Pharmacological Treatment Of Dementia Research Articles

Changes in Drug Prescribing Practices Are Associated With Improved Outcomes in Patients With Dementia in Sweden: Experience from the Swedish Dementia Registry 2008–2017

ObjectivesEvidence is lacking on how treatment of comorbidities improves outcomes in patients with dementia. In this study, we evaluated temporal changes in the management of comorbidities in relation to survival rates in incident dementia over a 10-year period in Sweden. DesignObservational cohort study. Setting and ParticipantsA total of 40,219 patients with recently diagnosed dementia in memory clinics from the Swedish Dementia Registry (SveDem) from 2008 to 2017. MethodsIn 1-year blocks, pharmacological treatment of dementia and comorbidities in relationship to risk for fractures, major cardiovascular events (MACE), and death were analyzed using Cox models. Standardized Incidence Ratios (SIR) of death are presented. ResultsAfter standardization for demographics and comorbidities, the risk of fracture, MACE, and mortality decreased by 16%, 23%, and 28%, respectively, between 2008 and 2016. Each year decreased the risk of fracture by 3% (hazard ratio 0.97, 95% confidence interval 0.96–0.99), MACE by 4% (0.96, 0.95–0.97), and death by 5% (0.95, 0.93–0.97). Adjustment for changes in medication use attenuated these associations. Compared with the general population, the risk of death declined by 11%, corresponding to standardized incidence rate ratio, between 2008 and 2016. Conclusions and ImplicationsOver 10 years, a reduction in the short-term risks of fracture, MACE, and death in patients with dementia was associated with changes in drug prescribing practices. These improvements seem to be partly explained by progressive implementation of dementia diagnostic, treatment guidelines, and general management of comorbidities.

The Effect of Dance and Movement Therapy on Balance and Depression of the Elderly Who Are Sick with Dementia

The subject of the research: The effect of dance and movement therapy.The problem of the research: Years are going on and old people meet a problem that their gait changes, their balance becomes worse and the muscle power decreases. People who have cognitive impairment frequently demonstrate disturbed gait which put them into an increased risk to fall down and get injured seriously. Patients who are sick with dementia very often experience symptoms of depression the treatment of which is investigated insufficiently. It is known that dance and movement therapy positively impacts the health of the people with dementia, improves their emotions and mental conditions. Many foreign scientists investigate how dance and movement therapy affects old people’s balance, depression, but the following indexes of people who are sick with dementia are not researched. In Lithuania no pharmacological treatment of dementia is popular. Nowadays in our country there is no research about the effect of dance and movement therapy’s effect on people who are sick with dementia, how it impacts their depression and static and dynamic balance. The hypothesis of the research: Dance and movement therapy can improve static and dynamic balance and reduce depression of the elderly who are sick with dementia The aim of the research was to evaluate the effect of dance and movement therapy on balance and depression of the elderly who are sick with dementia: The goals of the research were: To establish the effect of dance and movement therapy to static and dynamic balance for old people sick with dementia. To establish the effect of dance and movement therapy for depression of old people sick with dementia. Several conclusions were made in on the basis of the results of this study: Dance and movement therapy can help improve static and dynamic balance for the elderly with dementia (p < 0. 05). Dance and movement therapy can help reduce depression of the elderly with dementia (p < 0.05).Keywords: dementia, balance, depression, dance and movement therapy.

Pharmacological Treatment of Dementia

Pharmacological interventions are critical in dementia treatment to prevent disease progression. In this review, we aim to summarize and discuss about the current developments and recommendations in the pharmacological treatment of dementia. Cholinesterase inhibitors have demonstrated efficacy for Alzheimer’s disease, mixed pathology with vascular dementia and Parkinson’s disease dementia. The comparison study revealed no difference between each cholinesterase inhibitors. A high incidence of side effects of cholinesterase inhibitors could lower compliance. In this case, changing to the other drug or trying a transdermal type could be the solution. Memantine, a N-methyl-D-aspartate receptor antagonist, has proven to improve function at moderate to severe dementia and for dementia with Lewy body. But there are still insufficient evidences for the combination of a cholinesterase inhibitors and memantine. Discontinuing medicine in moderate to severe dementia may lead to worsening of cognitive function. For this reason, improving patients’ compliance is important and for drug selection we should consider the type of dementia, severity of cognitive impairment and side effects of each medicine. Noncognitive symptoms, behavioral and psychological symptoms of dementia (BPSD) are common and can dominate disease presentation. For depression, selective serotonin reuptake inhibitors could be effective. Atypical antipsychotics could be used for other neuropsychological symptoms such as agitation, aggression, delusions and hallucinations. (Brain & NeuroRehabilitation 2015; 8: 19-23)

Psychosoziale Interventionen bei Demenz

Psychosocial interventions improve cognitive abilities (cognitive stimulation, cognitive training), enhance emotional well-being (activity planning, reminiscence), reduce behavioral symptoms (aromatherapy, music therapy) and promote everyday functioning (occupational therapy). Through these effects they reinforce and augment pharmacological treatments for dementia. In addition, psychosocial interventions complement the treatment of patients by supporting family caregivers (educational groups, support programs). The potential of psychosocial interventions in dementia needs to be explored further in studies using improved methodology to determine effective components, clinical relevance and duration of effects, predictors of individual treatment response and health-economic implications.

