Dementia type

Other nootropic agents in some stage of clinical development include nebracetam (9), nefinacetam (10), and BMY 21502 (11). Nebracetam, an aminomethyl pyrrolidinone derivative, is expected to be approved in Japan in 1994 (73). In clinical studies involving patients having cerebrovascular or senile dementia of the Alzheimer s type, clinical symptoms such as spontaneous or emotional expression were enhanced in up to 71% of cases. Long-term treatment using nebracetam in patients with cerebral infarction also afforded marked improvement in most cases with few side effects (74). A review of this compound has beenpubUshed (75). 

Limited clinical data on BMY 21502 (11) suggest that some benefit may be provided to patients with dementia (87,88). This expectation is based on the abihty of (11) to increase the level of arousal and attention in patients with certain types of dementia. BMY 21502 enhances long-term potentiation... 

The anxiety disorders are common and surprisingly disabling conditions. Studies on the health economics of generalized anxiety disorder, panic disorder, social anxiety disorders and obsessive compulsive disorder document the cost to the individual and to society. Attention has focused on the major psychiatric disorders such as depression, schizophrenia and the dementias. Studies suggest that many anxiety disorders are of early onset and too often chronic they are quite common and impose a heavy burden on society. More studies will be needed to discern the fine grain in the survey material and to identify more precisely the location and type of societal costs. These factors will vary from country to country, from district to district, between men and women and between various age groups. 

McArthur JC (2004) HIV dementia an evolving disease. J Neuroimmunol 157(l-2) 3-10 McArthur JC, Hoover DR, BaceUar H, MUler EN, Cohen BA, Becker JT, Graham NM, McArthur JH, Seines OA, Jacobson LP et al (1993) Dementia in AIDS patients incidence and risk factors. Multicenter AIDS Cohort Study. Neurology 43(ll) 2245-2252 McManus CM, liu JS, Hahn MT, Hua LL, Brosnan CE, Berman JW, Lee SC (2000) Differential induction of chemokines in human microgUa by type I and II interferons. GUa 29(3) 273-280 McQuibban GA, Butler GS, Gong JH, BendaU L, Power C, Clark-Lewis I, OveraU CM (2001) Matrix metaUoproteinase activity inactivates the CXC chemokine stromal ceU-derived factor-1. J Biol Chem 276(47) 43503 3508... 

Zheng J, Ghorpade A, Niemann D, Cotter RL, Thylin MR, Epstein L, Swartz JM, Shepard RB, Liu X, Nukuna A, Gendelman HE (1999a) Lymphotrofric virions affect chemokine receptor-mediated neural signaling and apoptosis implications for human immunodeficiency virus type 1-associated dementia. J Virol 73(10) 8256-8267... 

Liu Y, Tang XP, McArthur JC, Scott J, Gartner S (2000) Analysis of human immunodeficiency virus type 1 gpl60 sequences from a patient with HIV dementia evidence for monocyte trafficking into brain. J Neurovirol 6(Suppl 1) S70-S81 Liu H, Dow EC, Arora R, Kimata JT, Bull LM, Arduino RC, Rice AP (2006) Integration of human immunodeficiency virus type 1 in untreated infection occurs preferentially within genes. J Virol 80(15) 7765-7768... 

Everybody suffers some intellectual and memory impairment with age. If it becomes very marked or occurs earlier in life (40+) it is known as dementia. Although it may be caused by alcoholism, cardiovascular disease such as multiple infarcts, and is often seen in the later stages of Parkinsonism, the most common cause is a neurodegenerative one, namely, Alzheimer s disease (AzD). In fact this is the primary and sole cause in over half the cases of dementia and is a contributory cause in a further quarter and the younger the patient, the more likely is the dementia to be of the Alzheimer type. 

Tohgi, H, Abe, T, Kimura, M, Saheki, M and Takahashi, S (1996) Cerebrospinal fluid acetylcholine and choline in vascular dementia of Binswanger and multiple small infarct types as compared with Alzheimer-type dementia. J. Neural Trans. 103 1211-1220. 

Voider, L. and Crino, P.B. (1990). Involvement of free radicals in dementia of the Alzheimer type a hypothesis. Neurobiol. Aging 11, 567-571. 

AD is the most common type of dementia, affecting approximately 4.5 million Americans in the year 2000.2 Table 32-2 lists the different classifications of dementia.3 This chapter will address only dementia of the Alzheimer s type. 

Dementia of the Alzheimer s type (early- or late-onset)... 

The ChE inhibitors all have the indication for the treatment of mild to moderate dementia of the Alzheimer s type. Guidelines for the treatment of AD were written before the approval of memantine and recommend the use of ChE inhibitors as a valuable treatment for AD.27-29 None of the ChE inhibitors have been compared in head-to-head studies, so the decision to use one over another is based on differences in mechanisms of action, adverse reactions, and titration schedules. 

Donepezil is approved for the treatment of mild to moderate dementia of the Alzheimer s type at a dose of 5 mg/day. This dose should be increased to 10 mg/day if needed after 4 to 6 weeks. Table 32-5 describes the dosing strategies for all of the approved agents for Alzheimer s disease.34-38... 

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