Treatment of Alzheimer's disease in Brazil: I. Cognitive disorders.

Francisco De Assis Carvalho Do Vale,Márcio Luiz Figueredo Balthazar,Nasser Allam,João Carlos Barbosa Machado,Paulo Henrique Ferreira Bertolucci,Ylmar Corrêa Neto,Delson José Da Silva

doi:10.1590/s1980-57642011dn05030005

Abstract

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer’s disease (AD) in Brazil, with special focus on cognitive disorders. It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of cognitive disorders in AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of cognitive disorders encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine and other drugs and substances) and non-pharmacological (including cognitive rehabilitation, physical activity, occupational therapy, and music therapy) approaches. Recommendations for the treatment of behavioral and psychological symptoms of dementia due to Alzheimer’s disease are included in a separate article of this edition.

Highlights

In 2005, the Scientific Department of Cognitive Neurology and Aging (DCNCE-ABN) of the Brazilian Academy of Neurology published a set of recommendations and suggestions for the treatment of Alzheimer’s disease (AD).[1]
The authors carried out a search of articles published since 2005 on the MEDLINE (PubMed), LILACS and Cochrane Library databases
The theme was split into two topics for the search: (I) pharmacological treatment, including acetyl-cholinesterase inhibitors, memantine and other drugs (Ginkgo biloba extract, selegiline, Vitamin E, non-steroidal anti-inflammatory drugs, statins, estrogens, omega 3, Vitamins B and folic acid); and (II) non-pharmacological treatment including rehabilitation/practice/ cognitive training, physical activity, occupational therapy, music therapy, physiotherapy and speech therapy

Summary

Introduction

In 2005, the Scientific Department of Cognitive Neurology and Aging (DCNCE-ABN) of the Brazilian Academy of Neurology published a set of recommendations and suggestions for the treatment of Alzheimer’s disease (AD).[1] The present report comprises an updated version of these recommendations for treatment of cognitive disorders based on current literature. Studies retrieved were categorized into four classes, and evidence into four levels (Table 1), based on the 2008 recommendations by the American Academy of Neurology.[2,3] A draft of the recommendations was presented to a panel of researchers from various disciplines (Neurology, Psychiatry, Geriatrics, Neuropsychology and Speech therapy) for discussion and consensus. C. Possibly effective, ineffective, or prejudicial (and probably useful/predictive or not useful/predictive) for a given condition in the specified population. Insufficient or conflicting data; based on current knowledge, the treatment (trial, prediction) is not proven. *In exceptional cases, a convincing Class I study may suffice for A recommendation if: (1) all criteria are fulfilled, (2) the magnitude of the effect is large (relative degree of better result >5 and lower limit of confidence interval >2)

Oral Transdermal*

Administration with food

Other drugs and substances

Findings

Instituto de Psiquiatria da Faculdade de Medicina da Universidade de São