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Alzheimer' s Disease: A Summary of Research Findings -Part XVII

(11/26/16)- The results of a study, published recently online by the journal JAMA International Medicine, that was funded by the National Institute on Aging concluded that dementia rates are declining, even though the population is aging.

The study found that the dementia rate in Americans 65 and older fell by 24% over 12 years, to 8.8 percent in 2012 from 11.6 percent in 2000. In 2000, people received a diagnosis of dementia at an average age of 80.71; in 2012, the average was 82.4.

The study included 21,000 Americans 65 and older across all races, education and incomes in the study known as the Health and Retirement Study. The study required participants to recall 10 nouns immediately and after a delay; to serially subtract 7 from 100, and to count backwards from 20.

(10/8/16)- 56% of persons aged 90 years or more with Alzheimer’s disease use psychotropic drugs whereas the same figure was 48% among younger persons with Alzheimer’s disease and 38% among those aged 90 years or more but without Alzheimer’s disease.

Psychotropic drugs include antipsychotics, antidepressants and benzodiazepines and related drugs which are used for anxiety and insomnia in short-term treatment. On the contrary, persons aged 90 years or more with Alzheimer’s disease used less frequently anti-dementia drugs (63%) when compared with younger persons with the same disease (72%).

(11/5/10)- The following is taken from an email sent by Physicians First Watch

"Contrary to epidemiological studies suggesting that docosahexaenoic acid (DHA) might lower risk for Alzheimer disease, a randomized trial in has found that DHA does not slow cognitive decline in patients with AD.

Researchers randomized some 400 adults with mild-to-moderate AD to receive DHA (2 g daily) or placebo for 18 months. At the end of treatment, there was no difference between the groups in the rate of cognitive decline, as measured by the Alzheimer's Disease Assessment Scale and the Clinical Dementia Rating sum of boxes.

Given their findings, the authors conclude that "there is no basis for recommending DHA supplementation" for patients with AD.

(1/28/09)- Researchers at Vanderbilt University concluded that long term usage of antipsychotic drugs pose a substantial risk to the elderly and the young. The results of the study were published in a recent edition of the New England Journal of Medicine.

The study also found that the risk of death increased for patients receiving larger doses of these drugs. Wayne Ray, a professor of preventive medicine at Vanderbilt was the lead investigator for the study.

The drugs involved in the study were Zyprexa made by Eli Lilly & Co., Risperdal made by J&J, Seroquel made by AstraZeneca PLC and .Clozaril, made by Novartis AG..

Researchers for the study reviewed the medical records of about 277,000 Tennessee Medicaid enrollees for the years 1990 to 2004. About 46,000 of them were taking atypical antipsychotic drugs and 44,000 were taking typical antipsychotic drugs. About 187,000 were not taking any of the drugs. Patients ranged in age from 30 to 74 years, with the average age being 46.

The researchers concluded that among patients taking the antipsychotic drugs, there were about three sudden cardiac deaths for every 1,000 patient-years. The death rate was about half that level for the control group of patients who were not taking any antipsychotic medications.

The study also found that the risk of death increased for patients receiving larger doses of both kinds of drugs.

(1/13/09)-The dementia antipsychotic withdrawal trial )DART-AD) long-term follow-up of a randomized placebo controlled trial study appeared in The Lancet Neurology, Early Online Publication, 9 January 2009. It was conducted by Clive Ballard et al "for the DART-AD investigators". These researchers looked at mortality in patients with Alzheimer's disease (AD) who are prescribed antipsychotics. They were interested in mortality data from a long-term placebo-controlled trial.

Between October 2001, and December 2004, patients with AD who resided in care facilities in the UK were enrolled into a randomized, placebo-controlled, parallel, two-group treatment discontinuation trial. Participants were randomly assigned to continue with their antipsychotic treatment (thioridazine, chlorpromazine, haloperidol, trifluoperazine, or risperidone) for 12 months or to switch their medication to an oral placebo. The primary outcome was mortality at 12 months. An additional follow-up telephone assessment was done to establish whether each participant was still alive 24 months after the enrolment of the last participant (range 24?54 months). Causes of death were obtained from death certificates.

