what happens around us is here

Some New Medical Points In Neurology

Donepezil treatment in severe Alzheimer’s disease: a pooled analysis of three clinical trials

Abstract Objective: Individual clinical trials have demonstrated benefits of donepezil in patients with severe Alzheimer’s disease (AD). Data were pooled from three randomized, placebo-controlled trials of donepezil for severe AD to further evaluate treatment effects and overall tolerability/safety. Methods: Total scores and sub-scores were analyzed for measures of cognition, global function, function, and behavior. Additional analyses were performed to investigate (1) relationships between cognitive, functional, and behavioral changes, and (2) patterns of combined domain response. Results: Using pooled total scores, significant treatment differences at endpoint in favor of donepezil were observed for cognition, global function (both p<0.0001), and function (p = 0.03), with an effect size (Cohen’s d) of 0.51, 0.26, and 0.17, respectively. There was no significant treatment difference for behavior. However, donepezil-treated patients with stabilized/improved cognition tended to show significant improvements in function and behavior over placebo-treated patients. Patients treated with donepezil were 2-3 times more likely to achieve a combined domain response than placebo-treated patients (p<0.0001). Adverse events were as expected for cholinergic therapy, and mortality rates were similar between the treatment groups. Conclusions: These findings suggest measurable donepezil-mediated symptomatic benefits in cognition, global function, and daily living activities in patients with severe AD. The treatment effects support the importance of cholinesterase inhibition as a clinically relevant therapeutic option across the spectrum of AD.

Extrapyramidal signs before and after diagnosis of incident Alzheimer disease in a prospective population study

BACKGROUND: Extrapyramidal signs (EPSs) are commonly accepted as a feature of Alzheimer disease (AD) and may influence both the profile of impairment and prognosis. OBJECTIVE: To examine rates of occurrence and risk factors for all types of EPSs and to describe the impact of EPSs over time on the clinical course of AD. DESIGN: Longitudinal study. SETTING: The Washington Heights Hamilton Heights Inwood Columbia Aging Project. Patients A total of 388 patients with incident AD (mean age, 79 years; 71.4% female). MAIN OUTCOME MEASURES: Extrapyramidal signs rated by means of a standardized portion of the Unified Parkinson’s Disease Rating Scale; prevalence and incidence rates and cumulative risk for non-drug-induced EPSs; and rates of change in EPSs over time, taking into account potential covariates. RESULTS: Extrapyramidal signs were detected in 12.3% of patients at first evaluation and 22.6% at last evaluation. In a multivariate-adjusted generalized estimating equation model of change, total EPS score increased at an annual rate of 1.3%. Women (relative risk [RR], 1.57; P = .03), older patients (RR, 1.03; P = .02), and those with EPSs at baseline (RR, 2.07; P = .001) had greater rates of cognitive decline. CONCLUSIONS: Extrapyramidal signs occur frequently and progress significantly in AD. Patients with incident AD and concomitant EPSs have a greater rate of cognitive decline than do patients with incident AD but without EPSs.

Levetiracetam reduces myoclonus in corticobasal degeneration: report of two cases

Levetiracetam (LEV) has been shown to suppress myoclonus of various origins. Corticobasal degeneration (CBD), a progressive neurodegenerative disorder with Parkinsonian syndrome, is frequently accompanied by myoclonus. We investigated the effect of LEV on myoclonus in two CBD patients. LEV remarkably decreased the myoclonic activity in both patients already at 1,500 mg/day dose. This is the first report on LEV alleviating myoclonus in CBD. Our data indicate that it might be worthwhile to assess this effect in an appropriately designed study

Treated hypothyroidism, cognitive function, and depressed mood in old age: The Rancho Bernardo Study

Objective: Overt hypothyroidism is associated with cognitive impairment, which can be reversed if treated early and appropriately. We compared cognitive function of euthyroid older adults with those who had long-term treated hypothyroidism. Methods: Between 1999 and 2003, the cognitive function of 885 euthyroid and 149 hypothyroid-treated older adults (primary hypothyroidism after surgery or auto-immune thyroid disease) was assessed using three standardized cognitive function tests: the Modified Mini-Mental State Examination, Trails B, and verbal fluency. Depressed mood was assessed using the Beck Depression Inventory (BDI). Only participants with thyroid stimulating hormone (TSH) in the normal range were included. Results: The treated hypothyroid group had been treated with L-thyroxine (LT4) for an average of 20 years. Those with treated hypothyroidism were older than the euthyroid group (76.1 +/- 9.6 vs. 73.6 +/- 10.2 yrs, P = 0.005) and much more often women (81.6% vs. 54.8%, P<0.001). TSH levels were similar between groups [median interquartile range=1.57(1.19) vs. 1.54(1.59) mIU/L, P = 0.81]. Compared to euthyroid, the treated hypothyroidism group had more frequent antidepressant medication use (19.5% vs. 8.5%, P<0.001) but similar BDI scores. Performance on the three cognitive function tests did not differ by thyroid hormone treatment. Results were not changed after adjustment for age, sex, antidepressant medication use, exercise, and total cholesterol. Conclusion: Long-term treated hypothyroidism is not associated with impaired cognitive function or depressed mood in old age. The lack of association with cognitive function is reassuring in regard to long-term use of thyroid hormone therapy.

Pulseless arrest in an elderly patient treated with intravenous tissue plasminogen activator for cardioembolic ischemic stroke

A 77-year-old woman, who had a history of rheumatic mitral stenosis with atrial fibrillation (AF), was referred and admitted to our hospital because of a transient ischemic attack at 4: 55 p.m.. She had taken warfarin for over 10 years, but her condition was not well controlled on admission. At 8: 30 p.m., she had acute ischemic stroke with right facial palsy, right hemiparesis and slurred speech. At 10: 35 p.m., she was treated with intravenous tissue plasminogen activator (t-PA) and her neurological deficits almost fully recovered by 0: 05 a.m. (90 min after t-PA started) . At 0: 08 a.m., she collapsed due to sudden pulseless arrest. Using advanced life support, she soon recovered with no complications. After mitral valve replacement and left atrial appendectomy, she was discharged with a modified Rankin scale 0 at day 40. To the best of our knowledge, this is the first case report showing pulseless arrest immediately after treatment with t-PA in an elderly patient with ischemic stroke. Left insular injury seemed to be a crucial mechanism of pulseless arrest in this case.


September 24, 2009 - Posted by | 1

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