early intervention for Alzheimer's disease
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Management
2001 recommendations of the American Academy of Neurology:*[1]
- cholinesterase inhibitors not cost-effective
- donepezil, galantamine or rivastigmine
- studies show small average degree of benefit
- vitamin E 1000 IU BID is NOT useful (see alpha-tocopherol)
- L-deprenyl (Selegiline) 5 mg BID may be substituted for vit E[4], insufficent evidence to recommend Selegiline[5]
- Ginkgo biloba of uncertain benefit
- no benefit in prevention of Alzheimer's disease
- avoid atypical antipsychotics for agitation (see 8,9 below & psychosis & agitation in the elderly)
- estrogen
- NOT currently indicated for prevention or treatment of Alzheimer's disease or other dementias[1][2][6]
Other (after 2001)
- neither rofecoxib 25 mg QD[3][4] nor naproxen 220 mg BID[3] affect cognitive decline over a 1 year period in patients with mild to moderate AD[3]
- risperidone, olanzapine no better than haloperidol & no less likely to cause adverse effects[7]
- antipsychotics associated with increased mortality[8][9]
- Mediterranean diet reduces mortality[11] & may reduce the risk of dementia as well help maintain global cognitive function[12]
- exercise of benefit (see exercise & Alzheimer's disease)
- adequate sleep may preserve cognition in preclinical & early symptomatic AD[13]
* original recommendations modified with new data
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Prescriber's Letter 8(7):40 2001 Doody RS et al, Practice Parameter: management of dementia (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology, Neurology 56:1154-1156, 2001 (Guideline withdrawn 02/2009) PMID: https://www.ncbi.nlm.nih.gov/pubmed/11342679 Seshardi et al, Postmenopausal estrogen replacement therapy and the risk of Alzheimer's diseaase, Arch Neurol 58(3):435, 2001
- ↑ 2.0 2.1 Prescriber's Letter 10(6):33 2003 Journal Watch 23(13):101, 2003 Shumaker SA et al, JAMA 289: 2651, 2003 Rapp SR et al, JAMA 289:2663, 2003 Wassertheil-Smoller S et al, JAMA 289:2673, 2003 Yaffe K, JAMA 289:2717, 2003
- ↑ 3.0 3.1 3.2 3.3 Journal Watch 23(14):108, 2003 Aisen PS et al, JAMA 289:2819, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12783912
- ↑ 4.0 4.1 4.2 Journal Watch 24(4):34, 2004 Reines SA t al, Neurology 62:66, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14718699
- ↑ 5.0 5.1 Delagarza VW et al, Am Fam 68:1365, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14567491
- ↑ 6.0 6.1 Estrogen-Alone Hormone Therapy Could Increase Risk of Dementia in Older Women (ADEAR News release) http://www.alzheimers.org/nianews/nianews66.html
- ↑ 7.0 7.1 Journal Watch 24(17):133, 2004 Lee PE, Gill SS, Freedman M, Bronskill SE, Hillmer MP, Rochon PA. Atypical antipsychotic drugs in the treatment of behavioural and psychological symptoms of dementia: systematic review. BMJ. 2004 Jul 10;329(7457):75. Epub 2004 Jun 11. Review. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15194601 <Internet> http://bmj.bmjjournals.com/cgi/content/full/329/7457/75
- ↑ 8.0 8.1 FDA Public Health Advisory Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances http://www.fda.gov/cder/drug/advisory/antipsychotics.htm http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#atypical
- ↑ 9.0 9.1 Wang PS, Schneeweiss S, Avorn J, Fischer MA, Mogun H, Solomon DH, Brookhart MA. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. N Engl J Med. 2005 Dec 1;353(22):2335-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319382
Ray WA. Observational studies of drugs and mortality. N Engl J Med. 2005 Dec 1;353(22):2319-21. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16319379 - ↑ Kaduszkiewicz H et al Cholinesterase inhibitors for patients with Alzheimer's disease: Systematic review of randomised clinical trials. BMJ 2005 Aug 6; 331:321-7. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16081444 <Internet> http://bmj.bmjjournals.com/cgi/content/full/331/7512/321
- ↑ 11.0 11.1 Scarmeas N et al, Mediterranean diet and Alzheimer's disease mortality. Neurology 2007, 69:1084 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17846408
Galvin JE Pass the grain; spare the brain. Neurology 2007, 69:1072 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17846407
Scarmeas N, Stern Y, Tang MX Mediterranean diet and risk for Alzheimer's disease. Ann Neurol. 2006 Jun;59(6):912-21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16622828 - ↑ 12.0 12.1 Scarmeas N et al. Physical activity, diet, and risk of Alzheimer disease. JAMA 2009 Aug 12; 302:627. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671904
Feart C et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009 Aug 12; 302:638. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671905
Knopman DS. Mediterranean diet and late-life cognitive impairment: A taste of benefit. JAMA 2009 Aug 12; 302:686. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19671912 - ↑ 13.0 13.1 Lucey BP, Wisch J, Boerwinkle AH et al Sleep and longitudinal cognitive performance in preclinical and early symptomatic Alzheimer's disease. Brain, Volume 144, Issue 9, September 2021, Pages 2852-2862 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34668959 PMCID: PMC8536939 (available on 2022-10-20) https://academic.oup.com/brain/article-abstract/144/9/2852/6401973