Anti-dementia Therapy Research Articles

The use of antidementia therapy in non-dementia cognitive disorders associated with COVID-19

IntroductionThe new coronavirus infection causes severe damage to the human body. One of the most serious complication is cognitive impairment.According to a meta-analysis by Maxime Taquet et al. (2021), which assessed neurological and psychiatric outcomes among 236,379 patients diagnosed with COVID-19, 1.7% of participants over 65 years of age were diagnosed with dementia.In a US online survey of 1,500 people (Sarah Ballou et al., 2020), about half reported difficulty concentrating on any task after experiencing COVID-19.It was also found that there is a decrease in the speed of reactions and problem-solving (Jeffrey D. Pyne et al., 2021).There are a number of studies that present the evidence-based efficacy of acetylcholinesterase (AChE) inhibitors in dementia prevention.However, in accordance with clinical guidelines for cognitive disorders in the elderly, anti-dementia drugs are not used at the stage of mild to moderate cognitive impairment (Ministry of Health of the Russian Federation, 2020).ObjectivesThe use of AChE inhibitors in cognitive impairments that do not reach the degree of dementia.MethodsResearch data from open sources.ResultsThe development of early cholinergic deficiency correlates with the development of cognitive impairment, while acetylcholine has a pronounced neuroplastic effect and increases the number of neurons (Gabriela Dumitrita Stanciu et al., 2019).In a double-blind, placebo-controlled study, a positive effect of rivastigmine was found in patients with mild to moderate cognitive impairment. The study’s results show that rivastigmine treatment (3, 6, 9 mg/day) for six months increases brain activity of the hippocampus in the control group by 32,5%. Rivastigmine prevented the clinical progression of symptoms of cognitive impairment and caused activation of some parts of the cerebral cortex (Nagaendran Kandiah et al., 2017).In a study by Wolfson C. et al. (2002), it was found that rivastigmine can slow down the development of cognitive impairment for at least six months in patients with mild to moderate massive cognitive dysfunction. Subjects treated with 1 to 21 mg per day for 7 to 12 weeks got more favorable ADAS-cog scores for the six months after treatment. While those who took the drug in doses of 6 to 12 mg showed a more pronounced positive effect compared to the placebo group.The Luca Rozzini in 2006 conducted a study based on 59 subjects with mild cognitive impairment. 15 subjects received both neuropsychological examination and acetylcholinesterase inhibitors. As a result, the remaining subjects were behind in terms of abstract thinking and behavioral symptoms, in comparison with a combined treatment group.ConclusionsIt is advisable to conduct further studies on the effectiveness of AChE inhibitors to prevent the progression of mild to moderate cognitive impairment and their transition to dementia.Disclosure of InterestNone Declared

Social Determinants of Health in Dementia

Dementia is a growing public health problem in the U.S. and globally. However, only 20-30% of Americans with dementia are accurately diagnosed with this condition; 50% are exposed to inappropriate medications; only 7% receive specific anti-dementia therapy; and 33% use acute care services at least once every 6 months. The gap in care is magnified among racial and ethnic minority groups. Black and Hispanic Americans have higher rates of missed diagnosis and longer time to diagnosis despite having a higher prevalence of Alzheimer's Disease. Women are disproportionately affected by the disease, as they represent higher number of patients and caregivers.In recent years, there has been growing interest in social determinants of health (SDoHs) from healthcare to public policy fields. SDoHs are defined as non-medical factors that have significant impact on a person's health and longevity, and include factors such as social connections, racism, poverty, ageism, and unhealthy environment. While much effort has been made to understand the biological determinants of dementia, the SDoHs of dementia are poorly understood. In this session, we will review the SDoHs of dementia and their assessment, putative psychosocial and biological mechanisms, and strategies for prevention and intervention. We will discuss both adverse and positive SDoHs related to dementia. Finally, we will elaborate on the clinical and policy implications of the SDoH of dementia.