The results indicated a reduction in survival in the patients who continued to receive antipsychotics compared with those who received placebo. The researchers concluded that there is an increased long-term risk of mortality in patients with AD who are prescribed antipsychotic medication. These results further highlight the need to seek less harmful alternatives for the long-term treatment of neuropsychiatric symptoms in nursing homes.

Usually, antipsychotics are prescribed when a demented patient is agitated. It should be noted that The Physicians' Desk Reference (PDR) labels these medications with a blackbox warning indicating an increased risk of death and/or strokes in these patients. We recently reviewed a book, The Nursing Home Guide by Dr. Joshua D. Schor (look in our index under books) who expressed an approach well worth quoting. "Do I personally prescribe antipsychotics? Of course I do, but I do so cautiously and only after talking to staff and family. I do follow the rules of trying to wean the medications at least twice a year, unless there is a very compelling reason not to...If you get in a tussle with the physician, ask him or her to provide documentation that the proposed drug works and see what they say." (p. 139-140) The need for long-term care patient advocacy is an essential factor in enhancing quality of life in care facilities.

(5/24/06)- The February 2006 issue of the Archives of General Psychiatry published a study that indicated that Alzheimer's patients with a lifetime history of depression have increased plaques and tangles in the hippocampus section of the brain and more rapid cognitive decline into dementia than those who did not have depression. Present treatment outcomes for this type of patient is less favorable.

(7/3/02)-After writing 16 articles on various aspects of Alzheimer's disease, it would seem helpful to our readers to summarize what is known about the disease as reflected in the many peer reviewed studies published in the research literature. More detailed information on many of the items listed below can be found in the various articles in this series.

These conclusions are subject to future research findings, but represent the most recent state of knowledge in the field.

See: Alzheimer’s Disease-PartI-Medications for Alzheimer's.
See: Alzheimer’s Disease Part II- Selegiline and AD.
See: Alzheimer's Disease Part III- Use of Gingko Biloba in memory problems of Alzheimer patients.
See: Alzheimer's Disease PartIV-Alternative Treatment.
See: Alzheimer's Disease Part V-Possible New Drugs for Alzheimer's Disease Treatment.
See: Alzheimer's Part VI -Early Diagnosis.
See: Alzheimer's Part VII -New Medication-Metrifonate
See:Alzheimer's

 Disease PartVIII -- Implications of Longer Life Expectancies
See: Alzheimer's Part IX-Ethical Care Principles

See: Alzheimer's Disease Part X-Estrogen and Alzheimer's Disease

See: Alzheimer's Disease Part XI-Pocket Smell Test

See: Alzheimer's Disease Part XII-MAO-B

See: Alzheimer's Disease Part XIII-Critical Flicker Fusion Threshold Test

See: Alzheimer's Disease Part XIV-Donepezil

See" Alzheimer's Disease Part XV-Cerebroylsin

See: Alzheimer's Disease Part XVI-MCI

See: Alzheimer's Disease Part XVIII-NO Releasing NSAIDs

See: Alzheimer's Disease Part XIX-Vitamin E

See: Alzheimer's Disease-Part XX-Clinical Trials

See: Alzheimer's Disease Part XXI-The Brain

See Dementia with Lewy Bodies- Part XXII-by Gourete Broderick

See: Alzheimer's Disease-Part XXIII-HMG

See: Alzheimer's Disease-Part XXIV-A Prequel

See: Alzheimer's Disease-Part XXV-Psychosis

See: Alzheimer's Disease-Part XXVI-Amyloid-beta Hypothesis Controversy

See: Alzheimer's Disease-Part XXVII- AD and Diabetes

See: Alzhemeir's Disease-Part XXVIII - Insulin and AD

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME"

Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated November 26, 2016

http://www.therubins.com

To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com

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