Neuroscience
This week's Journal of the American Medical Association includes a clinical review about current knowledge of dementia in the presence of both probable Alzheimer disease and cerebrovascular disease, including neuropsychological and behavioral information, as well as a discussion of potential medications.
- Neuropsychology Abstract Of The Day: Cognitive Function In 95-year-olds
Börjesson-Hanson A, Gustafson D, & Skoog I. Five-year mortality in relation to dementia and cognitive function in 95-year-olds. Neurology. 2007 Nov 27; 69(22): 2069-2075. Neuropsychiatric Epidemiology Unit, Psychiatry Section, Institute of Neuroscience...
- Fda: Alzheimer Disease, Aricept (donepezil Hydrochloride)
From the FDA last week: FDA Approves Expanded Use of Treatment for Patients With Severe Alzheimer's Disease FOR IMMEDIATE RELEASE P06-168 October 13, 2006 Media Inquiries: Susan Cruzan, 301-827-6242 Consumer Inquiries: 888-INFO-FDA...
- Abstract Of The Day: Gingko Biloba And Dementia Prevention
DeKosky ST, Fitzpatrick A, Ives DG, Saxton J, Williamson J, Lopez OL, Burke G, Fried L, Kuller LH, Robbins J, Tracy R, Woolard N, Dunn L, Kronmal R, Nahin R, & Furberg C; for the GEMS Investigators. The Ginkgo Evaluation of Memory (GEM) study: Design...
- Abstract Of The Day: Caregiver Rating Scale In Alzheimer Disease
Harvey PD, Moriarty PJ, Kleinman L, Coyne K, Sadowsky CH, Chen M, & Mirski DF. The validation of a caregiver assessment of dementia: the Dementia Severity Scale. Alzheimer Disease and Associated Disorders. 2005 Oct-Dec; 19(4): 186-194. OBJECTIVE: The...
- Abstract Of The Day: Alzheimer Disease Drug Treatments
Birks J. Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database Syst Rev. 2006 Jan 25; (1): CD005593. BACKGROUND: Since the introduction of the first cholinesterase inhibitor (ChEI) in 1997, most clinicians and probably most patients...
Neuroscience
Mixed Dementia
This week's Journal of the American Medical Association includes a clinical review about current knowledge of dementia in the presence of both probable Alzheimer disease and cerebrovascular disease, including neuropsychological and behavioral information, as well as a discussion of potential medications.
Mixed Dementia: Emerging Concepts and Therapeutic Implications
Kenneth M. Langa, MD, PhD; Norman L. Foster, MD; Eric B. Larson, MD, MPH
JAMA. 2004; 292: 2901-2908.
Context The prevalence of mixed dementia, defined as the coexistence of Alzheimer disease (AD) and vascular dementia (VaD), is likely to increase as the population ages.
Objectives To provide an overview of the diagnosis, pathophysiology, and interaction of AD and VaD in mixed dementia, and to provide a systematic literature review of the current evidence for the pharmacologic therapy of mixed dementia.
Data Sources, Study Selection, and Data Extraction The Cochrane Database of Systematic Reviews was searched using the keyword dementia. MEDLINE was searched for English-language articles published within the last 10 years using the keywords mixed dementia, the combination of keywords Alzheimer disease, cerebrovascular disorders, and drug therapy, and the combination of keywords vascular dementia and drug therapy.
Evidence Synthesis Dementia is more likely to be present when vascular and AD lesions coexist, a situation that is especially common with increasing age. The measured benefits in clinical trials for the treatment of mixed dementia are best described as statistically significant differences in cognitive test scores and clinician and caregiver impressions of change. In these studies, the control groups’ scores typically decline while the treatment groups improve slightly or decline to a lesser degree over the study period. Nevertheless, even the patients who experience treatment benefits eventually decline. Cholinesterase inhibitor (ChI) therapy for mixed dementia shows modest clinical benefits that are similar to those found for ChI treatment of AD. The N-methyl-D-aspartate (NMDA) antagonist memantine also shows modest clinical benefits for the treatment of moderate to severe AD and mild to moderate VaD, but it has not been studied specifically in mixed dementia. The treatment of cardiovascular risk factors, especially hypertension, may be a more effective way to protect brain function as primary, secondary, and tertiary prevention for mixed dementia.
Conclusions Currently available medications provide only modest clinical benefits once a patient has developed mixed dementia. Cardiovascular risk factor control, especially for hypertension and hyperlipidemia, as well as other interventions to prevent recurrent stroke, likely represent important strategies for preventing or slowing the progression of mixed dementia. Additional research is needed to define better what individuals and families hope to achieve from dementia treatment and to determine the most appropriate use of medication to achieve these goals.
- Neuropsychology Abstract Of The Day: Cognitive Function In 95-year-olds
Börjesson-Hanson A, Gustafson D, & Skoog I. Five-year mortality in relation to dementia and cognitive function in 95-year-olds. Neurology. 2007 Nov 27; 69(22): 2069-2075. Neuropsychiatric Epidemiology Unit, Psychiatry Section, Institute of Neuroscience...
- Fda: Alzheimer Disease, Aricept (donepezil Hydrochloride)
From the FDA last week: FDA Approves Expanded Use of Treatment for Patients With Severe Alzheimer's Disease FOR IMMEDIATE RELEASE P06-168 October 13, 2006 Media Inquiries: Susan Cruzan, 301-827-6242 Consumer Inquiries: 888-INFO-FDA...
- Abstract Of The Day: Gingko Biloba And Dementia Prevention
DeKosky ST, Fitzpatrick A, Ives DG, Saxton J, Williamson J, Lopez OL, Burke G, Fried L, Kuller LH, Robbins J, Tracy R, Woolard N, Dunn L, Kronmal R, Nahin R, & Furberg C; for the GEMS Investigators. The Ginkgo Evaluation of Memory (GEM) study: Design...
- Abstract Of The Day: Caregiver Rating Scale In Alzheimer Disease
Harvey PD, Moriarty PJ, Kleinman L, Coyne K, Sadowsky CH, Chen M, & Mirski DF. The validation of a caregiver assessment of dementia: the Dementia Severity Scale. Alzheimer Disease and Associated Disorders. 2005 Oct-Dec; 19(4): 186-194. OBJECTIVE: The...
- Abstract Of The Day: Alzheimer Disease Drug Treatments
Birks J. Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database Syst Rev. 2006 Jan 25; (1): CD005593. BACKGROUND: Since the introduction of the first cholinesterase inhibitor (ChEI) in 1997, most clinicians and probably most patients...