIC SYMPTOMS IN MCI


EDITORIAL
COMMENT

In the first study of neuropsychiatric symptoms in Mild Cognitive Impairment (MCI), Lyketsos et al assessed subjects in the longitudinal Cardiovascular Health Study and compared symptoms to subjects with Alzheimer's disease. In general, there is significant neuropsychiatric symptom burden in MCI and prevalence of symptoms falls midway between subjects with Alzheimer's disease and normal controls.


Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study

(JAMA 2002;288[12]:1475-1483)


CONSTANTINE G. LYKETSOS, MD, MHS,
OSCAR LOPEZ, MD,
BEVERLY JONES, MD,
ANNETTE L. FITZPATRICK, PHD,
ET AL,
BALTIMORE, MD

To view this abstract in
PubMed

click here!


VAGUS NERVE STIMULATION


EDITORIAL
COMMENT
Sjögren et al described the first series of patients to utilize vagus nerve stimulation (VNS) to improve cognition in AD. This novel treatment involves implanting a stimulator attached to the left vagus nerve by a surgical procedure. The procedure and stimulator are approved for treatment of refractory seizure disorder, and have recently been investigated for the treatment of depression. The treatment is based on the clinical observation of improved mood and cognition in the VNS-treated seizure disorder patients and the fact that 80% of the left vagus nerve contains afferent fibres that directly and indirectly influence brain areas important for cognition and behaviour in AD. These investigators suggest seven of 10 subjects improved cognitively with side effects that were generally mild and transient.


Cognition-enhancing effect of vagus nerve stimulation in
patients with Alzheimer's disease: a pilot study

(J CLIN PSYCHIATRY 2002;63[11]:972-980)


MAGNUS J.C.SJÖGREN, MD, PHD,
PER T.O. HELLSTRÖM, M.A.
MICHAEL A.G. JONSSON, MD,
MAGNUS RUNNERSTAM, MD, PHD,
ET AL,
MÖLNDAL, SWEDEN

To view this abstract in
PubMed

click here!


EXECUTIVE CONTROL FUNCTION


EDITORIAL
COMMENT

Executive, or frontal systems impairment, is a key feature of many dementias and other neuropsychiatric illnesses. In a report from the Committee on Research of the American Neuropsychiatric Association, the authors review the history, anatomical substrates, assessment and treatment of executive control function.


Executive control function: a review of its promise and
challenges for clinical research: a report from the Committee
on Research of the American Neuropsychiatric Association

(J NEUROPSYCHIATRY CLIN NEUROSCI 2002;14:377-405)


DONALD R. ROYALL, MD,
EDWARD C. LAUTERBACH, MD,
JEFFREY L. CUMMINGS, MD,
ALLISON REEVE, MD,
ET AL,
SAN ANTONIO, TX

To view this abstract in
PubMed

click here!

 

SUGGESTED
ABSTRACTS


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

NEUROPSYCHAITRIC FEATURES OF FRONTOTEMPORAL DEMENTIA: EVALUATION OF CONSENSUS CRITERIA AND REVIEW

 

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