June 2000
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June 2000 international |
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alzheimer's
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IN THIS ISSUEDONEPEZIL IN MODERATE TO
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| EDITORIAL FOREWORD |
A report on the efficacy and safety of a cholinesterase inhibitor
in later stages of AD was presented at the 2000 meeting of the American
Academy of Neurology. This multinational study involving predominantly patients
from Canada has clearly established the value of cholinergic replacement
therapy in later stages of AD than previously believed possible. Of particular
note is the selection by investigators of outcomes relevant to this stage
of disease, namely the Severe Impairment Battery, the Disability Assessment
for Dementia and the Caregiver Stress Scale (data reported at the 2000 meetings
of the American Psychiatric Association and the American Geriatric Society). |
| HOWARD FELDMAN, SERGE GAUTHIER, JANE HECKER, BRUNO VELLAS, ET AL, SAN DIEGO, CA |
SORRY, THIS ABSTRACT IS UNAVAILABLE |
| EDITORIAL COMMENT |
There are good epidemiological reasons to believe that estrogen
replacement therapy (ERT) and anti-inflammatory drugs could slow down the
decline observable over one year in mild to moderate stages of AD. Unfortunately
the studies by Mulnard et al and Henderson et al for ERT,
by Aisen et al for prednisone, and Sainati et al for celecoxib
are negative. It's still possible that such an approach may slow the conversion
from Mild Cognitive Impairment to AD, since the disease-modifying possibilities
of these substances may occur at a point when the pathology isn't so advanced.
The broad issue of pharmacological intervention in AD has been reviewed
by Emilien et al. |
| RUTH A. MULNARD, RN, DNSC, CARL W. COTMAN, PHD, CLAUDIA KAWAS, MD, CHRISTOPHER H. VAN DYCK, MD, ET AL, VARIOUS CENTRES USA |
| V.W. HENDERSON, MD, MS, A. PAGANINI-HILL, PHD, B.L. MILLER, MD, R.J. ELBLE, MD, PHD, ET AL, VARIOUS CENTRES, USA |
| P.S. AISEN, MD, K.L. DAVIS, MD, J.D. BERG, MS, K. SCHAFER, MS, ET AL, VARIOUS CENTRES, USA |
| S.M. SAINATI, D.M. INGRAM, S. TALWALKER, G.S. GEIS, ET AL, SKOKIE, IL |
SORRY, THIS ABSTRACT IS UNAVAILABLE |
| GÉRARD EMILIEN, PHD, KONRAD BEYREUTHER, PHD, COLIN L. MASTERS, MD, JEAN-MARIE MALOTEAUX, MD, PHD, BRUSSELS, BELGIUM, HEIDELBERG, GERMANY, PARKVILLE, AUSTRALIA |
| EDITORIAL COMMENT |
While the cholinesterase inhibitors like donepezil (Aricept) have
traditionally been considered "cognitive enhancers," emerging data suggests
these medications have significant effects on behavioural disturbances (BD),
such as hallucinations and apathy. Cummings provides an exhaustive review
of the preliminary evidence supporting these claims, as well as describing
the theoretical basis for how the cholinergic system is involved in behaviour.
A more traditional approach to treatment of BD involves use of antipsychotics,
and Goldberg provides evidence of long-term effectiveness and tolerability
for risperidone. Finally, an important study by Cohen-Mansfield et al suggests
long-term use of pharmacotherapy for BD may not always be necessary and
attempts to decrease or discontinue these medications is worthwhile. |
| JEFFREY L. CUMMINGS, MD, LOS ANGELES, CA |
| R.J. GOLDBERG, PROVIDENCE, RI |
SORRY, THIS ABSTRACT IS UNAVAILABLE |
| JISKA COHEN-MANSFIELD, PHD, STEVEN LIPSON, MD, PERLA WERNER, PHD, NATHAN BILLIG, MD, ET AL, ROCKVILLE, MD, WASHINGTON, DC, HAIFA, ISRAEL |
| EDITORIAL COMMENT |
Behavioural disturbances (BD) have long been known to be a hallmark
of dementia with Lewy Bodies (DLB). In a prospective study, Ballard et
al document the dramatic prevalence of BD such as hallucinations, depression,
and delusional misidentifications in DLB. These disturbances were significantly
more common than in a matched group of patients with Alzheimer's disease. |
| BALLARD, MRC, PSYCH, MD, HOLMES, MRC PSYCH, PHD, IAN MCKEITH, FRC PSYCH, MD, DAVID NEILL, MRC, PSYCH, PHD, ET AL, LONDON, UK, NEWCASTLE UPON TYNE, UK |
THE FOLLOWING WEBSITES WERE JUDGED BY
THE EDITORS TO BE OF INTEREST.
Alzheimer Society of Canada http://www.alzheimer.ca
Alzheimer's Association http://www.alz.org
Alzheimer's Disease Education & Referral (ADEAR) Center http://www.alzheimers.org