MicroRNA-195 rescues the impaired MS-dCA1 neural circuit and spatial memory in rats with chronic cerebral hypoperfusion

Chronic cerebral hypoperfusion (CCH) is a common risk factor for vascular dementia and Alzheimer’s disease (AD). The previous studies have shown that CCH-induced multiple AD-like pathological changes in the hippocampus and cortex through downregulating the microRNA-195 (miR-195) expression. However, whether and how miR-195 participates in the dysfunction of the medial septum (MS)-dorsal hippocampal CA1 (dCA1) neural circuit following CCH is still obscure. In the present study, we found that miR-195 was downregulated in the MS region of CCH rats. Moreover, using electrophysiological recording and immunofluorescence staining technique, we found that the knockdown of miR-195 through the injection of lenti- AMO-195 into the MS region led to a pathological change that mimicked the damage to the MS-dCA1 neural circuit in CCH rats, including the decreased input-output (I/O) curve, increased paired-pulse ratio (PPR), decreased numbers of ChAT+ and PV+ neurons in MS, and diminished theta rhythm in the hippocampus. More importantly, exogenously supplemented miR-195 into the MS region rescued the damaged neural circuit in MS-dCA1 of CCH rats by injecting lenti-pre-miR-195. Gain-of-function of miR-195 in the MS region significantly improved the cognitive dysfunction in CCH rats assessed by the Morris water maze test. In conclusion, knockdown of miR-195 in the MS region can impair MS-dCA1 neural circuit function, while upregulation of miR- 195 can rescue the impaired function of MS-dCA1 neural circuit and spatial memory ability in CCH rats. This provides a valuable reference for future anti-dementia therapy involving miR-195.

Effects of Sargassum wightii Methanolic Extract on L-Methionine Induced Experimental Vascular Dementia like Syndrome in Albino Wistar Rats

Sargassum wightii is brown seaweeds with high nutritive value with natural bioactive compounds having diverse therapeutic activity. In recent years, research on Sargassum wightii has gain much interest in neuropharmacological field. Basing on neuroprotective effect of Sargassum wightii against Parkinson’s disease animal models, the possible protective effect on dementia is hypothesised. Addressing this question the present study was designed to investigate the effect of S. wightii on L-methionine induced vascular dementia like syndrome in male wistar albino rats. Vascular dementia was induced by oral administration of L-methionine (1.7 g/kg) per body weight for 4weeks S. wightii was given from day1 to day32. The neurobehavioral assessment was performed by Morris water maze test for learning and memory ability and blood sample was collected for serum nitrite and homocysteine analysis. The whole brain content was subjected to a series of biochemical analysis that included brain cholinesterase, malondialdehyde, reduced glutathione and histopathological examination. L-methionine impaired learning and memory, increased serum homocysteine and decreased serum nitrite level significantly (p<0.001). It also increased brain thiobarbituric acid reactive substances, reduced glutathione and increased acetylcholinesterase activity significantly (p<0.001). Sargassum wightii at 200mg/kg and 400mg/kg body weight reversed the L-methionine induced learning and memory deficits (p<0.01) and (p<0.001) respectively. The L-methionine induced biochemical alterations in serum and brain as well as histopathological aberration in cortex and hippocampus were restored by Sargassum wightii (p<0.01). This study concluded that Sargassum wightii ameliorated L-methionine induced vascular dementia like syndrome and provided a new concept in anti-dementia therapy as a neuroprotectants.

The psychosocial factors in the formation of symptoms of dementia

IntroductionThe growing prevalence of severe cognitive impairment in populations, the involvement of a significant number of people of working age in the medical, psychological and social problems associated with dementia, the insufficiency and inconsistency of information about the mechanisms of formation of these disorders actualize a comprehensive social study of dementia.Objectivesthe psychosocial mechanisms of the formation of clinical, functional disorders in dementia, to develop comprehensive medical and psychosocial programs to help patients with dementia and those involved in caring for them, based on the proposals of the psychosocial model of dementiaMethodsA selective observational comparative dynamic study of 315 people with Alzheimer’s dementia and 214 people who care for the patients was carried out.ResultsChanges in family-role and social parameters, a high level of “expressed” emotions of caregivers have an adverse effect on the development of psychotic (r = 0.618), affective (r = 0.701), behavioral (r = 0.837) dementia disorders. The degree of adherence to anti-dementia therapy by the caregiver is one of the important factors determining the amount of care received by the patient (r = 0.698). Agitation / aggression (r = 0.761), anxiety (r = 0.562), sleep disturbances (r = 0.521) contribute to increased compliance. The low satisfaction of the caregiver with premorbid (r = 0.698) and current (r = 0.653) relationships with the patient leads to a decrease in the compliance of the caregiver.ConclusionsThe mechanism of psychopathological symptoms, functional disorders is heterogeneous, depending on the biological causes and psychosocial conditions of functioning of patients.DisclosureNo significant relationships.

