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early intervention for Alzheimer's disease

Management: 2001 recommendations of the American Academy of Neurology:* [1] 1) cholinesterase inhibitors not cost-effective a) donepezil, galantamine or rivastigmine b) studies show small average degree of benefit 2) vitamin E 1000 IU BID is NOT useful (see alpha-tocopherol) 3) L-deprenyl (Selegiline) 5 mg BID may be substituted for vit E [4], insufficent evidence to recommend Selegiline [5] 4) Ginkgo biloba of uncertain benefit - no benefit in prevention of Alzheimer's disease 5) avoid atypical antipsychotics for agitation (see 8,9 below & psychosis & agitation in the elderly) - risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel) 6) estrogen - NOT currently indicated for prevention or treatment of Alzheimer's disease or other dementias [1,2,6] Other (after 2001) 7) 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] 8) risperidone, olanzapine no better than haloperidol & no less likely to cause adverse effects [7] 9) antipsychotics associated with increased mortality [8,9] 10) Mediterranean diet reduces mortality [11] & may reduce the risk of dementia as well help maintain global cognitive function [12] 11) exercise of benefit (see exercise & Alzheimer's disease) 12) adequate sleep may preserve cognition in preclinical & early symptomatic AD [13] * original recommendations modified with new data

Related

exercise & Alzheimer's disease investigational therapies for treatment of Alzheimer's disease

General

guidelines for Alzheimer's disease management

References

  1. 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of the quality standards subcommittee of the American Academy of Neurology, Neurology 56:1154-1156, 2001 (Guideline withdrawn 02/2009) PMID: 11342679 Seshardi et al, Postmenopausal estrogen replacement therapy and the risk of Alzheimer's diseaase, Arch Neurol 58(3):435, 2001
  2. 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. Journal Watch 23(14):108, 2003 Aisen PS et al, JAMA 289:2819, 2003 PMID: 12783912
  4. Journal Watch 24(4):34, 2004 Reines SA t al, Neurology 62:66, 2004 PMID: 14718699
  5. Delagarza VW et al, Am Fam 68:1365, 2003 PMID: 14567491
  6. Estrogen-Alone Hormone Therapy Could Increase Risk of Dementia in Older Women (ADEAR News release) http://www.alzheimers.org/nianews/nianews66.html
  7. 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. PMID: 15194601 http://bmj.bmjjournals.com/cgi/content/full/329/7457/75
  8. 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. 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: 16319382 - Ray WA. Observational studies of drugs and mortality. N Engl J Med. 2005 Dec 1;353(22):2319-21. No abstract available. PMID: 16319379
  10. 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. PMID: 16081444 http://bmj.bmjjournals.com/cgi/content/full/331/7512/321
  11. Scarmeas N et al, Mediterranean diet and Alzheimer's disease mortality. Neurology 2007, 69:1084 PMID: 17846408 - Galvin JE Pass the grain; spare the brain. Neurology 2007, 69:1072 PMID: 17846407 - Scarmeas N, Stern Y, Tang MX Mediterranean diet and risk for Alzheimer's disease. Ann Neurol. 2006 Jun;59(6):912-21. PMID: 16622828
  12. Scarmeas N et al. Physical activity, diet, and risk of Alzheimer disease. JAMA 2009 Aug 12; 302:627. PMID: 19671904 - Feart C et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 2009 Aug 12; 302:638. PMID: 19671905 - Knopman DS. Mediterranean diet and late-life cognitive impairment: A taste of benefit. JAMA 2009 Aug 12; 302:686. PMID: 19671912
  13. 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: 34668959 PMCID: PMC8536939 (available on 2022-10-20) https://academic.oup.com/brain/article-abstract/144/9/2852/6401973