In patients with moderately severe impairment from Alzheimer's disease, treatment with selegiline or alpha-tocopherol slows the progression of disease.

Patients with MCI had a predominant memory impairment with relative sparing of other cognitive domains and were intermediate between clinically normal individuals and patients with AD on cognitive and functional ratings. These results demonstrate the successful implementation of operational criteria for this unique group of at-risk patients in a multicenter clinical trial.

ALZHEIMER DISEASE (AD) IS among the most important health problems of elderly persons, affecting more than 4 million people in the United States. In the last decade, cholinesterase inhibitors have been widely used to alleviate symptoms of cognitive dysfunction in AD. The use of anti-inflammatory drugs is among the strategies under active investigation for the development of effective disease-modifying treatment for AD. This approach is supported by a wealth of laboratory evidence that inflammatory mechanisms contribute to neuronal damage in AD. 1 Furthermore, many epidemiological studies suggest that antiinflammatory drugs have a protective effect, reducing the incidence of AD. 2 Results of small pilot clinical trials of nonsteroidal anti-inflammatory drug Author Affiliations and Participating members of this Alzheimer's Disease Cooperative Study are listed at the end of this article.

Based on actigraphy as an objective measure of sleep time, melatonin is not an effective soporific agent in people with Alzheimer's disease.

Global ratings of dementia severity are used increasingly in clinical trials of antidementia compounds. Such ratings are clinically relevant, but their reliability in multicenter settings has not been determined. To evaluate the reliability of one global scale, the Clinical Dementia Rating (CDR), 82 investigators of the multicenter Alzheimer's Disease Cooperative Study participated in a training and reliability protocol using videotaped assessments of subjects in various stages of Alzheimer's disease. Following training, overall agreement of the investigators with "gold standard" CDR scores was 83%. These results indicate that the training protocol is useful for establishing good levels of agreement in staging dementia severity and that the CDR can be standardized as a clinical global scale for multicenter studies of Alzheimer's disease.