Гинго билоба не эффективен в профилактике болезни Альгеймера

Another large trial shows no benefit from ginkgo biloba extract in preventing Alzheimer disease, researchers report in the Lancet Neurology.

Nearly 2900 older adults without dementia who spontaneously reported memory complaints to their physicians were randomized to consume standardized ginkgo biloba extract or placebo for 5 years. Overall, the rate of diagnosis with probable Alzheimer's did not differ significantly between the ginkgo and placebo groups (1.2 and 1.4 cases per 100 person-years).

The authors note that a lower-than-expected Alzheimer's rate in both groups reduced the study's power, while a Lancet Neurology editorialist concludes: "For adults aged 70 years or older with a memory complaint who might be mildly cognitively impaired, use of [ginkgo biloba extract] does not decrease the risk of Alzheimer's disease over 5 years.

 Ginkgo Biloba: No-Go for Alzheimer's Prevention

Назначение антидепрессантов при депрессивной симптоматике в рамках деменций не целесообразно

Antidepressants may provide little benefit but appear to increase adverse side effects in individuals with dementia and comorbid depression, suggesting that clinicians should reconsider use of these agents in this population, new research suggests.

Antidepressants of Little Use in Dementia Patients

Малые дозы лития могут предупреждать проблемы с памятью при болезни Альцгеймера

Low-dose lithium appears to slow the progression of memory loss and cognitive decline in individuals with amnestic mild cognitive impairment (aMCI), a significant risk factor for Alzheimer's disease (AD), a new study suggests.

A randomized, placebo-controlled trial showed treatment with lithium, an old drug historically used to treat bipolar disorder (BD) and major depression, was associated with a significant decrease in cerebrospinal fluid (CSF) concentrations of phosphorylated tau (P-tau) and better cognitive performance in individuals with aMCI. Furthermore, the drug was well tolerated and had a side effect profile similar to placebo.

Old Drug May Hold New Promise in Alzheimer's Disease

H2-блокаторы не снижают риск возникновения деменции и болезни Альгеймера

To examine whether histamine-2 receptor antagonist medications (H2RAs) are associated with a lower incidence of all-cause dementia or Alzheimer's disease (AD), as some studies have suggested.
Design: Prospective population-based cohort
Setting: Group Health, an integrated health maintenance organization, Seattle, Washington.
Participants: Two thousand nine hundred twenty-three participants aged 65 and older without dementia at baseline, with initial recruitment between 1994 and 1996.
Measurements: Follow-up occurred every 2 years to identify incident dementia and AD using standard criteria. Exposure to H2RAs was determined based on automated pharmacy data. Three aspects of exposure (time-varying) were examined based on standard daily dose (SDD): cumulative use, intensity of use (highest SDD in any prior 2-year window), and cumulative use stratified according to recency (1–3 years vs >3 years before).
Results: Over a mean follow-up of 6.7 years, 585 subjects developed dementia (453 developed AD). Total cumulative exposure was not associated with dementia (P=.35; omnibus test) or AD (P=.23). The adjusted hazard ratios for the highest exposure category (>1,080 SDDs) compared with light or no use were 1.28 (95% confidence interval (CI)=0.95–1.72) for dementia and 1.41 (95% CI=1.00–1.97) for AD. Intensity of use was not associated with dementia (P=.39) or AD (P=.63). Examining exposure according to recent and distant cumulative use also showed no association with dementia (P=.11) or AD (P=.30).
Conclusion: No association was found between H2RA use and risk of all-cause dementia or AD using more-detailed and -extensive information about past H2RA use than any prior study.

Histamine-2 Receptor Antagonist Use and Incident Dementia in an Older Cohort

Женьшень и когнитивные функции

There is a lack of convincing evidence to show a cognitive-enhancing effect of Panax ginseng in healthy people and no high-quality evidence about its efficacy in patients with dementia, according to a report published online December 8 in the Cochrane Database of Systematic Reviews.

"Ginseng appeared to have some beneficial effects on cognition, behavior, and quality of life. However, at present, recommendations of continuing taking or stopping cannot be made due to lack of high-quality evidence," first study author JinSong Geng, of the Evidence-based Medicine Center, Medical School of Nantong University in Jiangsu, China, told Medscape Medical News.