Effect of Multiple Medicines on Dementia Initial Treatment: Experience and Thinking.

Little is known about multiple medicines and initial therapy among people with dementia. To examine the effect of multiple medicines on the initiation of anti-dementia therapy in patients diagnosed with cognitive impairment (CI), a retrospective study with 2742 CI patients was conducted based on the outpatients' medical records. The dementias receiving 1-2 drugs were more likely to be prescribed with anti-dementia (one drug: OR = 1.877; two drugs: OR = 1.770) and psychotropic (one drug: OR = 1.980) treatment, whereas had lower chances of receiving psychotropic medication with the combinations of more than three drugs (Alzheimer's disease: OR = .365; vascular dementia: OR = .940; frontotemporal lobe degeneration: OR = .957; and dementia with Lewy bodies/Parkinson's disease dementia: OR = .952). Multiple medicines can affect anti-dementia therapy initiation in dementia patients and should be paid extreme caution.

Effects of angiotensin ii receptor blockers on cognitive functions in patients diagnosed with dementia undergoing anti-dementia therapy

Background and Aims: Literature regarding effects of antihypertensive therapy on cognition is infused by controversy. Our objective was to examine the effects of angiotensin II receptor blockers(ARBs) as associated with specific anti-dementia medication on cognitive functioning: memory(MMSE, Clock-Drawing-Test), functionality(ADL, IADL), behavior disorders(NPI-Q: Neuropsychiatric-Inventory-Questionnaire) and global deterioration(GDS-Test/Reisberg) in time.

433 - Burden of Disease Associated with Dementia-related Psychosis and Dementia-related Agitation & Aggression Using a National Long-term Care US Database

Abstract:Objective: Compare burden of disease among patients with dementia-related psychosis (DRP), dementia without psychosis (dementia only), and dementia-related agitation/aggression (DAA) in long-term care (LTC) facilities.Background: Patients with dementia often experience neuropsychiatric symptoms (NPS), including psychosis and agitation/aggression. Real-world data on the comorbidity profile of DRP and DAA patients are limited.Design/Methods: Dementia patients were identified from a US LTC database based on ?2 dementia diagnosis codes or 1 dementia diagnosis code and antidementia therapy prescription during 1 Jan 2013 to 30 May 2017. Patients were categorized into DRP (?2 psychosis or 1 psychosis diagnosis code and prescription of antipsychotic therapy and no history of agitation/aggression diagnosis), dementia only (no psychosis or agitation/aggression diagnosis and no history of antipsychotic therapy [dementia only]), and DAA (?2 diagnosis codes of agitation/aggression and no history of psychosis diagnosis or antipsychotic therapy) groups (index date). Comorbidities and concomitant therapies were defined during 12 months prior to index date.Results: There were 26,002 dementia residents: DRP (n=11,921; 46%); dementia only (n=11,432; 44%); DAA (n=2649; 10%). DRP patients were younger (mean age 80.8 years) than dementia only (84.3 years) or DAA (83.8 years). DRP patients were sicker overall versus dementia only: anemia (32% vs 29%); anxiety (55% vs 33%); bladder disorders (19% vs 13%); depression (75% vs 58%); hypertension (43% vs 33%); diabetes (43% vs 38%); insomnia disorders (32% vs 19%); (all P<0.05). More DAA patients had anxiety (43%), depression (66%), hypertension (43%), and insomnia disorders (26%) than dementia only (all P<0.05). Most DRP patients (94.3%) received off-label treatment for DRP; approximately one third (31.6%) of DAA patients received off-label treatment for DRP.Conclusions: This study, the first of its type to use a US LTC database, demonstrated a significant comorbidity burden associated with DRP or DAA compared with dementia only, which should be considered when using off-label treatments. These data highlight the need for safe and effective treatments for dementia NPS.Study Sponsored By: ACADIA Pharmaceuticals Inc.DisclosuresNR, SA, VA are employees of ACADIA PharmaceuticalsLC has served as a consultant, speaker, holds stock in, or receives royalties from: Acadia, Alkermes, Allergan, Avanir, BioXcel, Eisai, Impel, Indivior, Intra -Cellular Therapies, Janssen, Lundbeck, Luye, Merck, Neurocrine, Noven, Osmotica, Otsuka, Pfizer, Sage, Shire, Sunovion, Takeda, Teva, Vanda, Bristol-Myers Squibb, Eli Lilly, J & J; Wiley (Editor-in-Chief, International Journal of Clinical Practice), UpToDate (reviewer), Springer Healthcare (book)This submission is an encore of a poster abstract originally presented at ISPOR 2019, New Orleans, LA, USA, May 18–22, 2019; original presentation under the same title.

