June 1998   international   abstracts:   home   transplantation

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IN THIS ISSUE PREVENTION OF ALZHEIMER'S DISEASE NSAIDs may slow cognitive decline Estrogens may reduce risk of dementia Trial designs for slowing down progression or prevent AD are feasible TRIAL DESIGNS TO PROVE SLOWING OF ALZHEIMER'S DISEASE PROGRESSION Clinical trial designs may measure disease progression Signs that may show the beginning of hippocampal atrophy Tests do not show which patients will become demented DIFFERENTIAL DIAGNOSIS OF ALZHEIMER'S DISEASE Action versus object naming Implicit versus explicit memory Role for videopupillography Role of APOE genotyping as adjunct to clinical criteria THE COST OF ALZHEIMER'S DISEASE Small effects on MMSE can lead to substantial cost savings Early treatment with tacrine results in lower costs than a later start

EDITORIAL FOREWORD

PREVENTION OF ALZHEIMER'S DISEASE Z. Katchaturian has proposed that delaying the emergence of symptoms of Alzheimer's Disease (AD) by five years would reduce by half the prevalence of this disorder. Converging epidemiologic observations suggest that estrogens and nonsteroidal antiinflammatory drugs could delay the appearance of AD or its progression. Yaffe et al and Prince et al have reviewed these issues in dept and conclude that controlled clinical trials are indicated before these agents are used widely for the prevention of AD. Such trials will be facilitated by study groups, such as the one led by L. Thal, who has been studying the methodology for such studies, and the availability of nonfeminizing estrogen receptor agonists as well as selective COX-2 inhibitors.

Do antiarthritic drugs decrease the risk for cognitive decline? An analysis
based on data from the MRC Treatment Trial of Hypertension in Older Adults

Estrogen therapy in postmenopausal women:
Effects on cognitive function and dementia

Potential prevention strategies for Alzheimer disease

TRIAL DESIGNS TO PROVE SLOWING OF ALZHEIMER'S DISEASE PROGRESSION

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EDITORIAL COMMENT

Various trial designs are available to prove slowing of disease progression, from the randomized withdrawal design proposed by P. Leber and supported by the Harmonization of Dementia Drug Guidelines group to the time to reach endpoints such as diagnosable dementia (Bowen et al). In either case, surrogate variables such as hippocampal atrophy will be useful (Fox et al).

Protocols to demonstrate slowing of Alzheimer disease progression: Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines

Progression to dementia in patients with isolated memory loss

Presymptomatic hippocampal atrophy in Alzheimer's disease:
A longitudinal MRI study

DIFFERENTIAL DIAGNOSIS OF
ALZHEIMER'S DISEASE

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EDITORIAL COMMENT

The following abstracts are representative of the fields of neuropsychology, clinical tests and biological markers. Cappa et al have established that object versus action naming can help distinguish between AD and frontotemporal dementia, whereas Mouly et al have shown that implicit versus explicit memory testing can help distinguish these conditions from dementia with Lewy bodies. Ferrario et al report that the much popularized videopupillography test for AD is not useful (a strong accompanying editorial by H.R. Kardon, Neurology 1998;50:588, after reviewing all the published evidence, says to "leave the eye drops in the bottle"). Finally, a large Consortium of US scientists led by R. Mayeux reaffirms that apoE genotyping is not to be used as a diagnostic test for AD without adequate clinical evidence.

Object and action naming in Alzheimer's disease
and frontotemporal dementia

Implicit and explicit memory in Alzheimer's disease,
fronto-temporal dementia and dementia with Lewy bodies

Is videopupillography useful in the diagnosis of Alzheimer's disease?

Utility of the apolipoprotein E genotype in the
diagnosis of Alzheimer's disease

THE COST OF ALZHEIMER'S DISEASE

EDITORIAL COMMENT

As new drugs such as donepezil become available for the treatment of symptoms of AD, the debate as to the cost-utility of such drugs is raging. Models are being developed such as the one reported by Ernst et al. Data from Sweden based on the use of tacrine demonstrate a beneficial but modest effect on the cost of AD. These issues will be discussed in depth at the 1st International Pharmacoeconomic Conference on Alzheimer's Disease, Amsterdam, July 17th 1998, chaired by Drs. B. Winblad and P. Whitehouse.

Cognitive function and the costs of Alzheimer disease:
An exploratory study

Treatment of Alzheimer disease with tacrine: a cost-analysis model