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Recognition and treatment of Alzheimer's disease: A case-based review
Dana M. Marseille, MD
Daniel H.S. Silverman, MD, PhD
Neuronuclear Imaging Section, Division of Biological Imaging, David Geffen School of Medicine, University of California at Los Angeles Medical Center, Los Angeles, California
Early recognition and treatment initiation are pivotal in managing Alzheimer k disease (AD). Once a diagnosis of AD is made, a treatment plan is developed and should include treatment initiation with cholinesterase inhibitors (ChEfs) to improve cognition, management of comorbid conditions, and treat behavioral symptoms. Caregiver compliance is integral to AD treatment success. The purpose of this report is to present two real case studies of "suspected" AD or related dementia and stress the significance of early and accurate diagnosis in disease management. In case 1, a caregiver reports gradual but progressive loss of memory, and the patient himself complains of memory impairment. Neuroimaging analysis confirms "typical" AD. In case 2, initiation of ChEI therapy is followed by substantial clinical improvement in the face of a complex medical picture, and neuroimaging revealing more neurodegenerative changes than could be accountedfor by "pure" AD.
Key Words: Alzheimer's disease cholinesterase inhibitor dementia caregiver case study
References
- 1. Ernst RL, Hay JW: The US economic and social costs of Alzheimer's disease revisited. Am JPublic Health. 1994; 84: 1261-1264.[Abstract/Free Full Text]
- 2. Stommel M, Collins CE, Given BA: The costs of family contributions to the care of persons with dementia. Gerontologist. 1994; 34(2): 199-205.[Abstract]
- 3. Huang L, Cartwright W, Hu T: The economic cost of senile dementia in the United States, 1985. Public Health Rep. 1988; 103: 3-7.[Web of Science][Medline]
[Order article via Infotrieve]
- 4. Evans DA: Estimated prevalence of Alzheimer's disease in the United States. Milbank Q. 1990; 68: 267-289.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 5. Small GW, McDonnell DD, Brooks RL, et al.: The impact of symptom severity on the cost of Alzheimer's disease. JAm Geriatr Soc. 2002; 50: 321-327.[CrossRef][Medline]
[Order article via Infotrieve]
- 6. Leon J, Cheng CK, Neumann PJ: Alzheimer's disease care: Costs and potential savings. Health Aff(Millwood). 1998; 17(6): 206-216.[Abstract]
- 7. Hebert LE, Scherr PA, Bienias JL, et al.: Alzheimer disease in the US population: Prevalence estimates using the 2000 census. Arch Neurol. 2003; 60(8): 1119-1122.[Abstract/Free Full Text]
- 8. Sloane PD, Zimmerman S, Suchindran C, et al.: The public health impact of Alzheimer's disease, 2000-2050: Potential implication of treatment advances. Annu Rev Public Health. 2002; 23: 213-231.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 9. Tuokko H, Garrett DD, McDowell I, et al.: Cognitive decline in high-functioning older adults: Reserve or ascertainment bias? Aging Ment Health. 2003; 7(4): 259-270.[CrossRef][Medline]
[Order article via Infotrieve]
- 10. Rogers SL, Doody RS, Mohs RC, et al.: Donepezil improves cognition and global function in Alzheimer disease: A 15-week, doubleblind, placebo-controlled study. Arch Intern Med. 1998; 158(9): 1021-1031.[Abstract/Free Full Text]
- 11. Rogers SL, Farlow MR, Doody RS, et al.: A 24-week, doubleblind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Neurology. 1998; 50(1): 136-145.[Abstract/Free Full Text]
- 12. Burns A, Rossor M, Hecker J, et al.: The effects of donepezil in Alzheimer's disease-results from a multinational trial. Dement Geriatr Cogn Disord. 1999; 10(3): 237-244.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 13. Corey-Bloom J, Anand R, Veach J, for the ENA 713 B352 Study Group: A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetylcholinesterase inhibitor, in patients with mild to moderately severe Alzheimer's disease. Int J Geriatr Psychopharmacol. 1998; 1: 55-65.