The role of the treating practice in persistence among dementia patients inGermany and the UK .

There is a lack of studies investigating the role of physicians with regard to persistence among dementia patients. The aim was to analyze the rate of persistence with antidementia medication in Germany and the UK by focusing on the role of the treating physician. Dementia patients who had received at least 1 prescription for antidementia drugs in 240 general practices in Germany and 73 general practices in the UK between January 2013 and December 2016 were included. Persistence was defined as the time between therapy initiation and therapy discontinuation, the latter being defined as a gap of at least 90 days without antidementia therapy. The prevalence of persistent patients per practice was also estimated. High practice persistence was defined as > 60% of patients completing at least 12months of therapy. A total of 3,863 patients in Germany and 3,342 patients in the UK were analyzed. In Germany, 55.2% of patients were continuing therapy after 12months, while the figure in the UK was 80.2%. The proportion of patients with a persistence of at least 12 months per practice ranged from 0 to 80% in Germany and from 0 to 85% in the UK. The prevalence of practices with good persistence was lower in Germany than in the UK (9.6 versus 54.8%). Physicians play an important role with respect to the persistence of the dementia patients they treat. Further studies are needed to better understand the role of physicians of other specialties in patients' adherence.

Treatment Patterns of Patients with All-Cause Dementia in Russia.

Background:Studies on prevalence or the therapy of dementia are rare or non-existent in Russia.Objective:The purpose of this study was to analyze the prescription patterns of antidementia therapy in Russia in 2018.Methods:This retrospective cross-sectional study was based on the IQVIA Russia LRx database, which covers approximately 11% of all patients enrolled in federal or regional reimbursement state healthcare programs. We descriptively analyzed the proportions of patients treated with antidementia drugs, antipsychotics, antidepressants, and benzodiazepines.Results:A total of 12,051 dementia patients were available for analysis. Of those, 6,394 patients had a vascular dementia (VaD) diagnosis, while 3,413 were diagnosed with dementia in other diseases (DOD), 1,128 with Alzheimer’s disease (AD), and 1,116 with unspecified dementia (UD). The therapy with the highest patient proportion was antipsychotics, with 74% of VaD patients, 73% of UD patients, and 47% of DOD patients receiving these drugs. The proportion of patients treated with antidementia drugs was 68% in AZ, 56% in VaD, 45% in UD, and only 9% in DOD. Antidepressants were a relatively rare therapy in dementia patients (between 4% and 12%), and 30% of DOD patients received benzodiazepines, while the proportions of patients receiving this therapy class in other dementias was low (7–10%). Most patients were treated with old-generation drugs.Conclusion:The proportion of older drugs prescribed in Russia is higher than in Western Europe, which may likely be due to their low prices, resulting in a higher chance for successful health insurance reimbursement claims.

δ-Related Biomarkers Attenuate Multiple Alzheimer's Disease Conversion Risks and Offer Targets for Intervention.

We tested certain serum proteins' ability to mediate the effects of demographic variables on prospective 5-year conversion to clinical "Alzheimer's disease" from non-demented states (i.e. normal control and mild cognitive impairment). The proteins were rationally selected from previously published mediators of those same variables' (plural posessive) association with the latent variable "δ," a novel omnibus dementia severity metric. Each protein's attenuation of its risk factor's independent association with conversion was performed using logistic regression, adjusted for education, ethnicity, self-reported diabetes mellitus, and hypertension, among initially non-demented Mexican American and non-Hispanic white (N = 772) participants in the Texas Alzheimer's Research and Care Consortium. A total of 70 (9.1%) non-demented participants at baseline converted to "Alzheimer's disease", with a mean follow-up of 5.4 years. Age >80 years (odds ratio = 3.1), 30-item Geriatric Depression Scale >10/30 (odds ratio = 2.3), female gender (odds ratio = 2.2), and the presence of an apolipoprotein E ε4 allele (odds ratio = 2.4) were independently associated with prospective conversion. These effects were fully attenuated by five serum proteins: age: insulin-like growth factor-binding protein 2 and epidermal growth factor receptor 1; depression: resistin; gender: thrombopoietin; and apolipoprotein E: C-reactive protein. Clinical dementia arises from the sum of independent δ-related processes. This analysis provides proof of concept for the rational selection of antidementia targets and offers a foundation for precision antidementia therapy.

