Dementia in Alzheimer’s disease

Q48 was synthesised to mimic the nerve-blocking activity of cocaine Q49 is indicated for dementia in Alzheimer s disease Q50 was originally derived from the bark of the yew tree... 

Galantamine is a reversible inhibitor of acetylcholinesterase that also possesses nicotinic receptor agonist properties, and which is used in mild-to-moderate dementia in Alzheimer s disease. 

To deal with the different disorders included in this section would be excessive therefore, we focus on dementia in Alzheimer s disease (AD]. Nevertheless, the less specific treatment options for AD are also complementary options to the usual treatment approaches for other forms of dementia or cognitive deficits in which etiological or more specific treatments may be useful (e.g., dementia in normal pressure hydrocephalus). 

Also falling within the scope of modern psychiatric diagnostic systems are organic mental disorders (e.g. dementia in Alzheimer s disease), disorders due to substance misuse (e.g. alcohol and opiate dependence—see Chapter 10), personality disorders, disorders of childhood and adolescence (e.g. attention deficit/hyperactivity disorder, Tourette s syndrome) and mental retardation (learning disabilities). 

Prasher VP, Fung N, Adams C (2005) Rrvastigmine in the treatment of dementia in Alzheimer s disease in adults with Down syndrome. Int J Geriatr Psychiatry 20 496-497. 

Even in Alzheimer s disease (AD), the possible involvement of a weak excitotoxic process cannot be ruled out. Indeed, mitochondrial abnormalities (such as cytochrome oxidase alterations) [36, 37] and increased levels of markers of oxidative stress [38] have been reported in AD. This has been the rationale for testing the NMDA antagonist memantine in Alzheimer s dementia [39]. 

Singleton, A. B., Gibson, A. M., McKeith, I. G. et al. Alpha2-macroglobulin polymorphisms in Alzheimer s disease and dementia with Lewy bodies. Neuroreport 10 1507-1510, 1999. 

The most common form of dementia is Alzheimer s disease, constituting 20% of psychiatric hospitalizations (Adams et al. 1997). In a European... 

Frontotemporal dementias are characterized by gross structural changes in the frontal and anterior temporal lobes, metabolic disturbances, and involvement of certain subcortical structures as well (Ishii et al. 1998). Whereas in Alzheimer s disease the early cognitive disturbances are in memory, in frontotemporal dementias the early manifestations are in executive and behavioral function (Pfeffer et al. 1999 Varma et al. 1999). This relative cognitive distinction persists throughout the course of the two disorders (Pachana et al. 1996). Disinhibition and disorganization are common, and psychotic symptoms may be prominent in frontotemporal dementia. 

Although the meta-analysis by Oken and colleagues examined efficacy in Alzheimer s disease only, improvements have been seen in other conditions such as age-related memory decline and vascular dementia (Kanowski et al. 1996 Haase et al. 1996 Allain et al. 1993). More research is needed to establish the quantitative clinical significance of ginkgo extract. 

Table 10.2 Potential therapeutic strategies in Alzheimer s disease and dementia... 

Scacchi, R., De Bernardini, L., Mantuano, E., et al. (1998) DNA polymorphisms of apoUpo-protein B and angiotensin I-converting enzyme genes and relationships with Upid levels in Italian patients with vascular dementia or Alzheimer s disease. Dement. Geriatr. Cogn. Disord., 9, 186-190. 

Bar, K. J., Franke, S., Wenda, B., Muller, S., Kientsch-Engel, R., Stein, G., and Sauer, H. (2002). Pentosidine and N(epsilon)-(carboxymethyl)-lysine in Alzheimer s disease and vascular dementia. Neurobiol. Aging 24, 333-338. 

The statins may lower the risk of CHD by decreasing inflammation, an important component of atherogene-sis. Lovastatin decreased elevated plasma levels of C-reactive protein, a marker for cellular inflammation, and acute coronary events in patients with relatively low plasma cholesterol levels. Recent studies also suggest that use of statins may decrease the risk of stroke, dementia, and Alzheimer s disease and may improve bone... 

Tourette s syndrome, a heterogeneous behavioral disorder associated with motor and vocal tics of variable form and severity, can be effectively treated with haloperidol. Antipsychotics can also be employed to control disturbed behavior in senile dementia or Alzheimer s disease, since they decrease confusion, agitation, and hyperactivity. Most of these drugs also exhibit a strong antiemetic effect and can sometimes be used clinically for this purpose. 

Adler LE, Hoffer LD, Wiser A, et al Normalization of auditory physiology by cigarette smoking in schizophrenic patients. Am J Psychiatry 150 1856-1861, 1993 Adolfsson R, Gottfries GG, Oreland L, et al Reduced levels of catecholamines in the brain and increased activity of monoamine oxidase in platelets in Alzheimer s disease therapeutic implications, in Alzheimer s Disease Senile Dementia and Related Disorders [Ageing, Vol 7). Edited by Katzman R, Terry RD, Bick KL. New York, Raven, 1978, pp 441-451... 

Barnes NM, Costall B, Naylor RJ, et al Normal densities of 5-HT3 receptor recognition sites in Alzheimer s disease. Neuroreport 1 253-254, 1990 Barnes R, Veith R, Okimoto J, et al Efficacy of antipsychotic medications in behaviorally disturbed dementia patients. Am J Psychiatry 139 1170-1174, 1982 Baron BM, Ogden AM, Siegel BW, et al Rapid down regulation of beta-adrenoceptors by co-administration of desipramine and fluoxetine. Eur J Pharmacol 154 25-134, 1988... 

Bowden CL, Brugger AM, Swann AC, et al Efficacy of divalproex vs lithium and placebo in the treatment of mania. JAMA 271 918-924, 1994b Bowen DM, Davison AN Biochemical studies of nerve cells and energy metabolism in Alzheimer s disease. Br Med Bull 42 75-80, 1986 Bowen DM, Smith CB, White P Accelerated ageing or selective neuronal loss as an important cause of dementia Lancet 1 11-14, 1979 Bowen DM, Smith CB, White P, et al Biochemical assessment of serotonergic and cholinergic dysfunction and cerebral atrophy in Alzheimer s disease. J Neuro-chem 41 266-272, 1983... 

Cummings JL, Miller B, Hill MA, et al Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Arch Neurol 44 389-393, 1987 Cundall RL, Brooks PW, Murray LG A controlled evaluation of lithium prophylaxis in affective disorders. Psychol Med 2 308-311, 1972 Cutler NR, Haxy J, Kay AD, et al Evaluation of zimeldine in Alzheimer s disease cognitive and biochemical measures. Arch Neurol 42 744-748, 1985 Czyrak A The effect of chronic nifedipine and ECS in the forced swimming test in rats. PolJ Pharmacol 45 191-195, 1993... 

---