Evidence That Ginseng Boosts Brain Function 'Not Convincing'

Свекла, нитраты и мозг

Drinking beet juice increases blood flow to the brain in older people, a finding that suggests the dark red vegetable may fight the progression of dementia, a new study shows.

Beet roots contain high concentrations of nitrates, which are converted into nitrites by bacteria in the mouth. And nitrites help open blood vessels in the body, increasing blood flow and oxygen to places lacking in oxygen.

Previous studies have shown that nitrites -- also found in high concentrations in celery, cabbage, and other leafy, green vegetables like spinach -- widen blood vessels, but researchers say this was the first to find that nitrites also increase blood flow to the brain.

Beet Juice Good for Brain

Смертность пациентов с деменцией получающих антипсихотические препараты

They found that no antipsychotic was associated with greater long-term mortality, but that haloperidol, olanzapine, and risperidone, but not quetiapine, were associated with a short-term increase in mortality during the first 30 days of prescribing.

Are Commonly Prescribed Antipsychotics Associated With Greater Mortality in Patients With Dementia?

Ингибиторы ацетилхолинэстеразы при зрительных галлюцинациях

Background

Visual hallucinations occur in various neurological diseases, but are most prominent in Lewy body dementia, Parkinson's disease and schizophrenia. The lifetime prevalence of visual hallucinations in patients with schizophrenia is much more common than conventionally thought and ranges from 24% to 72%. Cortical acetylcholine (ACh) depletion has been associated with visual hallucinations; the level of depletion being related directly to the severity of the symptoms. Current understanding of neurobiological visual processing and research in diseases with reduced cholinergic function, suggests that AChEI's may prove beneficial in treating visual hallucinations. This offers the potential for targeted drug therapy of clinically symptomatic visual hallucinations in patients with schizophrenia using acetylcholinesterase inhibition.
Methods

A systematic review was carried out investigating the evidence for the effects of AChEI's in treating visual hallucinations in Schizophrenia.
Results

No evidence was found relating to the specific role of AChEI's in treating visual hallucinations in this patient group.
Discussion

Given the use of AChEI's in targeted, symptom specific treatment in other neuropsychiatric disorders, it is surprising to find no related literature in schizophrenia patients. The use of AChEI's in schizophrenia has investigated effects on cognition primarily with non cognitive effects measured more broadly.
Conclusions

We would suggest that more focused research into the effects of AChEI's on positive symptoms of schizophrenia, specifically visual hallucinations, is needed.

Acetylcholinesterase Inhibitors (AChEI's) for the treatment of visual hallucinations in schizophrenia: A review of the literature

Background

Visual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia. Current models of visual processing and studies in diseases including Parkinsons Disease and Lewy Body Dementia propose that Acetylcholine (Ach) plays a pivotal role in our ability to accurately interpret visual stimuli. Depletion of Ach is thought to be associated with visual hallucination generation. AchEI's have been used in the targeted treatment of visual hallucinations in dementia and Parkinson's Disease patients. In Schizophrenia, it is thought that a similar Ach depletion leads to visual hallucinations and may provide a target for drug treatment
Case presentation

We present a case of a patient with Schizophrenia presenting with treatment resistant and significantly distressing visual hallucinations. After optimising treatment for schizophrenia we used Rivastigmine, an AchEI, as an adjunct to treat her symptoms successfully.
Conclusions

This case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia. Targeted therapy of this kind can be considered in challenging cases although more evidence is required in this field.

Acetylcholinesterase Inhibitors (AChEI's) for the treatment of visual hallucinations in schizophrenia: A case report.