Antidementia Drug Therapy of Alzheimer's Dementia: Status 2018 and Outlook

Antidementia therapy: The clinical use of acetylcholinesterase inhibitors (AChE-I) for the symptomatic treatment of mild to moderate Alzheimer's dementia is recognized worldwide, despite its modest effectiveness. AChE-I may be continued to be used into severe stages of the dementia. In moderate to severe Alzheimer's dementia, the NMDA-receptor-antagonist Memantin is indicated.Lewy body dementia is treated as Alzheimer's disease; for Parkinson's dementia, there is a separate indication for rivastigmin. A worsening in motor symptoms may occur. There is no evidence-based antidementia drug therapy for frontotemporal or vascular dementia.Future Therapeutic Strategies: Disease modification is a major focus of current clinical trials. There are several clinical trials targeting anti-amyloid (phase 3) or anti-tau strategies. However, other therapeutic targets are persued, too. In current clinical trials, mild cognitive impairment due to Alzheimer's disease is targeted as the most meaningful study population.Implications for practice: At present, there just is symptomatic anti-dementive drug therapy available for Alzheimer's dementia, Parkinson's dementia and Lewy body dementia. Despite its modest effect sizes, treatment with these drugs is clinically relevant and seems to be cost-effective.

Relevance of Coded Prodromal Mild Cognitive Impairment in the Routine Treatment of Patients with Dementia in Germany.

Little is known about the impact of prior mild cognitive impairment (MCI, ICD-10: F06.7) diagnosis on the time to dementia diagnosis, anti-dementia drug therapy, and treatment persistence in patients with dementia (PWD). Patients with dementia diagnoses who started anti-dementia therapy between January 2010 and December 2016 were selected from 203 neurological/psychiatric practices in the Disease Analyzer databank (IQVIA). Patients with a history of MCI were compared to non-MCI controls in terms of demographic characteristics, anti-dementia therapy, and the rate of persistence with anti-dementia drugs. For persistence analyses, a 1:1 matching procedure was used based on age, gender, type of residence, and depression and dementia diagnosis. Persistence was represented using Kaplan-Meier curves. A Cox regression analysis was used to determine the influence of MCI diagnosis on persistence with anti-dementia drugs. 339 PWD with MCI diagnoses and 339 controls were available for analysis. PWD with MCI were younger (78.9 versus 80.4 years), less likely to live in a nursing home (8.5% versus 22.5%), more frequently received donepezil (40.1% versus 33.7%), and more likely to exhibit comorbid depression (29.6% versus 16.9%). There was no association between the risk of treatment discontinuation and prior MCI diagnosis. After 24 months, 40% versus 41.1% of patients had discontinued treatment. The prior MCI diagnosis presumably led to an earlier diagnosis of dementia and earlier anti-dementia treatment. Treatment continuity did not differ, which would suggest that it does not depend on prior MCI diagnosis but on the behavior of patients and their caregiving relatives.

The Influence of Polypharmacy on the Initiation of Anti-Dementia Therapy in Germany.

