© Geriatric Times. All rights reserved.
Alzheimer's Disease Detection and New Treatment Alternatives Discussed at
Symposium
| Geriatric Times |
 |
January/February 2001 |
|
Vol. II |
|
Issue 1 |
At a symposium of the 13th Annual Psychiatric & Mental Health Congress on
Nov. 16, 2000, William E. Reichman, M.D., emphasized the increasing occurrence
of Alzheimer's disease (AD), which is a major public health concern as the
population continues to age at an exponential rate. AD accounts for 60% to 70%
of all dementia cases and affects 35% to 40% of people over the age of 85.
Reichman, associate professor of psychiatry and director of the division of
geriatric psychiatry at the University of Medicine and Dentistry of New Jersey,
said, "[Dementia] creeps up on people. Onset is insidious and patients
gradually regress over time." He said that the initial signs of dementia are
subtle and may include impairment in memory, visuospatial ability, executive
functioning and calculation, as well as behavioral changes such as increased
irritability, paranoia and aggression. Patients also often appear physically
robust, making it easy for physicians and family members to overlook the early
signs of dementia. According to Reichman, AD screening¾with tests such
as the 7-Minute Screen, which examines orientation, memory, visuospatial
difficulty and verbal fluency¾is necessary for early detection in
addition to obtaining the patient's dementia history, a physical and
neurological examination, and laboratory studies.
Treatment options were discussed by co-presenter Gary W. Small, M.D.,
Parlow-Solomon Professor on Aging and director of the Center on Aging at the
University of California, Los Angeles School of Medicine. In the area of
pharmacological treatment, Small said that cholinesterase inhibitors and
vitamin E are currently recommended for the treatment of AD.
Cholinesterase inhibitors (e.g., tacrine [Cognex], donepezil [Aricept],
rivastigmine [Exelon] and galantamine [Reminyl]) were proven to be modestly
effective in improving cognition and maintaining functional status of patients
with AD, Small stated. Vitamin E, which is less expensive, he continued, was
shown in studies to delay progression from moderate to severe dementia by
approximately 230 days, as compared to placebo.
New drugs are currently being developed for AD treatment, however, Small
said that it is also important to try nonpharmacologic strategies such as
arranging social and family activities as often as possible, incorporating
regular exercise, keeping daily activities routine, and using clocks and
calendars to maximize orientation-RT