78 research outputs found
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Neuropsychological Test Performance in African-American and White Patients with Alzheimer's Disease
Little information exists on the performance of black versus white patients with Alzheimer's disease on neuropsychological tests for dementia.In this study, we compared performance on the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) neuropsychological battery between white (n equals 830) and black (n equals 158) patients with Alzheimer's disease enrolled in the CERAD study at 23 university medical centers in the United States. The black patients were older, had fewer years of formal education, and were more impaired in their activities of daily living than were the white patients. After controlling for these characteristics and for duration of the disease and severity of dementia, there were differences in the performance of black and white patients on several of the cognitive measures. Black patients scored lower than whites on tests of visual naming and constructional praxis and on the Mini-Mental State Examination. There were no statistical differences in performance on tests of fluency and word list memory. These findings suggest that cultural or experiential differences may modify performance on specific neuropsychological tests. These factors, in addition to age and educational background, should be considered when interpreting performance on neuropsychological tests in elderly black patients with dementia
DOMINO-AD protocol: donepezil and memantine in moderate to severe Alzheimer's disease - a multicentre RCT.
BACKGROUND: Alzheimer's disease (AD) is the commonest cause of dementia. Cholinesterase inhibitors, such as donepezil, are the drug class with the best evidence of efficacy, licensed for mild to moderate AD, while the glutamate antagonist memantine has been widely prescribed, often in the later stages of AD. Memantine is licensed for moderate to severe dementia in AD but is not recommended by the England and Wales National Institute for Health and Clinical Excellence. However, there is little evidence to guide clinicians as to what to prescribe as AD advances; in particular, what to do as the condition progresses from moderate to severe. Options include continuing cholinesterase inhibitors irrespective of decline, adding memantine to cholinesterase inhibitors, or prescribing memantine instead of cholinesterase inhibitors. The aim of this trial is to establish the most effective drug option for people with AD who are progressing from moderate to severe dementia despite treatment with donepezil. METHOD: DOMINO-AD is a pragmatic, 15 centre, double-blind, randomized, placebo controlled trial. Patients with AD, currently living at home, receiving donepezil 10 mg daily, and with Standardized Mini-Mental State Examination (SMMSE) scores between 5 and 13 are being recruited. Each is randomized to one of four treatment options: continuation of donepezil with memantine placebo added; switch to memantine with donepezil placebo added; donepezil and memantine together; or donepezil placebo with memantine placebo. 800 participants are being recruited and treatment continues for one year. Primary outcome measures are cognition (SMMSE) and activities of daily living (Bristol Activities of Daily Living Scale). Secondary outcomes are non-cognitive dementia symptoms (Neuropsychiatric Inventory), health related quality of life (EQ-5D and DEMQOL-proxy), carer burden (General Health Questionnaire-12), cost effectiveness (using Client Service Receipt Inventory) and institutionalization. These outcomes are assessed at baseline, 6, 18, 30 and 52 weeks. All participants will be subsequently followed for 3 years by telephone interview to record institutionalization. DISCUSSION: There is considerable debate about the clinical and cost effectiveness of anti-dementia drugs. DOMINO-AD seeks to provide clear evidence on the best treatment strategies for those managing patients at a particularly important clinical transition point. TRIAL REGISTRATION: Current controlled trials ISRCTN49545035.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are
Advances in the therapy of Alzheimer's disease: Targeting amyloid beta and tau and perspectives for the future
Worldwide multidisciplinary translational research has led to a growing knowledge of the genetics and molecular pathogenesis of Alzheimer's disease (AD) indicating that pathophysiological brain alterations occur decades before clinical signs and symptoms of cognitive decline can be diagnosed. Consequently, therapeutic concepts and targets have been increasingly focused on early-stage illness before the onset of dementia; and distinct classes of compounds are now being tested in clinical trials. At present, there is a growing consensus that therapeutic progress in AD delaying disease progression would significantly decrease the expanding global burden. The evolving hypothesis- and evidence-based generation of new diagnostic research criteria for early-stage AD has positively impacted the development of clinical trial designs and the characterization of earlier and more specific target populations for trials in prodromal as well as in pre- and asymptomatic at-risk stages of AD
Optimal design of clinical trials for drugs designed to slow the course of Alzheimer's disease.
ASSESSMENT OF COGNITION IN THE OLDER ADULT WITH SCHIZOPHRENIA: THE DEMENTIA OF DEMENTIA PRAECOX
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Search Processes for Associative Structures in Long-Term Memory
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Effects of short-term memory contents on short- and Iong-term memory searches
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5 - Memory Changes with Aging and Dementia
This chapter describes the different concepts of memory function with old age and dementia. There are several memory systems that have been identified to interact with each other constantly, whereas others appear to operate independently. It provides a general overview of the human memory system and at the same time, describes how the various aspects of memory change during the course of human aging. The chapter compares these changes, which are associated with normal aging, with the much more devastating changes that occur in patients with dementing illness. Aging is associated with different changes in performance on tasks that involve primary and secondary memory. Along with these, studies of cognitive changes in Alzheimer's disease (AD) use a variety of different assessment instruments where the tools are described in details
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Optimal design of clinical trials for drugs designed to slow the course of Alzheimer's disease.
Compounds now in clinical development are hypothesized to slow the clinical progression and pathogenesis of Alzheimer's disease (AD) by their effects to diminish production, increase clearance, or decrease aggregation of amyloid beta protein. Options for investigating the effects of these and other drugs on clinical progression and pathogenesis of AD were examined at a conference that included: (1) a review of experimental methods used to investigate disease-modifying drugs for multiple sclerosis, rheumatoid arthritis, cardiovascular disease, and osteoporosis; (2) discussion of possible study designs and outcome measures for trials in patients with AD; and (3) discussion of biomarkers available for AD. There is no uniformly best way to investigate a drug's impact on AD progression but characteristics of studies supportive of a disease-slowing effect can be specified. Relevant clinical outcomes in drug-treated patients versus placebo-treated patients should be compared over at least 1 and possibly as long as 2 years with biomarkers reflective of pathogenesis and of the drug's mechanistic effects measured concurrently
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