The goal of the present retrospective study was to focus on the potential influence of polypharmacy on the initiation of antidementia therapy in patients diagnosed with dementia in general practices in Germany. The current study sample included patients diagnosed with dementia in 1,217 general practices in Germany between 2014 and 2016 (index date). The primary outcome measure was the rate of prescription of anti-dementia drugs within one year following the index date. The explanatory variable was the number of different drugs prescribed at baseline per patient. Independent variables included age, sex, and type of dementia. Logistic regression analyses were conducted to study the impact of the number of different drugs prescribed at baseline per participant on the odds of receiving anti-dementia therapy (in all patients and in patients diagnosed with Alzheimer's disease). The study included 21,888 patients with all-cause dementia. Mean age was 80.2 years (SD = 7.3 years) and 61.4% of the study population were women. Individuals receiving six drugs or more at baseline were significantly less likely to be prescribed anti-dementia treatment when compared to those without any drug at baseline (6- 9 drugs: odds ratio [OR] = 0.75;≥10 drugs: OR = 0.58). In the subgroup of patients with Alzheimer's disease, the odds of being prescribed anti-dementia therapy were lower in individuals with four drugs or more, compared to patients who had not been prescribed any drugs at baseline (4- 5 drugs: OR = 0.60; 6- 9 drugs: OR = 0.49;≥10 drugs: OR = 0.36). There is a negative association between polypharmacy and antidementia therapy initiation in general practices in Germany.

Sleep disorders and Alzheimer’s disease

Alzheimer’s disease (AD), one of the leading causes of dementia worldwide, is commonly accompanied by behavioral and psychopathological disorders. The earliest observed symptoms of AD include sleep disorders, the incidence of which varies from 25 to 60%. Sleep problems and sleep disorders can develop as one of the symptoms accompanying cognitive impairment, but can also be associated with an increased risk of cognitive decline and with a higher risk of dementia. Anti-dementia therapy is of great importance in preventing and treating sleep disorders in patients with AD. Akatinol memantine is one of the drugs with proven efficacy in such patients.

Risk of hospitalization associated with anticholinergic medication for patients with dementia.

With the ageing of the general population, demand has grown for measures to prevent hospitalization for dementia, which can exacerbate problems associated with activities of daily living in elderly individuals. Anticholinergic medication has been shown to cause falls, delirium, and cognitive impairment in aged patients. However, the risk of hospitalization associated with the administration of anticholinergics is unclear. We analyzed the records of 61 outpatients (26 men, 35 women; mean age: 78 ± 7 years; mean follow-up period: 420 days) diagnosed with dementia (Alzheimer's disease: n = 45; dementia with Lewy bodies: n = 3; undifferentiated n = 13) and prescribed anti-dementia drugs between May 2013 and December 2014. Medication history was noted, and the patients were divided into two groups according to the Anticholinergic Risk Scale: with risk (n = 13) and without risk (n = 48). Outcome was judged based on an end-point of hospitalization or death. Kaplan-Meier survival and Cox proportional hazard analyses were performed. Eight patients with anticholinergic risk and 12 without anticholinergic risk reached the end-point (P < 0.005). Analysis with a proportional hazard model showed that anticholinergic medication administration was related to a higher risk for reaching the end-point (crude hazard ratio: 3.62, 95% confidence interval: 1.45-9.04, P < 0.01; adjusted hazard ratio: 4.54, 95% confidence interval: 1.03-20.0, P < 0.05). In contrast, Mini-Mental State Examination score, Charlson Comorbidity Index, and the number of drugs were not major risk factors for hospitalization in patients with dementia. The Anticholinergic Risk Scale findings were shown to be a strong predictor of hospitalization for patients with dementia. We should evaluate the anticholinergic burden before initiating anti-dementia therapy.

Is it personalized treatment of dementia based on the CYP2D6 gene polymorphism possible?

To genotype the single nucleotide polymorphism 1846G>A in the CYP2D6 gene and evaluate its effect on the efficacy and safety of donepezyl in the treatment of Alzheimer's disease (AD). Twenty-one patients with AD were genotyped for the CYP2D6 1846G>A polymorphism, which corresponds to the most common in Caucasians allele CYP2D6*4. An effect of this polymorphism on the efficacy and safety of donepezyl was assessed. There was no association between the CYP2D6 genotype and the efficacy of antidementia therapy (OR=0,44, 95% CI -3.0-1,38; p=0,46).

