Background
The
Ginkgo biloba
special extract, EGb 761
®
has been widely used in the treatment of neuropsychiatric disorders, including Alzheimer’s disease (AD).
Methods
To guide clinical practice in the Asian region, the Asian Clinical Expert Group on Neurocognitive Disorders compiled evidence‐based consensus recommendations regarding the use of EGb 761
®
in neurocognitive disorders with/without cerebrovascular disease.
Results
Key randomized trials and robust meta‐analyses have demonstrated significant improvement in cognitive function, neuropsychiatric symptoms, activities of daily living (ADL) and quality of life with EGb 761
®
versus placebo in patients with mild‐to‐moderate dementia. In those with mild cognitive impairment (MCI), EGb 761
®
has also demonstrated significant symptomatic improvement versus placebo. World Federation of Societies of Biological Psychiatry guidelines list EGb 761
®
with the same strength of evidence as acetylcholinesterase inhibitors and N‐methyl‐D‐aspartate (NMDA) antagonists e.g. memantine (Grade 3 recommendation; Level B evidence). Only EGb 761
®
had Level B evidence in improving cognition, behaviour, and ADL in both AD and vascular dementia patients. Safety analyses show EGb 761
®
to have a positive risk‐benefit profile. While concerns have been raised regarding a possible increased bleeding risk, several randomized trials and two meta‐analyses have not supported this association.
Conclusions
The Expert Group foresee an important role for EGb 761
®
, used alone or as an add‐on therapy, in the treatment of MCI and dementias, particularly when patients do not derive benefit from acetylcholinesterase inhibitors or NMDA antagonists. EGb 761
®
should be used in alignment with local clinical practice guidelines.
AD+CVD is likely to be under-recognised in Asia. Further research is needed to establish the true prevalence of this treatable and potentially preventable disease.
This paper is dedicated to the memory of Prof Simeon Marasigan, coinvestigator of the NEU-RITES trial who unfortunately passed away after the manuscript was finalized. Prof Marasigan was a towering figure in Philippine neurology and psychiatry. He was kind-hearted, humble, caring; a true friend, assiduous mentor, tenacious scholar, and a magnanimous leader. He will be sorely missed.
ClinicalTrials.gov Identifier: NCT01847924
We report the results of an ultrastructural study of Pick bodies (PB). A histogram constructed with the maximal width of each filamentous component in PB revealed a wide range of sizes among the filaments, in contrast to the unique composition of the paired helical filaments (PHF) seen in the neurofibrillary tangle of Alzheimer type (NFT-AT). Morphologically, three groups of filaments could be distinguished. The first group consisted of straight smooth-surfaced filaments of 10-14 nm diameter, which were presumably altered neurofilaments. The second one was of straight smooth-surfaced "tubules" of 15-22 nm diameter, smaller than normal microtubules. The third one was of PHF thought to be formed by a pair of filaments of the first group. The PHF found in PB differed from PHF of NFT-AT in the distance between crossovers, and rather resembled the loosely interwinding PHF reported in NFT of progressive supranuclear palsy.
Background
Dementia is not a disease in is itself but a collection of related to cognitive decline. Aside from cognitive decline, behavioral and psychological symptoms of dementia (BPSD), which multifactorial in origin and is often brought about by maladaptation to the environment and struggles with the activities of daily living. Several tool have been made to screen BPSD, one of which is the Abe BPSD Score.
Method
Two bilingual persons independently translated the scale to the Filipino language. The translated version underwent evaluation by a team of experts composed of 5 neurologists, 5 experts in dementia and 5 psychiatrists. The items were further refined and revised, accordingly, by these specialists. The revised questionnaire was used for the face validity with 30 cognitively intact adults. The final Filipino version of the questionnaire was back translated by another independent native speaker of the Filipino language. The final Filipino version and the version translated to English were compared.
Result
All items had a CVR or >0.49 for the evaluation of content validity ratio (see table 1) and clarity of > 79% (see table 3) so that all items were retained and deemed appropriate. Regarding relevance, item 1 needed to be revised. There was a significant change of the ranking of the symptoms as compared to the English version of the Abe’s BPSD Score, thus the order of the symptoms were revised.
Conclusion
The Filipino version of the Abe score for BPSD, ABS‐P, is a simple and easily understandable scoring system for assessing the presence and extent of BPSD. The translated and adapted Filipino version is practical for use in daily clinical practice since it has short administration time. A validation study can subsequently be carried out with the ABS‐P.
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