Scientific Basis for Alzheimer's Disease Treatment Information
Cholinesterase for Alzheimer's Disease
Studies
Results from 10 randomized, double-blind, placebo-controlled trials show that six months of treatment with recommended doses of donepezil, galantamine or rivastigmine averaged improvements in cognitive function in people with mild, moderate or severe dementia due to Alzheimer's disease.
The study clinicians more actively assessed the overall clinical status of the treated patients. The benefits of the treatment were also seen in measures of daily living and behavior. None of these treatment benefits are large.
The effects are similar in patients with severe dementia, but there is little evidence from only two trials. There is evidence of more adverse events, in total, in patients treated with ChEI than with placebo.
Many types of adverse events were reported, but nausea, vomiting, and diarrhea were significantly more common in the ChEI group than in the placebo group.
There is only one randomized, double-blind study comparing two ChEIs, and donepezil is compared with rivastigmine. There is no evidence of differences between donepezil and rivastigmine in cognitive function, activities of daily living, and behavioral disturbances at 2 years. Fewer patients suffer from adverse events with donepezil than with rivastigmine.
Conclusion.
The three cholinesterase inhibitors are effective in treating mild to moderate Alzheimer's disease; despite slight differences in the mechanisms of action of the three cholinesterase inhibitors, there is no evidence of any difference between them in terms of efficacy. Evidence from one large trial shows fewer adverse events associated with donepezil than with rivastigmine.
Burks JS Cholinesterase inhibitors in Alzheimer's disease. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD005593. doi: 10.1002 / 14651858.CD005593
Psychological interventions for people with Alzheimer's disease
What is the study?
The study was conducted in Szczecin, Poland. The research team obtained a list of individuals who were eligible for financial assistance and who agreed to be contacted by the research team. The individuals requiring care were diagnosed with AD by a physician (either a neurologist or psychiatrist) and had an average age of 78.3 years. A letter explaining the study was sent to caregivers inviting them to participate.
Of the 124 potential participants who met the eligibility criteria, 33 (27%) agreed to participate in the study. Of the 124 potential participants who met the eligibility criteria, 33 (27%) agreed to participate in the study, and 30 ultimately participated.
The grouping was based on the availability of financial aid and the unavailability of financial aid. Five sessions of psychological training were given to the participants.
Results
The average level of depression among the caregivers was 14.3 in the
The mean level of depression among caregivers in the intervention group was 14.3 (SD = 6.9) 13.8 (SD = 6.2) in the control group.
The mean score for caregiver burden was
41.1 (SD = 8.8) in the intervention group
The mean score for caregiver burden was 41.1 (SD = 8.8) in the intervention group and 37.6 (SD = 9.2) in the control group.
For AD knowledge, participants in the intervention group scored on average 21.1 (SD = 2.7) points, while participants in the control group had a mean score of 37.6 (SD = 9.2).
Conclusion
In conclusion, the results of the study showed that the psychological intervention slightly increased depression and caregiver burden. However, after 6 months of follow-up, there seemed to be no significant difference in levels.
In light of this, can psychological interventions be used to prevent depression?
And might it increase the burden on caregivers?
This is what we found out.
Many of the caregivers commented on how they feel and think when they have Alzheimer's disease, and how little they understand the symptoms of Alzheimer's disease. There seemed to be a strong desire to understand more.
However, this is the result of psychological interventions.
So, one of the ideal interventions that was suggested was
"financial support.
This includes
Transportation
Food
Medical supplies
Equipment such as electric mattresses
Home modifications
The following are included.
It also includes the hiring of caregivers.
This is easy to imagine, so I won't go into it further.
Research has shown that there are concerns that psychological interventions may increase the burden. However, the benefits of psychological interventions are strong.
By understanding the disease, caregivers can understand how to treat the person in need of care. There is a possibility of clearing up misunderstandings in communication and other areas.
In this experiment, we found that among the health care providers, doctors provided information on AD, but not on symptoms.
In addition, in this experiment, although information was provided by doctors for AD among the health care providers, many of them did not know how to obtain information from non-doctors, even though they could obtain information about symptoms. There were many people who said, "I don't know how to get information from other sources.
If you are prepared.
The word "preparedness" seems to be a difficult word for people who don't want to look for it unless they actually experience it.
And for some reason, it also sounds like a convenient word.
I've heard the suffering of families who have had to actually care for their children.
If you have genetic concerns, I think you should start learning about Alzheimer's disease now.
Magdalena Leszko, Effectiveness of psychoeducational and financial interventions to support caregivers of Alzheimer's patients in Poland, Innovations in Aging, Volume 3, Issue 3, July 2019, igz026, https: //doi.org/10.1093/geroni/igz026
The Link Between Periodontal Disease and Alzheimer's
In a study by JamPotempa, a professor at the University of Louisville School of Dentistry in Kentucky, DNA found in bacteria was found to be better in Alzheimer's brains. And while the DNA was found in both Alzheimer's patients and non-Alzheimer's patients, it was found at a higher frequency in Alzheimer's patients.
And the brains of the Alzheimer's patients secreted high levels of a toxin called zingipine. This bacteria can often be observed in periodontal disease and gingivitis, and the experiment was also conducted on mice.
