Alzheimer's disease: treatment research finds new targets

Pharmacologic management of Alzheimer disease, Part I: Hormonal and emerging investigational drug therapies

OBJECTIVE

To provide information about current genetic research in Alzheimer disease (AD) and potential pharmacologic interventions. Investigational pharmacologic management of AD, including serenics, hormonal therapy, neurotransmitter augmentation, neurobiologic agents, nootropics, and ampakines are also reviewed.

DATA SOURCES

Studies, review articles, and editorials identified from MEDLINE searches (from January 1993 to December 1996), and bibliographies of identified articles.

STUDY SELECTION

Studies, review articles, and editorials addressing current areas of AD pharmacotherapy research, including hormonal therapy and select investigational agents.

DATA EXTRACTION

Pertinent information was selected and the data were synthesized into a review format.

DATA SYNTHESIS

AD is a devastating disease characterized by progressive memory loss, cognitive decline, and behavioral disturbances. The behavioral problems associated with AD can present a difficult clinical challenge. Many patients with AD are intolerant of traditional pharmacologic management, including antipsychotics, antidepressants, and anxiolytics. Hormonal agents, including estrogen, medroxyprogesterone, and cyproterone acetate, may be efficacious therapeutic alternatives in the management of sexual behavioral disturbances in men. Research regarding estrogen's role in AD prevention and effect on cognitive function and behavioral symptoms in women with AD are evaluated. Studies evaluating neurotransmitter augmentation and neurobiologic agents in AD are reviewed.

CONCLUSIONS

Environmental, genetic, neurobiologic, hormonal, and neurotransmitter influences, and their respective roles in AD pathology, are being investigated. Researchers concur that it is imperative to recognize the correlation of these factors in the etiology of AD to design effective prevention and treatment strategies. Additional studies are essential to elucidate the most efficacious treatments for AD and the attendant behavioral disturbances.

Roadblocks encountered in recruiting patients for a study of sleep disruption in Alzheimer's disease

Recruitment strategies and the roadblocks encountered in a clinical trial are described. A four-group, repeated measures design was used to test the effects of three sleep-related behavioral interventions on sleep disruption and related variables in Alzheimer's disease patients and their primary caregivers. Despite extensive recruitment efforts, enrollment did not meet expectations. Data analysis revealed three types of roadblocks to recruitment: caregiver resistance, provider resistance, and a mismatch of the disease characteristics with protocol requirements. Recommendations are made to help others solve recruitment problems.

Microdialysis-coupled place cell detection in the hippocampus: a new strategy for the search for cognition enhancer drugs

1. The MPCD method in freely moving rats is a new neuroscience technique. It is able to detect the location-specific firing of hippocampal place cells, and to deliver, via microdialysis, various drug solutions into the extracellular environment of the detected neurons. Place cells are critical elements of the neural system in brain which governs cognitive processes. It is emphasized in this article that effective cognition enhancer drugs must selectively and significantly affect the firing of these cells. 2. By using MPCD, it is possible to recognize drug combinations which can increase the location-specific firing of place cells to an optimal level. This paper proposes that such pharmacological action facilitates engram-creation in extrahippocampal cortical areas, improving cognitive functions. Thus, an MPCD-based research strategy may lead to the rational development of a new generation of cognition enhancer drugs for the treatment of learning and memory disorders, including Alzheimer's disease (AD).

[New therapeutic prospects in Alzheimer disease]

The approval for marketing of tacrine (Cognex), an acetylcholinesterase inhibitor, allowed physicians and the general people to attract attention to a degenerative disease, which prevalence dramatically increases every year. This drug is hopeful. Meanwhile, we must keep in mind that it has only a symptomatic effect. Its hepatotoxicity requires regular biological tests. Many medications are actually in earlier stages of development along with various etiological approaches.