Low dose, high dose, or no dose: better prescribing of cholinesterase inhibitors for Alzheimer's disease

Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

“…There is considerable uncertainty about when dementia pharmacotherapy should be discontinued because of a perceived lack of clinically meaningful benefit, and limited data on how long therapy with these agents should persist. [95][96][97][98] There are concerns that treatment may continue even when potentially inappropriate (for example, among patients on ChEIs hospitalized for bradycardia), 99 but also the possibility for underuse among eligible patients. 44 Decisions about continuing therapy need to be patient-centred, and based on clinical judgment rather than arbitrarily made.…”

Efectos de un programa combinado de actividad física y entrenamiento cognitivo en pacientes chilenos con Alzheimer leve

“…Cumplida la tarea, se aumentaban los estímulos (6,9,12,15), hasta llegar a un máximo de 18 reactivos. Se esperó como techo mínimo de evocación auditiva 12 palabras evocadas.…”

“…Entre la tercera y la cuarta series de ejercicios, al frente de los participantes se proyectaban fotografías simples a color en grupo de 3 reactivos (flor, bebé, auto), que luego debían ser reconocidas dentro de una lista que contenía imágenes de interferencia (2 reactivos: pez y luna). Resuelta la actividad, se duplicaba el número de estímulos (6,9,12,15), así como las imágenes de interferencia (4, 6, 8 y 10), con un máximo de 18 fotografías y 12 estímulos de interferencia. Se esperó como techo mínimo de reconocimiento visual 12 imágenes.…”

“…La incidencia de EA y los factores asociados se han tratado de reducir en la última década, a través de medidas farmacológicas centradas en los déficits de neurotransmisores del trastorno neurocognitivo, proporcionando un alivio sintomático de breve duración, pero incapaces de detener el proceso neurodegenerativo 15 . Se han intentado diversas estrategias terapéuticas orientadas a prevenir la formación y deposición de ␤-amiloide y tau o acelerar su eliminación, con éxito limitado 16 .…”

Prospective cohort studies in dementia

“…The last of these may be an epiphenomenon related to the scoring characteristics of the Mini-Mental State Examination (Folstein et al, 1975), and perhaps some other measures of dementia severity, which appear to exhibit sinusoidal decline curves in most people with Alzheimer ' s dementia (Burns et al, 1991), while the second may refl ect some aspect of cognitive reserve protecting individuals from exhibiting symptoms as early as those with less reserve (Stern et al, 1999), but clearly we need more and better conducted studies to refi ne our understanding of the phenomenon of decline, so that we can give better prognostic advice to those diagnosed with Alzheimer ' s disease and their families. Findings from the Australian Imaging and Biomarkers Lifestyle (AIBL) study of ageing that indicated a more rapid decline in those subjects diagnosed with Alzheimer ' s dementia who were taking cholinesterase inhibitors (Sona et al, 2012) alarmed those of us involved in their collection and interpretation at fi rst, but are paralleled by an earlier report from the Alzheimer ' s Disease Neuroimaging Initiative (ADNI) by Schneider and colleagues (2011) and may be a consequence of a too early and injudicious ' treatment ' with cholinesterase inhibitors (Ritchie & Zhinchin, 2013). The fi nding may simply refl ect the propensity of doctors to prescribe treatment more often to those who are clearly declining, but reports from other cohorts confi rming or refuting these observations are needed urgently.…”