Longitudinal lipid profile variations and clinical change in Alzheimer's disease dementia

Hypercholesterolemia and statin use have been unevenly associated with clinical change in Alzheimer's disease dementia. In this longitudinal study, 192 consecutive outpatients with late-onset Alzheimer's disease dementia were stratified according to APOE haplotypes, and followed for one year to investigate associations of lipid profile variations and lipophilic statin therapy with changes in cognition, caregiver burden, basic and instrumental functionality. Overall, 102 patients (53.1%) carried APOE4+ haplotypes and 90 (46.9%) carried APOE4- haplotypes; 189 patients (98.4%) used either a cholinesterase inhibitor, or Memantine, or both; 144 patients had dyslipidemias and 143 of them received statin therapy. Total cholesterol, LDL-cholesterol, Mini-Mental State Examination scores, and functional independence scores were significantly lower at the end of the follow-up, while Clinical Dementia Rating sum-of-boxes scores were higher. Exclusively for APOE4- carriers, rising LDL-cholesterol levels were associated with a trend toward improvements in the Index of Independence in Activities of Daily Living (β=0.010; ρ=0.16), whereas rising HDL-cholesterol levels were associated with lowered scores (β=−0.051; ρ=0.04). Lipophilic statin therapy had non-significant protective effects over Clinical Dementia Rating sum-of-boxes score variations only for APOE4- carriers. APOE4- haplotypes might enhance lipid availability to protect neuronal membranes, thus overcoming their supposed dysfunction in cholesterol metabolism, while APOE4+ carriers have inefficient neural repair mechanisms. In conclusion, APOE haplotypes seem to influence the protective effects of lipid profile variations for patients with Alzheimer's disease dementia, but current evidence is insufficient to propose lipid-lowering drugs as specific anti-dementia therapy.

Prescription patterns and drug costs in German patients with dementia in nursing homes and home-care settings .

To analyze prescription patterns and drug costs in German patients with dementia who are in home-care settings and nursing homes. The present retrospective study based on the Disease Analyzer epidemiological database and included 41,064 patients treated by general practitioners (GPs) and 20,649 patients treated by psychiatric practitioners (PPs), who were diagnosed with dementia in 2014. Four different types of antidementia therapy were included in the analysis. The shares of prescriptions and the associated costs in dementia patients in home-care settings and nursing homes were estimated. Regression analyses were performed to study the impact of the type of residence on the likelihood of receiving a defined therapy and incurring its associated cost. Antidementives were more frequently prescribed to patients in home-care settings, whereas antidepressants, antipsychotics, and benzodiazepines were more commonly administered to nursing-home patients in both the GP and the PP groups. Individuals residing in nursing homes had a lower likelihood of receiving antidementives but exhibited a higher likelihood of being prescribed antidepressants, antipsychotics, and benzodiazepines. The total cost of therapy was higher in nursing homes than in home-care settings (GPs: difference of €27.20; PPs: difference of €107.90). The cost of antidementives was significantly lower in GP patients residing in nursing homes than in GP patients living at home. There was no significant difference in the cost of antidementives in the PP groups. By contrast, the costs of the three other families of drugs were lower in individuals cared for at home than in individuals residing in nursing homes, in both practice types. Prescription patterns and the drug costs in dementia patients significantly differed between home-care settings and nursing-home settings. .

Application status of memantine in patients with dementia in the Chongqing area of Southwest China

PurposeMemantine has been proven to be effective in patients with moderate to severe Alzheimer's disease (AD) and has been available in China since 2006. However, antidementia therapy is not widely used in patients with AD in our region. Therefore, we surveyed the situation of memantine utilization in our hospital. MethodsData on dementia patients who received memantine were obtained from the database of The First Affiliated Hospital of Chongqing Medical University between January 2011 and September 2012. Data were collected by face-to-face interview and/or telephone interview by direct questions on memantine dosage, efficacy, adverse events (AEs), Clinical Global Impression Change (CGI-C) score, and the reasons for drug withdrawal, and the results were summarized. ResultsA total of 118 patients were selected, of which 88 patients completed this study. Memantine was prescribed for patients with dementia and the status of its application is as follows: 32 patients were treated with the drug for <1 month; 15 patients were treated between 1 month and 6 months; 41 patients were treated for >6 months. The reasons for memantine withdrawal included the lack of knowledge about dementia care, economic problems, lack of satisfaction with efficacy, and obvious side effects. The improvement of the clinical condition was found in patients treated with memantine for >6 months compared with the patients treated with memantine for <1 month (CGI-C score, 3.80 vs. 4.72, p < 0.05). Of the 88 patients, four (4.54%) had AEs. ConclusionPrescription of memantine is reasonable in our region. However, medication compliance is not optimal. Thus, public should be educated about dementia and about the available medications.