Alzheimer's Disease Detection and New Treatment Alternatives Discussed at Symposium
| Geriatric Times |  |
January/February 2001 | |
Vol. II | |
Issue 1 |
At a symposium of the 13th Annual Psychiatric & Mental Health Congress on Nov. 16, 2000, William E. Reichman, M.D., emphasized the increasing occurrence of Alzheimer's disease (AD), which is a major public health concern as the population continues to age at an exponential rate. AD accounts for 60% to 70% of all dementia cases and affects 35% to 40% of people over the age of 85.
Reichman, associate professor of psychiatry and director of the division of geriatric psychiatry at the University of Medicine and Dentistry of New Jersey, said, "[Dementia] creeps up on people. Onset is insidious and patients gradually regress over time." He said that the initial signs of dementia are subtle and may include impairment in memory, visuospatial ability, executive functioning and calculation, as well as behavioral changes such as increased irritability, paranoia and aggression. Patients also often appear physically robust, making it easy for physicians and family members to overlook the early signs of dementia. According to Reichman, AD screening¾with tests such as the 7-Minute Screen, which examines orientation, memory, visuospatial difficulty and verbal fluency¾is necessary for early detection in addition to obtaining the patient's dementia history, a physical and neurological examination, and laboratory studies.
Treatment options were discussed by co-presenter Gary W. Small, M.D., Parlow-Solomon Professor on Aging and director of the Center on Aging at the University of California, Los Angeles School of Medicine. In the area of pharmacological treatment, Small said that cholinesterase inhibitors and vitamin E are currently recommended for the treatment of AD.
Cholinesterase inhibitors (e.g., tacrine [Cognex], donepezil [Aricept], rivastigmine [Exelon] and galantamine [Reminyl]) were proven to be modestly effective in improving cognition and maintaining functional status of patients with AD, Small stated. Vitamin E, which is less expensive, he continued, was shown in studies to delay progression from moderate to severe dementia by approximately 230 days, as compared to placebo.
New drugs are currently being developed for AD treatment, however, Small said that it is also important to try nonpharmacologic strategies such as arranging social and family activities as often as possible, incorporating regular exercise, keeping daily activities routine, and using clocks and calendars to maximize orientation-RT