Dec 1997

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IN THIS ISSUE

DIFFERENTIAL DIAGNOSIS OF ALZHEIMER'S DISEASE

  • Is it dementia?
  • Corticobasal degeneration overlaps with other degenerative disorders
  • Pick's disease is underdiagnosed in clinical practice

NATURAL HISTORY OF ALZHEIMER'S DISEASE

  • Comparing the evolution of AD, vascular dementia and mixed dementia
  • AD associated with extrapyramidal signs has greater cognitive and functional impairment
  • Predicting time to institutionalization

TREATING ALZHEIMER'S

  • Donepezil delays loss of activities of daily living
  • Selegiline or alpha -- tocopherol slows progression
  • Xanomeline improves cognitive function
  • A randomized controlled trial of Linopirdine
  • Does participation in clinical trials affect long-term outcome in AD?

MISCELLANEOUS

  • Elderly patients and vitamin E: an immune system boost?

PREVENTION AND EARLY DETECTION

EDITORIAL FOREWORD It is with great pleasure that I welcome you to the first issue of International Abstracts on Alzheimer's Disease. I plan to update readers on recent advances in the research on the causes and treatments of Alzheimer's disease (AD). Such an initiative is timely as new medications for the symptomatic treatment of AD are becoming available for general prescription use. This will increase the interest in early diagnosis and provide impetus for improvement in disease management at all stages of disease progression. This first issue will look at highlights of recently published reports on differential diagnosis, natural history and treatments of AD. Additional abstracts are available from the FAX-back section.

 

DIFFERENTIAL DIAGNOSIS OF
ALZHEIMER DISEASE


EDITORIAL COMMENT: The article by Gelbacher and Whitehouser, from a supplement of Neurology, edited by S. DeKosky on Managing Alzheimer's disease, is a short and well-referenced review of diagnostic issues in AD. There are also recent publications on the differentiation between AD and cortico-basal ganglionic degeneration (Schneider et al), and from Pick's disease (Litvan et al).

Differential diagnosis of Alzheimer's disease

(NEUROLOGY 1997;48(SUPPL 6):S2-S9)
DAVID S. GELDMACHER, MD,
PETER J. WHITEHOUSE, Jr, MD, PHD, CLEVELAND, OH

To view abstract in
PubMed

Corticobasal degeneration: Neuropathologic and clinical heterogeneity

(NEUROLOGY 1997;48:959-969)
J.A. SCHNEIDER, MD,
R.L. WATTS, MD,
M. GEARING, PHD,
R.P. BREWER, MD,
S.S. MIRRA, MD,
ATLANTA, GA

To view abstract in
PubMed

What are the obstacles for an accurate clinical diagnosis of Pick's disease? A clinicopathologic study

(NEUROLOGY 1997;49:62-69)
I. LITVAN, MD,
Y. AGID, MD, PHD,
N. SASTRJ, BS,
J. JANKOVIC, MD,
ET AL,
PARIS, FRANCE,
LONDON, UK,
VARIOUS CENTRES, USA

To view abstract in
PubMed

NATURAL HISTORY OF ALZHEIMER DISEASE


EDITORIAL COMMENT: There is great interest in knowing the natural history of AD, vascular disease and mixed dementia, as new treatments are being tested to slow down the expected decline. Bowler et al report on the University of Western Ontario registry, whereas Clark et al and Heyman et al report from the CERAD data base. A canadian initiative led by Drs Howard Feldman and Ken Rockwood is also building a country-wide data base, under the MRC/PMAC Health Program funded ACCORD project.

