Supplement to MAYO CLINIC HEALTH LETTER OCTOBER 2008

Alzheimer’s diseas. New research brings hope.

You’ve misplaced your car keys — again. Family members keep mentioning conversations you don’t remember having. You’ve been finding it difficult to concentrate, and you’re more irritable than you used to be. You won­der if these changes are a normal part of aging or something more serious — Alzheimer’s disease.

Healthy microtubules the loss of intellectual and social abilities severe enough to interfere with within a neuron daily functioning. (See “Dementia and Alzheimer’s,” page 2.) The Alzheimer’s Association estimates that 5.2 million older Americans have Alzheimer’s. This number is expected to increase dramatically over the next few Tau molecules decades — potentially reaching 11 million to 16 million by 2050. Although there’s no cure for Alzheimer’s disease, researchers have made progress. Treatments are available that improve the quality of life for some people with Alzheimer’s, and more drugs are being studied. If you do have Alzheimer’s or another form of dementia, the sooner you’re evaluated and diagnosed.… [Continue Reading]

April 19, 2012 — Florbetapir (Amyvid, Eli Lilly/Avid Radiopharmaceuticals), a new agent to detect beta-amyloid plaques in living patients with possible Alzheimer’s disease (AD), has just been approved by the US Food and Drug Administration (FDA). The question now is how this imaging option will be used in practice.

Although they are for the most part enthusiastically awaiting access to this new agent, expected to be available by June, many neurologists are also striking a cautionary note. Cost, availability, the need for expert interpretation of scans using the florbetapir tracer, and what it really means for a diagnosis of AD are a few of the concerns being raised.

Medscape Medical News polled experts in the field of AD to see how they view the approval and how they see this diagnostic tool may fit into their clinical practice.… [Continue Reading]

During 1 year of follow-up, MMSE scores and activities-of-daily-living scores indicated deterioration in all four groups. Patients who continued donepezil alone had significantly less deterioration on these scores than patients who stopped donepezil; the MMSE difference of 2 points was considered clinically important by prespecified criteria. Memantine was also associated with statistically less deterioration than no memantine on both scores, but differences were small and not considered clinically important. Adding memantine to donepezil had no benefit over donepezil monotherapy. Neither drug significantly influenced important secondary outcomes: caregivers’ assessment of patients’ quality of life and caregivers’ own psychological symptoms.

After several years of treatment with donepezil, patients with moderate-to-severe Alzheimer disease appeared to derive cognitive benefit from continuing this drug; substituting or adding memantine was not fruitful. However, neither drug significantly affected outcomes that are important from the caregiver’s perspective. Drug therapies for AD clearly have some measurable benefits, but their overall impact on most patients and families remains limited.

References

• Howard R et al. Donepezil and memantine for moderate-to-severe Alzheimer’s disease. N Engl J Med 2012 Mar 8; 366:893.