Pharmacological treatment of dementia

In this article, we discuss new data on currently licensed drugs for dementia and novel developments in the management of neuropsychiatric symptoms in patients with dementia. During the last years, a large body of evidence has been accumulated to support the use of antidementia medication in patients with severe Alzheimer's disease. Combination therapy with acetylcholinesterase inhibitors and memantine for Alzheimer's disease remains controversial, as controlled trials have yielded conflicting results. Memantine is not indicated in patients with mild Alzheimer's disease. Studies on memantine for Parkinson's disease dementia and dementia with Lewy bodies were inconclusive. In adult patients with dementia in the context of Down syndrome, memantine is not effective, and further studies on acetylcholinesterase inhibitors are warranted. There is still no treatment established for patients with vascular or frontotemporal dementia. The efficacy of antidepressants to treat depression associated with dementia is not proven. Treatment of agitation and psychosis in patients with dementia remains a challenge. Recent systematic clinical reviews and new research on currently available treatment options provide valuable assistance for clinicians to deal with frequent clinical problems in the context of dementia.

Pharmacological treatment of dementia and mild cognitive impairment due to Alzheimerʼs disease

To give an overview of recent developments in pharmacological treatment options of cognitive as well as behavioural and psychological symptoms of dementia (BPSD) associated with Alzheimer's disease (AD) dementia and mild cognitive impairment due to AD (MCI-AD). Knowledge about the efficacy and limitations of the antidementive drugs memantine and cholinesterase inhibitors (ChEIs) in different stages of AD is further expanding. The prediction of treatment response to ChEI and assessment of treatment outcome in the individual patient remain unsolved issues. Commonly prescribed antidepressants have recently failed to be beneficial in depressed AD dementia patients. Clinical trials on new disease-modifying drugs have been disappointing so far. There is an urgent need for more effective treatment options for cognitive symptoms and BPSD in AD dementia and MCI-AD and for disease-modifying drugs to stop the underlying neurodegenerative process. Recently published new research criteria for the diagnosis of AD enlarge the window for the detection of the disease to early, predementia stages and include biomarkers related to the underlying cerebral AD pathology. In future studies, these criteria will hopefully facilitate the identification of effective drugs in early AD stages.

A comprehensive strategy for dementia from primary prevention to end‐stage management

A comprehensive strategy for dementia from primary prevention to end‐stage management

2. Pharmacological Treatment of Dementia.

2. Pharmacological Treatment of Dementia.

Pharmacological treatment of dementia in people with learning disabilities

Dementia in older persons with learning disabilities is a growing concern for all those involved in their care. There is at present no effective treatment, but the importance of current drug treatments is reviewed. Developments in drug treatments for dementia remain an active area of ongoing research.

Pharmacogenomics and therapeutic strategies for dementia

Recent advances in genomic medicine have contributed to the acceleration of our understanding regarding the pathogenesis of dementia, improving diagnostic accuracy with the introduction of novel biomarkers and personalizing therapeutics with the incorporation of pharmacogenetic and pharmacogenomic procedures to drug development and clinical practice. Most neurodegenerative disorders, including Alzheimer’s disease (AD), share some common features, such as a genomic background in which hundreds of genes might be involved, genome–environment interactions, complex pathogenic pathways, poor therapeutic outcomes and chronic disability. The main aim of a cost-effective treatment is to halt disease progression via modification of the functional cascade involving AD genomics, transcriptomics, proteomics and metabolomics. Unfortunately, the drugs available for the treatment of dementia are not cost effective. The pharmacological treatment of dementia accounts for 10–20% of direct costs, and fewer than 20% of the patients are moderate responders to conventional drugs, some of which may cause important adverse drug reactions. Future antidementia drugs must address the complex pathogenic niche of the disease from a multifactorial perspective. Pharmacogenetic and pharmacogenomic factors may account for 60–90% of drug variability in drug disposition and pharmacodynamics. In addition to antidementia drugs, patients with AD or with other forms of dementia need concomitant medications for the treatment of diverse disorders of the CNS associated with progressive brain dysfunction. Approximately 60–80% of drugs acting on the CNS are metabolized via enzymes of the CYP gene superfamily, and 10–20% of Caucasians are carriers of defective CYP2D6 polymorphic variants that alter the metabolism of many psychotropic agents. Only 26% of the patients are pure extensive metabolizers for the trigenic cluster integrated by allelic variants of the CYP2D6, CYP2C19 and CYP2C9 in combination. Although many genes have been suggested to be associated with AD, with the exception of APOE, most polymorphic variants of potential risk exhibit a very weak association with AD. APOE-4/4 carriers exhibit a dramatic biological disadvantage in comparison with other genotypes, and AD patients harboring this homozygous condition are the worst responders to conventional drugs. The incorporation of pharmacogenetic/pharmacogenomic protocols into AD research and clinical practice can foster the optimization of therapeutics by helping to develop cost-effective biopharmaceuticals and improving drug efficacy and safety.