The mice were injected with the causative bacteria, P. gingivalis, in their mouths, and the bacteria spread to their brains. There was no mention of testing the cognitive function of the mice infected with the toxin P. gingivalis, but amyloid, an abnormal protein often found in the brains of Alzheimer's patients, was identified and is being studied in cooperation with a company in San Francisco.
The study was published as a paper, but it is still under peer review and will not be officially published until the future. In the U.S., 46% of adults over the age of 30 are said to have gum disease, and 9% of them are severely affected.
To prevent these, it has been announced that dental flossing twice a day is enough to prevent the disease. And another research team is studying a possible link between periodontal disease and the herpes virus.
This is from the team conducting the study.
Alzheimer's disease is a condition for which there is no clear cause, genetic or otherwise. Alzheimer's disease could be reduced if the oral bacteria that are currently thought to be associated with the disease can be identified and therapeutic drugs can be developed to treat them. He commented.
Although this is still an animal experiment and the evidence is low, the means of prevention is simple as a possibility. If brushing your teeth well can prevent Alzheimer's disease, then brushing your teeth is something you can work on willingly.
Alzheimer's Disease and Muscle Strength
Older people with strong muscles have a lower risk of developing Alzheimer's disease and mild cognitive impairment than those with weaker muscles, according to a report in the Archives of Neurology. The study builds on previous research showing a link between grip strength and the risk of Alzheimer's disease.
What does the study say?
In this study, researchers at the Alzheimer's Disease Center at Rush University in Chicago measured a wide range of cognitive skills and muscle strength across the entire body in 970 participants with an average age of 80 years.
Conclusions.
During a follow-up period of about four years, 138 people developed Alzheimer's disease. After adjusting for age and other variables, they found that the 10% of participants with the strongest muscle strength had a 61% lower risk of developing Alzheimer's disease compared to the 10% of study participants with the weakest muscle strength. Muscle strength and mild cognitive impairment, conditions that often precede Alzheimer's disease, were similar but less closely related.
Stronger muscles were also found to be associated with slower cognitive decline.
The researchers speculate that a general underlying disease process may explain the association between muscle weakness and cognitive decline.
Replication of results in population-based studies is important, the authors add and comment.
Boyle, Pennsylvania, et al. Association of muscle strength with risk of Alzheimer's disease and rate of cognitive decline in community-dwelling older adults Archives of Neurology. 2009. 66(11): 1339-44.
Pharmacotherapy for lethargy in Alzheimer's disease.
Study details
We included 21 studies with a total of 6384 participants in our quantitative analysis.
The risk of bias is very low to moderate. All studies reported appropriate methods of randomization and blinding. The main objective of four studies (three methylphenidate, one modafinil) was to improve indifference.
In these studies, all participants had clinically significant indifference at baseline.
Methylphenidate may improve indifference compared to placebo.
This finding was present when apathy was assessed using the Apathy Evaluation Scale (AES), which was used in all three studies investigating methylphenidate.
Conclusion.
Methylphenidate may be beneficial for apathy and may have a small benefit on cognitive and functional performance in AD patients, but this finding is associated with low quality evidence. Our meta-analysis is limited by the small number of studies within each drug class, risk of bias, publication bias, imprecision among studies, and inconsistencies. Additional studies should be encouraged to investigate indifference as a primary outcome measure and to target people with AD who have clinically significant indifference with longer time periods and larger sample sizes. This will improve the quality of the evidence for methylphenidate and confirm whether it is an effective pharmacotherapy for indifference in AD.
Ruchirakhan MT, Herman N, Abraham EH, Chan S, Lankt KL. Pharmacological interventions for apathy in Alzheimer's disease. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. no.: CD012197. DOI: 10. 1002 / 14651858.CD012197.pub2.
Cognitive Function and Vitamin E
Vitamin E, which has antioxidant properties, is expected to improve cognitive function in Alzheimer's disease and mild dementia. Vitamin E, which has antioxidant properties, is expected to improve cognitive function.
I've never heard of it, but I'd like to know if there is any evidence for this effect. I'd like to introduce it here.
Research
Four studies met the selection criteria, but we were only able to extract outcome data from two studies, one in the AD population (n = 304) and one in the MCI population (n = 516), following the protocol.
No evidence of a clinically important effect of vitamin E on dementia, as measured by change from baseline on the Alzheimer's Disease Rating Scale, was found in the AD population. There was no evidence of a difference in risk of experiencing at least one serious adverse event between the vitamin E and placebo groups over 6 to 48 months. No evidence was found of an effect of vitamin E on the probability of progression from MCI to possible dementia due to AD over 36 months.
The study authors found no evidence that vitamin E differed from placebo in its effects on cognitive function, overall severity, or activities of daily living.
There was also no evidence of differences between the groups in more commonly reported adverse events.
Conclusion.
We found no evidence that vitamin E alpha-tocopherol given to people with MCI interferes with progression to dementia or improves cognitive function in people with MCI or dementia due to AD. However, there is moderate quality evidence from a single study that it may slow functional decline in AD. In the trials in this review, vitamin E was not associated with an increased risk of serious adverse events or death. Although these conclusions have changed since the last update, they are based on a small number of trials and participants, and it is very likely that further research will influence the results.
Farina N, Llewellyn D, Isaac MGEKN, Tabet N. Vitamin E for Alzheimer's disease and mild cognitive impairment.Cochrane Database of Systematic Reviews 2017, Issue 4. art. No.: CD002854. doi: 10.1002 / 14651858.CD002854.pub5.