- 14. Rosler M, Anand R, Cicin-Sain A, et al.: Efficacy and safety of rivastigmine in patients with Alzheimer's disease: International randomised controlled trial. BMJ. 1999; 318(7184): 633-638.[Abstract/Free Full Text]
- 15. Tariot PN, Solomon PR, Morris JC, et al.: A 5-month, randomized, placebo-controlled trial of galantamine in AD. Neurology. 2000; 54(12): 2269-2276.[Abstract/Free Full Text]
- 16. Wilcock GK, Lilienfeld S, Gaens E, on behalf of the Galantamine International-I Study Group: Effficacy and safety of galantamine in patients with mild to moderate Alzheimer's disease: Multicentre randomised controlled trial. BMJ 2000; 321(7274): 1445-1449.[Abstract/Free Full Text]
- 17. Hill JW, Futterman R, Mastey V, et al.: The effect of donepezil therapy on health costs in a Medicare managed care plan. Manag Care Interface. 2002; 15(3): 63-70.[Medline]
[Order article via Infotrieve]
- 18. Farlow M, Anand R, Messina J Jr, et al.: A 52-week study of the efficacy of rivastigmine in patients with mild to moderately severe Alzheimer's disease. Eur Neurol. 2000; 44(4): 236-241.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 19. Doody RS, Geldmacher DS, Gordon B, et al.: Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients withAlzheimer disease. Arch Neurol. 2001; 58: 427-433.[Abstract/Free Full Text]
- 20. Raskind MA, Peskind ER, Wessel T, et al.: Galantamine in AD: A six-month randomized, placebo-controlled trial with a six-month extension. Neurology. 2000; 54(12): 2261-2268.[Abstract/Free Full Text]
- 21. Winblad B, Engedal K, Soininen H, et al.: A 1 -year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD. Neurology. 2001; 57(3): 489-495.[Abstract/Free Full Text]
- 22. Geldmacher DS, Provenzano G, McRae T, et al.: Donepezil is associated with delayed nursing home placement in patients with Alzheimer's disease. JAm Geriatr Soc. 2003; 51(7): 937-944.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 23. Lopez OL, Becker JT, Wisniewski S, et al.: Cholinesterase inhibitor treatment alters the natural history of Alzheimer's disease. J NeurolNeurosurg Psychiatry. 2002; 72(3): 310-314.[Abstract/Free Full Text]
- 24. Knopman D, Schneider L, Davis K, et al.: Long-term tacrine (Cognex) treatment: Effects on nursing home placement and mortality. Tacrine Study Group. Neurology. 1996; 47(1): 166-177.[Abstract/Free Full Text]
- 25. Courtney C, Farrell D, Gray R, et al.: Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): Randomised double-blind trial. Lancet. 2004; 363(9427): 2105-2115.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 26. Small GW, Rabins PV, Barry PP, et al.: Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society. JAMA. 1997; 278(16): 1363-1371.[Abstract/Free Full Text]
- 27. Morris JC, Storandt M, Miller JP, et al.: Mild cognitive impairment represents early-stage Alzheimer's disease. Arch Neurol. 2001; 58: 397-405.[Abstract/Free Full Text]
- 28. Galasko DR, Gould RL, Abramson IS, et al.: Measuring cognitive change in a cohort of patients with Alzheimer's disease. Stat Med. 2000; 19(11-12): 1421-1432.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 29. Boise L, Camicioli R, Morgan DL, et al.: Diagnosing dementia: Perspectives of primary care physicians. Gerontologist. 1999; 39(4): 457-464.[Abstract]
- 30. Geldmacher DS: Cost-effective recognition and diagnosis of dementia. SeminNeurol. 2002; 22(1): 63-70.
- 31. Knopman DS, DeKosky ST, Cummings JL, et al.: Practice parameter: diagnosis of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001; 56GB files: 1143-1153.
