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You are here: Home / Archives for Alzheimer Disease

Alzheimer Disease Treatment & Management

To date, only symptomatic therapies for Alzheimer disease (AD) are available. All drugs approved by the US Food and Drug Administration (FDA) for the treatment of AD modulate neurotransmitters, either acetylcholine or glutamate. The standard medical treatment for AD includes cholinesterase inhibitors (ChEIs) and a partial N -methyl-D-aspartate (NMDA) antagonist.[65] [66]

Secondary symptoms of AD (eg, depression, agitation, aggression, hallucinations, delusions, sleep disorders) can be problematic. Behavioral symptoms in particular are common and can exacerbate cognitive and functional impairment. The following classes of psychotropic medications have been used to treat these secondary symptoms[67] :

  • Antidepressants
  • Anxiolytics
  • Antiparkinsonian agents
  • Beta-blockers
  • Antiepileptic drugs (for their effects on behavior)
  • Neuroleptics

Most studies of psychotropic drugs for AD have demonstrated no or limited efficacy. However, many issues make interpretation of data from these studies difficult.… [Continue Reading]

Filed Under: Alzheimer Disease

Alzheimer Disease

Alzheimer disease (AD) is an acquired disorder of cognitive and behavioral impairment that markedly interferes with social and occupational functioning. It is an incurable disease with a long and progressive course. AD not only has detrimental effects on the patient but often takes a significant toll on patients’ families and caretakers as well.

The most common form of dementia, AD affects about 5.4 million people in the United States alone, and that number is projected to reach 12-16 million by the year 2050[1] (see Epidemiology). Economically, AD is a major public health problem. In the United States in 2011, the cost of health care, long-term care, and hospice services for people aged 65 years and older with AD and other dementias was expected to be $183 billion, and this figure does not include the contributions of unpaid caregivers.[1]

Currently, an autopsy or brain biopsy is the only way to make a definitive diagnosis of AD. In clinical practice, the diagnosis is usually made on the basis of the history and findings on Mental Status Examination (see Presentation).

Symptomatic therapies are the only treatments available for AD. The standard medical treatments include cholinesterase inhibitors and a partial N -methyl-D-aspartate (NMDA) antagonist. Psychotropic medications are often used to treat secondary symptoms of AD, such as depression, agitation, and sleep disorders.… [Continue Reading]

Filed Under: Alzheimer Disease

Alzheimer’s disease – New research brings hope

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]

Filed Under: Alzheimer Disease

Florbetapir Approved: Now How Do We Use It?

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]

Filed Under: Alzheimer Disease

Managing Drug Therapies as Alzheimer Disease Progresses

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.

Filed Under: Alzheimer Disease

Discontinuing Donepezil or Starting Memantine for Alzheimer’s Disease

Lon S. Schneider, M.D.
N Engl J Med 2012; 366:957-959

Donepezil, the most frequently prescribed cholinesterase inhibitor for the treatment of Alzheimer’s disease, was marketed in 1997 on the basis of the results of 3-month and 6-month clinical trials showing that patients had improvements in cognitive test scores and in the ability to perform daily activities, and subsequent trials indicated that the drug had efficacy over the course of 1 to 2 years.About half of the patients who are prescribed cholinesterase inhibitors, however, discontinue them within a year, apparently because of a perceived lack of efficacy and adverse effects such as anorexia, weight loss, agitation, bradycardia, and syncope.… [Continue Reading]

Filed Under: Alzheimer Disease

Medical Food May Improve Cognition in Alzheimer’s

By Deborah Brauser

March 20, 2012 (Washington, DC) — AC-1202 (Axona, Accera Inc) may help improve practical cognitive tasks in patients with Alzheimer’s disease (AD), new research suggests.

In an analysis from a randomized controlled trial of elderly patients with mild to moderate AD, those who received AC-1202 for 90 days showed significantly higher performance improvement scores on constructional praxis/drawing tasks than the patients who received placebo.

In addition, the improvements persisted for 2 weeks after last administration.

“This suggests real-world benefit,” principal investigator David W. Crumpacker, MD, adult and geriatric psychiatrist in private practice in Plano, Texas, and former assistant chief of psychiatry at Baylor Medical Center in Dallas, told Medscape Medical News.… [Continue Reading]

Filed Under: Alzheimer Disease

A New Biomarker of Cognitive Decline in Alzheimer’s

by Megan Brooks

March 8, 2012 — In a study of patients with very mild Alzheimer’s disease (AD), baseline levels of visininlike protein 1 (VILIP-1) in cerebrospinal fluid (CSF) strongly predicted the rate of cognitive decline over roughly 3 years, report researchers at Washington University School of Medicine in St. Louis.

Memory and other cognitive abilities declined faster in patients with the highest levels of VILIP-1, a neuronal calcium-sensor protein that is a sign of neuronal injury.

“VILIP-1 appears to be a strong indicator of ongoing injury to brain cells as a result of Alzheimer’s disease,” lead author Rawan Tarawneh, MD, now an assistant professor of neurology at the University of Jordan, in Amman, said in a statement. “That could be very useful in predicting the course of the disease and in evaluating new treatments in clinical trials.”… [Continue Reading]

Filed Under: Alzheimer Disease

The Clinical Use of Structural MRI in Alzheimer Disease

Giovanni B. Frisoni; Nick C. Fox; Clifford R. Jack; Philip Scheltens; Paul M. Thompson

Structural imaging based on magnetic resonance is an integral part of the clinical assessment of patients with suspected Alzheimer dementia. Prospective data on the natural history of change in structural markers from preclinical to overt stages of Alzheimer disease are radically changing how the disease is conceptualized, and will influence its future diagnosis and treatment. Atrophy of medial temporal structures is now considered to be a valid diagnostic marker at the mild cognitive impairment stage. Structural imaging is also included in diagnostic criteria for the most prevalent non-Alzheimer dementias, reflecting its value in differential diagnosis. In addition, rates of whole-brain and hippocampal atrophy are sensitive markers of neurodegeneration, and are increasingly used as outcome measures in trials of potentially disease-modifying therapies. Large multicenter studies are currently investigating the value of other imaging and nonimaging markers as adjuncts to clinical assessment in diagnosis and monitoring of progression. The utility of structural imaging and other markers will be increased by standardization of acquisition and analysis methods, and by development of robust algorithms for automated assessment.… [Continue Reading]

Filed Under: Alzheimer Disease

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