Clinical Dementia Rating

Female or male 50-85 years old with a caregiver Mini Mental Status (MMS) test between 16 and 26 inclusive Clinical Dementia Rating (CDR) test inferior or equal to 1 National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer s Disease and Related Disorders Association (NINCDS/ADRDA) test positive for Alzheimer s disease Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM IV) test positive for dementia Exclusion Criteria ... 

I Clinical Dementia Rating (CDR) six domains rating deterioration in ability. Score 0 to 3 (severe). 

Prednisone, 10 mg/day for 1 year, has been evaluated in 136 patients with probable Alzheimer s disease in a double-blind, randomized, placebo-controlled trial (196). There were no differences in the primary measures of efficacy (cognitive subscale of the Alzheimer Disease Assessment Scale), but those treated with prednisone had significantly greater memory impairment (Clinical Dementia sum of boxes), and agitation and hostility/suspicion (Brief Psychiatric Rating Scale). Other adverse effects in those who took prednisone were reduced bone density and a small rise in intraocular pressure. 

Acetyl-i-carnitine (4) is marketed in Italy for dementia as of this writing it is also in Phase III clinical trials in the United States and Europe. In a double-blind, placebo-controUed clinical trial over a one-year period involving 130 patients with clinically diagnosed AD, a slower rate of deterioration in 13 of the 14 outcome measures was observed in the dmg-treated group (28). Earfler smaller scale pilot studies in demented patients had also shown some improvement of various behavioral and cognitive functions (29). 

Treatment with atypical antipsychotics recently has been associated with an almost twofold increased mortality rate when used in elderly patients with dementia. Although these medications are not approved for treatment of dementia-related psychosis, such use is common in clinical practice (Herrmann and Lanctot 2005). At present, this appears to be a risk for the entire class. The risk associated with atypical antipsychotics is not statistically different from the risk associated with treatment with conventional antipsychotics (Gill et al. 2005). 

Scores of clinical studies with HA have been reported thus far. Favorable efficacy of HA was demonstrated in the treatment of more than 1000 patients suffering from age-related memory dysfunction or dementia in China. An early study conducted on 100 patients with probable AD oral HA (0.15-0.25 mg, t.i.d.) showed significant improvement in all rating scores evaluated by the Buschke Selective Reminding task. An inverted U-shaped dose response curve for memory improvement was... 

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