Винпоцетин при деменции

All identified studies were performed before the 1990s and used various terms and criteria for cognitive decline and dementia. The three studies included in the review involved a total of 583 people with dementia treated with vinpocetine or placebo. The reports of these studies did not make possible any differentiation of effects for degenerative or vascular dementia. The results show benefit associated with treatment with vinpocetine 30mg/day and 60 mg/day compared with placebo, but the number of patients treated for 6 months or more was small. Only one study extended treatment to one year. Adverse effects were inconsistently reported and without regard for relationship to dose. The available data do not demonstrate many problems of adverse effects but intention-to-treat data were not available for any of the trials. REVIEWER'S CONCLUSIONS: Although the basic science is interesting, the evidence for beneficial effect of vinpocetine on patients with dementia is inconclusive and does not support clinical use. The drug seems to have few adverse effects at the doses used in the studies. Large studies evaluating the use of vinpocetine for people suffering from well defined types of cognitive impairment are needed to explore possible efficacy of this treatment.

Vinpocetine for cognitive impairment and dementia.

Сосудистая деменция: фармакотерапия

Vascular dementia is a common condition for which there are no effective approved pharmacological treatments available. Absence of effective treatments creates a difficult situation for those suffering from the disease, their caregivers, and healthcare providers. This review will address our current understanding of the mechanisms of nerve cell damage due to ischemia and summarize available clinical trial data on several commonly used compounds including memantine, donepezil, galantamine, rivastigmine, nimodipine, hydergine, nicergoline, CDP-choline, folic acid, as well as such nonpharmacological approaches as validation therapy.

From the studies reviewed here, one may draw several conclusions. First, there are relatively few studies on vascular dementia treatment and no compound has been approved by any regulatory body for treatment of vascular dementia. Second, it appears that there are several compounds with different mechanisms of action that show mild efficacy in improving cognition and even ADLs in patients with vascular dementia. Third, there is one compound (memantine) that has been suggested to act within the confines of the current excitotoxic cell death model, although direct evidence confirming this hypothesis is still lacking. Overall, one could easily conclude that a number of different mechanisms may be at play in ethiopathogenesis of vascular dementia. Vascular conditions aside, nerve cell resistance to injury and our efforts to manipulate it still remains a conundrum, which will require new technologies to solve.

Vascular dementia: Pharmacological treatment approaches and perspectives

Антиконвульсанты в терапии поведенческих и психологических симптомов деменции

"INTRODUCTION: Dementia, besides the dominant cognitive disorders that define it, is associated with behavioral disturbances, the consequences of which are, on various levels, a determining factor for the handling of these patients. The treatment of behavioral and psychological symptoms is essential and although, to date, no therapeutic solution is satisfactory, it is necessary to look for an alternative to the neuroleptics usually employed, which raise real problems of tolerance in this geriatric population. BACKGROUND: For several years, anticonvulsants, among which some have shown mood stabilizing activity, have been the object of research in this indication. The purpose of this review of the literature is to assess the interest and the limits of anticonvulsant mood stabilizers (carbamazepine, valproic acid, gabapentin, lamotrigine, topiramate, oxcarbazepine) in the treatment of the so-called "noncognitive" symptoms of dementia. Their mechanism of action in mood disorders is not well known, but it would appear to be via the modulation of glutamate-mediated excitatory synaptic transmission and gamma-aminobutyric acid (GABA)-mediated inhibitory synaptic transmission that anticonvulsants might reduce behavioral symptoms in demented patients. METHODS: The method employed in this work was a systematic bibliographic review, in which only the double-blind placebo-controlled studies or the clinically detailed enough open-labelled studies using validated scales were retained. RESULTS: Among these medications, only carbamazepine demonstrated its efficacy in behavioral and psychological symptoms of dementia (BPSD) in controlled studies, notably that of Tariot et al. [J Am Geriatr Soc 42 (1994) 1160-1166 and Am J Psychiatry 155 (1998) 54-61] and Olin et al. [Am J Geriatr Psychiatry 9 (2001) 400-405], but with significant adverse events (sedation, hyponatremia, cardiac toxicity), particularly in the elderly and, being a strong enzymatic inducer, with a high likelihood of drug-drug interactions. Valproic acid showed some interesting results in BPSD within a large number of open studies and case reports. However, among the five controlled studies that have been published [Curr Ther Res 62 (2001) 51-67; Am J Geriatr Psychiatry 9 (2001) 58-66; Int J Geriatr Psychiatry 17 (2002) 579-585; Curr Alzheimer Res 2 (2005) 553-558 and Am J Geraitr Psychiatry 13 (2005) 942-945], none confirmed its efficacy on these symptoms. Regarding its tolerability in the geriatric population, no notable major side effect was reported (haematologic and hepatic effects are not more frequent than in the general population), except possible excessive sedation. Moreover, it appears that valproic acid could have neuroprotective effects, even if the contrary has been observed in a recent study. More studies need to be (and are being) conducted, notably on the interest of valproic acid in prophylaxis of BPSD. Gabapentin seems to be worthwhile and well tolerated in this indication, but no controlled study has been conducted to prove its efficacy, even if a quite important number of case reports and open studies have shown encouraging results. Concerning lamotrigine, which may potentially induce severe cutaneous side effects when administered with valproic acid, this drug has shown its efficacy in bipolar disorders and two recent case reports seem to indicate some interest in BPSD. Furthermore, lamotrigine appears to have neuroprotective effects. Although topiramate has shown interesting results in one open study in BPSD, its use in demented patients cannot be recommended because of its deleterious effect on cognitive functions. Oxcarbazepine, theoretically, could be an alternative to carbamazepine, which is, as aforesaid, the only anticonvulsant that proved its interest in BPSD. However, no clinical study has yet been published to support this hypothesis. This drug is better tolerated than carbamazepine, but induces severe and more frequent hyponatremia. DISCUSSION AND CONCLUSION: Finally, although we all know that antipsychotics should no longer be prescribed in the elderly, the treatment of behavioral and psychological symptoms of dementia remains a difficult problem, considering the lack of a real alternative to these medications. Anticonvulsant mood stabilizers are an interesting solution but none of them, other than carbamazepine, which did, but which is not better tolerated than the usual drugs in this population - was able to prove its efficacy in this indication. Among these medications, valproic acid, gabapentin and lamotrigine should be studied further, and the neuroprotective effect of some of them is an interesting route for research."