- 32. Small GW, Mazziotta JC, Collins MT, et al.: Apolipoprotein E type 4 allele and cerebral glucose metabolism in relatives at riskfor familial Alzheimer disease. JAMA. 1995; 273(12): 942-947.[Abstract/Free Full Text]
- 33. Small GW, Ercoli LM, Silverman DH, et al.: Cerebral metabolic and cognitive decline in persons at genetic risk for Alzheimer's disease. Proc NatlAcad Sci USA. 2000; 97(11): 6037-6042.[Abstract/Free Full Text]
- 34. Silverman DH, Small GW, Chang CY, et al.: Positron emission tomography in evaluation of dementia: Regional brain metabolism and long-term outcome. JAMA. 2001; 286(17): 2120-2127.[Abstract/Free Full Text]
- 35. Reiman E, Caselli R, Yun L, et al.: Preclinical evidence of Alzheimer's disease in persons homozygous for the epsilon 4 allele for apolipoprotein E. NEngl JMed. 1996; 334(12): 752-758.
- 36. Minoshima S, Giordani B, Berent S, et al.: Metabolic reduction in the posterior cingulate cortex in very early Alzheimer's disease. Ann Neurol. 1997; 42(1): 85-94.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 37. Silverman DHS, Cummings J, Small GW, et al.: Added clinical benefit of incorporating 2-deoxy-2-[18F]fluoro-D-glucose with positron emission tomography into the clinical evaluation of patients with cognitive impairment. Mol Imaging Biol. 2002; 4(4): 283-293.[CrossRef][Medline]
[Order article via Infotrieve]
- 38. Silverman DH, Gambhir SS, Huang HW, et al.: Evaluating early dementia with and without assessment of regional cerebral metabolism by PET: A comparison of predicted costs and benefits. JNucl Med. 2002; 43(2): 253-266.[Abstract/Free Full Text]
- 39. Newberg AB, Alavi A: The role of PET imaging in the management of patients with central nervous system disorders. Radiol Clin North Am. 2005; 43(1): 49-65.[CrossRef][Medline]
[Order article via Infotrieve]
- 40. Silverman DH: Brain 1 8F-FDG PET in the diagnosis of neurodegenerative dementias: Comparison with perfusion SPECT and with clinical evaluations lacking nuclear imaging. J Nucl Med. 2004; 45(4): 594-607.[Abstract/Free Full Text]
- 41. Seltzer B, Zolnouni P, Nunez M, et al.: Donepezil treatment benefits in early-stage Alzheimer's disease. JAm Geriatr Soc. 2003; 51(4): S100-S101.
- 42. Rogers SL, Friedhoff LT, for the Donepezil Study Group: The efficacy and safety of donepezil in patients with Alzheimer's disease: Results of a US multicentre, randomized, double-blind, placebo-controlled trial. Dementia. 1996; 7(6): 293-303.[Web of Science][Medline]
[Order article via Infotrieve]
- 43. Rogers SL, Doody RS, Pratt RD, et al.: Long-term efficacy and safety of donepezil in the treatment of Alzheimer's disease: Final analysis of a US multicentre open-label study. Eur Neuropsychopharmacol. 2000; 10: 195-203.[Web of Science][Medline]
[Order article via Infotrieve]
- 44. Feldman H, Gauthier S, Hecker J, et al.: A 24-week, randomized, double-blind study of donepezil in moderate to severe Alzheimer's disease. Neurology. 2001; 57(4): 613-620.[Abstract/Free Full Text]
- 45. Mohs R, Doody R, Morris J, et al.: I-year prospective placebo-controlled functional survival study. JNeurol. 2000; 247(suppl 3): 15-15.[CrossRef][Web of Science][Medline]
[Order article via Infotrieve]
- 46. Winblad B, Engedal K, Soininen H, et al.: Long-term efficacy of donepezil in patients with mild to moderate Alzheimer's disease: Results from a one-year placebo-controlled study and two-year follow-up study [abstract]. IntPsychogeriatr. 2003; 15(suppl 2): 293-294.
- 47. Swanberg M, Cummings J: Benefit-risk considerations in the treatment of dementia with lewy bodies. Drug Safety. 2002;25(7): 511-523.[CrossRef][Medline]
[Order article via Infotrieve]
American Journal of Alzheimer's Disease and Other Dementias®, Vol. 21, No. 2,
119-125 (2006)
DOI: 10.1177/153331750602100212

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