A double-blind, placebo-controlled study of tacrine in Chinese patients with Alzheimer's disease

Therapeutic Approach to Alzheimer’s Disease: Current Treatments and New Perspectives

Alzheimer’s disease (AD) is the most common cause of dementia. The pathophysiology of this disease is characterized by the accumulation of amyloid-β, leading to the formation of senile plaques, and by the intracellular presence of neurofibrillary tangles based on hyperphosphorylated tau protein. In the therapeutic approach to AD, we can identify three important fronts: the approved drugs currently available for the treatment of the disease, which include aducanumab, donepezil, galantamine, rivastigmine, memantine, and a combination of memantine and donepezil; therapies under investigation that work mainly on Aβ pathology and tau pathology, and which include γ-secretase inhibitors, β-secretase inhibitors, α-secretase modulators, aggregation inhibitors, metal interfering drugs, drugs that enhance Aβ clearance, inhibitors of tau protein hyperphosphorylation, tau protein aggregation inhibitors, and drugs that promote the clearance of tau, and finally, other alternative therapies designed to improve lifestyle, thus contributing to the prevention of the disease. Therefore, the aim of this review was to analyze and describe current treatments and possible future alternatives in the therapeutic approach to AD.

A randomized controlled trial of the group reminiscence approach in patients with vascular dementia

AIM

To evaluate the beneficial effect of the group reminiscence approach (GRA) in patients with vascular dementia on the aspect of cognitive and observed behavioral parameters.

METHODS

Sixty patients who were diagnosed to have vascular dementia were randomly assigned to three arms: group reminiscence arm, social contact arm, and control arm. A 1-hour session of GRA and social contact was given once a week for 3 months to the group reminiscence and the social contact arm, respectively. Only supportive care was given in the control arm. Improvement in cognitive function and behavioral activities were defined as the primary outcome.

RESULTS

No significant improvements in the main outcome measures were demonstrated.

CONCLUSION

These results do not support the hypothesis that GRA is beneficial to patients with vascular dementia.

Utility of the clinical dementia rating in Asian populations

Consistent with the worldwide demographic trend of population aging, dementia is expected to become a burgeoning public health problem in Asian populations. Thus, there is a pressing need for reliable and valid methods of dementia diagnosis and staging that are applicable in heterogeneous Asian populations. The Clinical Dementia Rating (CDR) is an informant-based global assessment scale with established reliability and validity that has been widely utilized as a severity-ranking scale in many studies of Asian populations. From a diagnostic standpoint, the CDR is congruent with the Diagnostic and Statistical Manual of Mental Disorders approach of dementia diagnosis. It exhibits excellent discriminatory ability in the very mild stages of dementia, a useful property that is germane to the surging interest in mild cognitive impairment and related concepts. Limitations of the CDR include its length of administration, reliance on clinical judgment and collateral source information, and relative insensitivity as a measure of change in interventional studies. Since the exercise of clinical judgment is inherent in scoring, CDR raters should be mindful of the influence of cultural factors on premorbid lifestyle, informant reliability and performance in certain CDR test items (especially those pertaining to the categories of judgment and problem solving, community, and home and hobbies). Thus, in future studies that involve the nascent use of the CDR in Asian populations, it is recommended that any transcultural adaptation of CDR items be described in detail and appropriate validation studies be carried out before adopting the CDR as a yardstick measure of assessment. The potential of adapted versions of the CDR in chronic care settings and advanced cases should be explored. An integrative approach, combining brief informant interview in conjunction with brief objective cognitive testing, could be a viable strategy for dementia screening in the clinical and research setting that warrants further evaluation in Asian populations.

National haemodialysis guidelines: an assessment of compliance from 2001-2003

AIM

The Caring for Australians with Renal Impairment (CARI) clinical practice guidelines were established in 2000 to provide recommended ranges for parameters associated with anaemia management in patients with chronic kidney disease. This study used data from the Renal Anaemia Management (RAM) database to determine the level of compliance with the CARI Guidelines in Australia since their implementation.

METHODS

De-identified data from haemodialysis patients at 15 dialysis centres were obtained from the RAM database provided by Janssen-Cilag Pty Ltd, Australia. Validated data were extracted over 6 months (April-September) in 2001 (n = 2586 patients) and 2003 (n = 3190 patients). The percentage of patients with biochemical and haematological parameters that were within the ranges recommended in the CARI Guidelines was compared from 2001-2003.

RESULTS

There was a significant increase in the number of patients with values within the recommended ranges for serum ferritin, phosphate, calcium phosphate product and urea reduction ratio from 2001-2003. There was no change in the proportion of patients with values within the recommended ranges for haemoglobin, transferrin saturation, calcium or parathyroid hormone. There was considerable variation in compliance with recommended ranges between and within individual dialysis centres. Compliance to the target haemoglobin level (> or =110 g/L) ranged from 42-78% of patients at different centres in 2003.

CONCLUSION

Although the number of patients with values within those recommended in the CARI guidelines has increased for some parameters, many patients in Australia have clinical parameters outside the ranges recommended in the CARI Guidelines.

Stereotypes and steroids: using a psychobiosocial model to understand cognitive sex differences

To further our understanding of cognitive sex differences, we studied the relationship between menstrual phase (via serum estradiol and progesterone levels) and cognitive abilities and cognitive performance in a sample of medical students in eastern Turkey. As expected, we found no sex differences on the Cattell "Culture Fair Intelligence Test" (a figural reasoning test), with females scoring significantly higher on a Turkish version of the Finding A's Test (rapid word knowledge) and males scoring significantly higher on a paper-and-pencil mental rotation test. The women showed a slight enhancement on the Finding A's Test and a slight decrement in Cattell scores during the preovulatory phase of their cycle that (probably) coincided with a rise in estrogen. There were also small cycle-related enhancements in performance for these women on the mental rotation test that may reflect cyclical increases in estrogen and progesterone. Additional analyses showed an inverted U-shaped function in level of estradiol and the Cattell Test. Finally, for women who were tested on Day 10 of their menstrual cycle, there was a negative linear relationship between their Cattell scores and level of progesterone. Stereotypes about the cognitive abilities of males and females did not correspond to performance on the mental rotation or Finding A's Test, so the sex-typical results could not be attributed to either stereotype threat or stereotype activation. For practical purposes, hormone-related effects were generally small. Variations over the menstrual cycle do not provide evidence for a "smarter" sex, but they do further our understanding of steroidal action on human cognitive performance.