Comparative evolution of Alzheimer disease, vascular dementia, and mixed dementia

(ARCH NEUROL 1997;54:697-703)
JOHN V. BOWLER, MB, MD, MRCP,
MICHAEL ELIASZIW, PHD,
RUNA STEENHUIS, PHD,
DAVID G. MUNOZ, MD, FRCPC,
ET AL,
LONDON, ON

The relationship between extrapyramidal signs and cognitive performance in patients with Alzheimer's disease enrolled in the CERAD study

NEUROLOGY 1997;49:70-75)
C.M. CLARK, MD,
D. EWBANK, PHD,
A. LERNER, MD,
R. DOODY, MD, PHD,
ET AL,
AND THE CERAD COLLABORATORS,
VARIOUS CENTRES, USA

To view abstract in
PubMed

Predictors of time to institutionalization of patients with Alzheimer's disease: THE CERAD experience, Part XVII

(NEUROLOGY 1997;48:1304-1309)
A. HEYMAN, MD,
B. PETERSON, PHD,G. FILLENBAUM, PHD,C. PIEPER, DRPH,
DURHAM, NC

To view abstract in
PubMed

TREATMENTS FOR ALZHEIMER DISEASE


EDITORIAL COMMENT: Using the activities of daily living (ADL) domains of the Clinical Dementia Rating scale, Friedhoff and Rogers found that the cholinesterase inhibitor donepezil delays loss of ADL abilities. A similar "time to substantial loss" approach was used by Sano et al in the use of selegiline and tocopherol. Bodick et al report about the clinical efficacy of the muscarinic agonist xanomeline on cognitive function, ADL and disturbing behaviors, although gastro-intestinal side-effects and syncope at therapeutic dose caused many drop-outs. Negative results regarding the efficacy of linopirdine, an acetylcholine releasing agent, were reported by Rockwood et al. These results are compounded by the fact that participation in clinical trials per se has a therapeutic benefit, as demonstrated by Albert et al.

Donepezil lengthens time to loss of activities of daily living in patients with mild to moderate Alzheimer's disease -- results of a preliminary evaluation

(NEUROLOGY 1997;48:PA100)
LAWRENCE FRIEDHOFF,
SHARON L. ROGERS,
TEANECK, NJ

Sorry,
This abstract not available for hyperlinking

.

A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease

(N ENGL J MED 1997;336:1216-1222)
MARY SANO, PHD,
CHRISTOPHER ERNESTO, MS,
RONALD G. THOMAS, PHD,
MELVILLE R. KLAUBER, PHD,ET AL,
FOR THE MEMBERS OF THE ALZHEIMER'S DISEASE COOPERATIVE STUDY,
VARIOUS CENTRES, USA

Effects of xanomeline, a selective muscarinic receptor agonist, on cognitive function and behavioral symptoms in Alzheimer disease

(ARCH NEUROL 1997;54:465-473)
NEIL C. BODICK, MD, PHD,
WALTER W. OFFEN, PHD,
ALLAN I. LEVEY, MD, PHD,
NEAL R. CUTLER, MD,
ET AL,
VARIOUS CENTRES, USA
VERDUN, QC

A randomized, controlled trial of linopirdine in the treatment of Alzheimer's disease

(CAN J NEUROL SCI 1997;24:140-145)
KENNETH ROCKWOOD,
B. LYNN BEATTIE,
M. ROBIN EASTWOOD,
HOWARD FELDMAN,
ET AL,
VARIOUS CENTRES, CANADA

Participation in clinical trials and long-term outcomes in Alzheimer's disease

(NEUROLOGY 1997;49:38-43)
S.M. ALBERT, PHD,
M. SANO, PHD,
K. MARDER, MD,
D.M. JACOBS, PHD,
ET AL,
NEW YORK, NY,
BALTIMORE, MD,
BOSTON, MA

To view abstract in
PubMed

MISCELLANEOUS

Vitamin E supplementation and in vivo immune response in health elderly subjects: a randomized controlled trial

(JAMA 1997;277:1380-1386)
SIMIN NIKBIN MEYDANI, DVM, PHD,
MOHSEN MEYDANI, DVM, PHD,
JEFFREY B. BLUMBERG, PHD,
LYNETTE S. LEKA,
ET AL,
BOSTON,
MA
To view abstract in
PubMed