Researchers have examined the evidence in favour of giving people considered to be close to developing dementia the drugs that are most commonly used to treat the condition itself. They have concluded that these drugs (cholinesterase inhibitors) do not seem to delay the appearance of Alzheimer disease or other forms of dementia.
Three cholinesterase inhibitors – donepezil, rivastigmine and galantamine – are currently approved for use in mild-to-moderate Alzheimer disease. Some experts are not convinced that they are effective, but other experts and patient support groups have called for the drugs to be given to people with “mild cognitive impairment (MCI)” – the term that is used to describe the condition where people have memory problems that are more severe than those normally seen in others of their age, but otherwise have no symptoms of dementia. It is believed that people with MCI are at high risk of developing Alzheimer disease.
Dr Raschetti and colleagues at Italy’s National Centre for Epidemiology, Surveillance and Health Promotion in Rome conducted a systematic review of the data from clinical trials that had addressed the use of cholinesterase inhibitors with MCI patients. In none of the six trials that they examined did the use of the drugs significantly reduce the rate of progression from MCI to dementia.
One problem that came to light during their review was that there is no generally accepted precise definition for MCI. There was therefore some variation between the trials in the mental state of the people given the drugs. Dr Raschetti and his team have called for more clinical trials to be done, but using a single agreed definition of mild cognitive impairment. Until such trials have found a benefit from using cholinesterase inhibitors in this way, there seems to be no justification for doctors to do so in clinical practice.
Citation: Raschetti R, Albanese E, Vanacore N, Maggini M (2007) Cholinesterase inhibitors in mild cognitive impairment: A systematic review of randomised trials. PLoS Med 4(11): e338.
IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040338
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-11-raschetti.pdf
CONTACT:
Roberto Raschetti
National Centre for Epidemiology, Surveillance and Health Promotion
National Institute of Health
Viale Regina Elena 299
Rome, 00161
Italy
+39 0649904242
+39 0649904248 (fax)
roberto.raschetti@iss.it
THE FOLLOWING RESEARCH ARTICLE WILL ALSO BE PUBLISHED ONLINE:
Truncated LRP5 receptor in hyperparathyroidism tumors
Gunnar Westin and colleagues report the expression of an aberrantly spliced LRP5 receptor in primary and spontaneous parathyroid tumors and implicate it in the deregulated activation of the Wnt/â-catenin signaling pathway.
Citation: Bjorklund P, Akerstrom G, Westin G (2007) An LRP5 receptor with internal deletion in hyperparathyroid tumors with implications for deregulated WNT/bcatenin signaling. PLoS Med 4(11): e328.
IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040328
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-11-westin.pdf
CONTACT:
Gunnar Westin
Uppsala University
Surgical sciences
Uppsala Academic Hospital
Entre 70, 3rd floor, FOA2
Uppsala, SE-75185
Sweden
+46 186 112 965
gunnar.westin@surgsci.uu.se
Journal
PLoS Medicine