Anticonvulsant mood stabilizers in the treatment of behavioral and psychological symptoms of dementia (BPSD)

Кататония - обзор

http://www.psyobsor.org/1998/35/3-4.html

Нейролептики при деменции

После рекомендации воздерживаться от употребления атипичных нейролептиков из-за повышенного риска инсультов, Trifiro отметил убедительный рост количества назначений классических антипсихотиков. Но эти препараты несут такой же высокий (зависимый от дозы) риск инсульта, что и атипичные антипсихотики, по сравнению с пациентами, которые не принимали никаких психотропных препаратов. В некоторых подгруппах классических нейролептиков риск намного выше, в частности, 5,8 для фенотиазинов и 3,6 для бутирофенонов (например, галоперидола). Trifiro призывает максимально ограничить использование обоих классов лекарств. ''Употреблять их только при необходимости, в самых низких дозах и в течение максимально короткого времени''. Trifiro не отмечает при использовании классических антипсихотиков повышенного риска (в т.ч. фатальной) пневмонии, по сравнению с атипичными антипсихотиками. Вместе с тем, он ожидал повышенных рисков в связи с действием на экстрапирамидную систему, что вызывает акинезию и впоследствии может вызвать аспирационную пневмонию. Но, как оказалось, летальные случаи от воспаления легких чаще встречались при использовании атипичных антипсихотиков. Вероятность пневмонии возрастает в связи с аффинитетом антипсихотиков к гистаминергическим рецепторам Н1. Именно поэтому у фенотиазинов самый высокий сравнительный риск 4,3 – по сравнению с пациентами, которые не принимают психотропных препаратов. Trifiro объясняет это тем, что гистаминовые рецепторы участвую в седации, а седация может создавать проблемы с глотанием и впоследствии аспирационную пневмонию.

МНИИП

Детская деменция

Isobel was diagnosed with early on set dementia, aged just nine, when she began to slur her words and display the same problems as people eight times her age.
Child dementia affects around one in twelve million youngsters around the world, but is sometimes treatable.
There are 100 different types of dementia, including Alzheimer's, but doctors say Isobel's condition is unique and she has not responded to any medication.

Schoolgirl diagnosed with dementia