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Early Promise For Dementia Drug (pp 1265, 1283)
April 10, 2002Encouraging short-term results of a randomised trial in this week's issue of THE LANCET suggest that the drug galantamine could offer therapeutic benefits to people with Alzheimer's disease with cerebrovascular disease and in those with probable vascular dementia.
Vascular dementia-dementia caused by multiple strokes or other cerebrovascular damage-is the second commonest form of dementia after Alzheimer's disease (AD); furthermore, vascular factors contribute to the development of dementia in many patients with AD. The drug galantamine has been shown to offer benefit (in relation to cognition, behaviour, and in improving daily living activities) in patients with AD. Timo Erkinjuntti from Helsinki University Central Hospital, Finland, and colleagues report results from an international study which investigated the effects of galantamine in patients with a diagnosis of probable vascular dementia or AD combined with cerebrovascular disease.
Around 600 patients were randomly assigned galantamine 24 mg/day or placebo in a multicentre, 6-month trial. Primary endpoints were cognition (assessed by the AD assessment scale, cognitive subscale [ADAS-cog]) and global functioning (clinician's interview-based impression of change plus caregiver input [CIBIC-plus]). Daily living activities and behavioural symptoms were also assessed.
After six months, patients given galantamine improved by 1.7 points on the ADAS-cog scale, whereas those on placebo deteriorated by an average of 1 point. 74% of patients given galantamine were stable according to the CIBIC-plus scale compared with 59% of patients given placebo. Activities of daily living and behavioural symptoms were also significantly improved compared with placebo.
Timo Erkinjuntti comments: "Galantamine, being equally effective in dementia due to Alzheimer's disease and in dementia due to cerebrovascular disease, provides a treatment option to a broad range of patients for whom little pharmacological help has been available. We found that galantamine provides an effective symptomatic treatment for patients with these disorders, offering a range of therapeutic effects that will give important benefits to patients with dementia."
In an accompanying Commentary (p 1265), Lon Schneider from University of Southern California Keck School of Medicine, USA, concludes: "Before recommending galantamine or other cholinesterase inhibitors for clinical use in vascular dementia, several concerns need to be addressed. Above all there need to be confirmatory trials that are adequately powered to detect both cognitive and global change, and to allow secondary analyses. Trials need to be designed to account for the substantial clinical and biological heterogeneity in vascular dementia."
Lancet
After six months, patients given galantamine improved by 1.7 points on the ADAS-cog scale, whereas those on placebo deteriorated by an average of 1 point. 74% of patients given galantamine were stable according to the CIBIC-plus scale compared with 59% of patients given placebo. Activities of daily living and behavioural symptoms were also significantly improved compared with placebo.
Timo Erkinjuntti comments: "Galantamine, being equally effective in dementia due to Alzheimer's disease and in dementia due to cerebrovascular disease, provides a treatment option to a broad range of patients for whom little pharmacological help has been available. We found that galantamine provides an effective symptomatic treatment for patients with these disorders, offering a range of therapeutic effects that will give important benefits to patients with dementia."
In an accompanying Commentary (p 1265), Lon Schneider from University of Southern California Keck School of Medicine, USA, concludes: "Before recommending galantamine or other cholinesterase inhibitors for clinical use in vascular dementia, several concerns need to be addressed. Above all there need to be confirmatory trials that are adequately powered to detect both cognitive and global change, and to allow secondary analyses. Trials need to be designed to account for the substantial clinical and biological heterogeneity in vascular dementia."
Lancet
Alzheimer Disease Current Events and Alzheimer Disease News RSSDelirium in hospitalized adults: Situation critical, no relief available
Every year as many as seven million adults in the United States experience delirium during hospitalization.
New data demonstrate potential for early detection of Alzheimer's disease
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Measuring brain atrophy in patients with mild cognitive impairment
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Commonly used ulcer drugs may offer treatment potential in Alzheimer's disease
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New test for mysterious metabolic diseases developed at Stanford/Packard
Scientists at Stanford University School of Medicine have devised a much-needed way to monitor and find treatments for a mysterious and devastating group of metabolic diseases that arise from mutations in cells' fuel-burning mechanism.
Recalibrating 'fight or flight'
A Canadian/U.S. research team has reported a novel approach to stimulating recovery from chronic stress disorders. Details of the therapeutic model, which exploits the natural dynamics of the body's "fight or flight" system, are published January 23 in the open-access journal PLoS Computational Biology
Vitamin B does not slow cognitive decline in Alzheimer's
A clinical trial led by Paul S. Aisen, M.D., professor of neurosciences at the University of California, San Diego School of Medicine, showed that high-dose vitamin B supplements did not slow the rate of cognitive decline in patients with mild to moderate Alzheimer disease.
Protecting patient privacy the new fashioned way
Protecting patient privacy has been recognized as the duty of health-care providers for about as long as doctors have seen patients. In 1996 that duty became a legal obligation when Congress passed the Health Insurance Portability and Accountability Act.
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