An assessment of the new memory clinic at Cork University Hospital

AbstractObjective: Dementia is a progressive brain disease. The prevalence of dementia increases with age. Symptomatic pharmacological treatments for dementia are available. Psychological and social interventions can support the patient and their carer. Early recognition and diagnosis of dementia are necessary to access this care and reduce crisis-led intervention. A memory clinic service is ideally placed to commence the assessment and management of dementia. The objective of this paper was to describe the setting up of the memory clinic in Cork University Hospital and review the characteristics of the first 118 patients.Method: One hundred and eighteen patients were assessed at the memory clinic between July 2004 and Feb 2007. In general the service operated on a two-appointment system. The first appointment was for a comprehensive assessment with investigations. The second appointment was a feedback session with discussion of the diagnosis, prognosis and management plan for the patient and generally their carer. We examined their demographic characteristics, clinical details, psychological test results and results of investigations.Results: Of the 127 patients referred, 118 (92.9%) attended. Fifteen (12.7%) patients had diagnosis of mild cognitive impairment (MCI), 93 (78.8%) patients were diagnosed with dementia and 5 (4.2%) had diagnosis of depressive disorder with no co-morbid dementia. The dementia type in descending frequency was Alzheimer's disease (50.5%), vascular dementia (34.4%), mixed type dementia (10.8%), Frontal lobe dementia (2.2%) and Lewy body type (2.2%). Of the 93 (78.8%) patients with dementia, 47 (50.5%) had MMSE score ≥20, 29 (31.2%) had MMSE score 11-19 and 17 (18.3%) had score of 0-10. Thirty-three (35.5%) patients were on antidementia medication at the point of referral and a further 16 (17.2%) patients were commenced on these drugs following assessment.Conclusion: The memory clinic provides a service for the assessment of mild cognitive impairment (MCI) and dementia. It offers diagnosis, an opportunity to receive specific advice regarding dementia management, differentiation between dementia and depression and a resource point for carers and patients.

Non-pharmacological interventions in dementia

It is increasingly recognised that pharmacological treatments for dementia should be used as a second-line approach and that non-pharmacological options should, in best practice, be pursued first. This review examines current non-pharmacological approaches. It highlights the more traditional treatments such as behavioural therapy, reality orientation and validation therapy, and also examines the potential of interesting new alternative options such as cognitive therapy, aromatherapy and multisensory therapies. The current literature is explored with particular reference to recent research, especially randomised controlled trials in the area. Although many non-pharmacological treatments have reported benefits in multiple research studies, there is a need for further reliable and valid data before the efficacy of these approaches is more widely recognised.

Evidence-based pharmacological treatment of dementia.

The current literature on the pharmacological treatment of dementia was reviewed and the strength of evidence for the efficacy of each drug was categorized using an evidence-based approach. Acetylcholinesterase-inhibitors represent the only category of drugs with consistently demonstrable efficacy in well-designed studies of Alzheimer's disease, although the effect is not large. There is a lack of prospective, controlled, randomized studies for most of the nootropics. Epidemiological evidence suggests prophylactic effects of oestrogens and anti-inflammatory agents, and a single large-scale trial suggests that long-term administration of vitamin E or selegiline may be associated with improved outcome in patients with Alzheimer's disease. A number of drugs were reported to be effective in the treatment of non-cognitive symptoms of dementia including classical and atypical neuroleptics, antidepressants and anticonvulsants. The evidence for efficacy, however, is not strong for the majority of these compounds.

Mechanism of Action of Phosphorylacetic Acid Hydrazides as Memory Enhancers and Neuroptotectors

Introduction Dementias and amnesias as the result of neurodegenerative diseases or continious ischemia of brain are now recognised as a major problem and affect a significant proportion of the elderly population. The pharmacological treatment of dementia is directed primaraly at correction of neurotransmitter deficits or enchancement of cerebral metabolic activity, but options are limited at present, because neurochemical pathology of dementias also include a disrupted regulation of neurotransmitter systems-signal transduction mechanism, which depends on cell's membranes conditions.

Mechanism of Action of Phosphorylacetic Acid Hydrazides as Memory Enhancers and Neuroptotectors

Introduction Dementias and amnesias as the result of neurodegenerative diseases or continious ischemia of brain are now recognised as a major problem and affect a significant proportion of the elderly population. The pharmacological treatment of dementia is directed primaraly at correction of neurotransmitter deficits or enchancement of cerebral metabolic activity, but options are limited at present, because neurochemical pathology of dementias also include a disrupted regulation of neurotransmitter systems-signal transduction mechanism, which depends on cell's membranes conditions.