Therapeutic management of major neurocognitive disorder due to Alzheimer’s disease*

Abstract

Background. According to a meta-analysis conducted by S. Gauthier (2015), Cerebrolysin® was significantly superior to placebo at 4 weeks and 6 months in mild-to-moderate Alzheimer’s disease (AD), while its safety was comparable to placebo. Data from translational research support a decrease in synaptic and behavioral deficits in mice undergoing Cerebrolysin® injections, due to various effects over signaling regulation, control of APP metabolism and expression of neurotrophic factors. Combining Cerebrolysin® with cholinesterase inhibitors indicated synergistic effects in the long-term treatment for mild-to-moderate AD. Clinical presentation. We present the case report of a 66-year-old female patient diagnosed with major neurocognitive disorder due to AD (probable), according to the DSM-5 criteria, who had memory, complex attention, executive function and learning deficits for at least two years prior to her first psychiatric evaluation. A thorough workup for differential diagnosis was carried out, and there were identified no data in favor of a cerebrovascular disease, folate or vitamin B12 deficiency, thyroid disorder, Parkinson disease, Huntington disease, HIV or other infectious diseases, chronic use of alcohol, sedatives, hypnotics, anxiolytics or inhalants, repeated cerebral traumas, demyelinating disorders, or brain tumor. No significant abnormal values were found during routine blood analyses, except for elevated levels of cholesterol. The Alzheimer’s Disease Assessment Scale – cognitive subscale (ADAS-Cog) reflected low scores on multiple domains (e.g., word recall, naming objects and fingers, word recognition). Mini-Mental State Examination (MMSE) score was 17, and the neuropsychiatric inventory (NPI) reflected high scores on anxiety, irritability, and nighttime behaviors. Cerebrolysin® was initiated concomitantly with rivastigmine patches, memantine and trazodone. At the 3-month visit, MMSE and ADAS-Cog scores stabilized, and the Global Assessment of Functioning (GAF) values showed a slight trend for improvement. NPI scores decreased significantly on all three dimensions previously mentioned. Conclusions. Cerebrolysin® was well tolerated and it may be administered together with other nootropics due to its lack of CYP450 interactions. It may be useful in stabilizing overall cognitive status in moderate AD.