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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Current Trends in the Diagnosis and Treatment of Alzheimer's Disease and Dementia


GOAL
To provide neurologists with current information for diagnosing and treating Alzheimer's disease and dementia.

TARGET AUDIENCE
This activity is designed for neurologists, particularly those who treat patients with Alzheimer's disease and dementia.

LEARNING OBJECTIVES
After reading this issue, the participant should be able to:

  • Identify the benefits of walking for reducing cognitive decline.
  • Define the tools used for predicting which patients with mild cognitive impairment are at high risk for dementia.
  • Describe the benefits of pharmacotherapy for treating Alzheimer's disease and dementia

ACCREDITATION STATEMENT
This activity has been planned and produced in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education. The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Johns Hopkins School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this continuing medical education activity for a maximum of 1 hour in Category 1 credit toward the American Medical Association Physicians' Recognition Award. Each physician should claim only those hours of credit that are actually spent on the educational activity. Credits are available until the expiration date of October 31, 2003.

This continuing education activity was produced under the supervision of Peter Rabins, MD, MPH, Professor of Psychiatry, Johns Hopkins University School of Medicine

This program is supported by an unrestricted educational grant from Ortho-McNeil Pharmaceuticals, Inc.

Publisher's Note and Disclaimer: The opinions expressed in this issue are those of the authors, presenters, and/or panelists and are not attributable to the publisher, editor, advisory board of Advanced Studies in Medicine, or The Johns Hopkins University School of Medicine or its Office of Continuing Medical Education. Clinical judgment must guide each professional in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this issue are not necessarily the same as indicated in the package insert for the product and may reflect the clinical experience of the authors, presenters, and/or panelists or may be derived from the professional literature or other clinical sources. Consult complete prescribing information before administering.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, LLC, an HMG Company. P.O. Box 340, Somerville, NJ 08876. (908) 253-9001. Web site: www.galenpublishing.com. Copyright ©2001 by Galen Publishing, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Bulk postage paid at Somerville, NJ Post Office and at additional mailing offices. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC. Printed on acid-free paper. BPA Membership applied for December 2000.

The contents of this issue of Advanced Studies in Medicine include highlights from the 53rd Annual Meeting of the American Academy of Neurology held on May 5-11, 2001, in Philadelphia, Pennsylvania.

FACULTY ADVISORS

    Peter Rabins, MD, MPH
    Professor of Psychiatry
    Johns Hopkins University School of Medicine
    Baltimore, Maryland
    • Dr. Rabins reports serving on the speakers' bureaus for Pfizer and Janssen.

PARTICIPATING FACULTY

    Howard M. Chertkow, MD, FRCP(C)
    Associate Professor of Neurology
    McGill University
    Co-director, McGill Jewish General Hospitals Memory Clinic
    Montreal, Quebec, Canada
    • Dr. Chertkow reports no financial or advisory relationship with pharmaceutical companies.

    Rachelle S. Doody, MD, PhD
    Associate Professor
    Baylor College of Medicine
    Houston, Texas
    • Dr. Doody reports receiving honoraria from and serving as a consultant to Janssen.

    Dorene M. Rentz, PsyD
    Instructor of Neurology
    Harvard Medical School
    Division of Cognitive and Behavioral Neurology
    Brigham and Women's Hospital
    Boston, Massachusetts
    • Dr. Rentz reports no financial or advisory relationships with pharmaceutical companies.

    David Wilkinson, MRCGP, FRCPsych
    Director, Memory Assessment and Research Centre
    Southampton University
    Southampton, United Kingdom
    • Dr. Wilkinson reports receiving grant/research support from and serving on the advisory boards for Pfizer, Eisai, Novartis, Janssen, Shire, Elan, and AstraZeneca.

    Kristine Yaffe, MD
    Assistant Professor
    Departments of Psychiatry, Neurology, Epidemiology, and Biostatistics
    University of California, San Francisco
    Chief, Geriatric Psychiatry
    San Francisco Veteran Affairs Medical Center
    San Francisco, California
    • Dr. Yaffe reports no financial or advisory relationships with any pharmaceutical company pertaining to this therapeutic area.

Because of the large number of coauthors listed on some of the articles in this issue, Advanced Studies in Medicine provides disclosure information for the lead presenters for each major article. Advanced Studies in Medicine makes every effort to provide the reader with full disclosure information from major contributors. Advanced Studies in Medicine does not provide disclosure information for authors of abstracts and power presentations. The reader shall be advised that coauthors on presentations and authors and coauthors on poster presentations may or may not maintain financial or advisory relationships with pharmaceutical companies.

Advanced Studies in Medicine provides disclosure information from contributing authors, participating faculty, and presenters only. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Current Trends in the Diagnosis and Treatment of Alzheimer's Disease and Dementia
Peter Rabins, MD, MPH1

In many respects, our understanding of the diagnosis and management of Alzheimer's disease (AD) is in its infancy. There are now several therapies that delay cognitive decline, and advances in neuroimaging have provided many answers to long-asked questions regarding brain atrophy and how it relates to clinical symptoms. Yet, clinicians are still unable to predict who will succumb to AD, and we cannot stop its progression after initial onset of the disease.

This issue of Advanced Studies in Medicine includes presentation highlights from the 53rd Annual Meeting of the American Academy of Neurology held in Philadelphia, Pennsylvania, May 5-11, 2001. Perhaps the most striking aspect of the presentations are the innovative strategies being employed to better identify those at risk of developing AD, prevent the onset of AD (especially in those at risk), and treat AD using a multidisciplinary approach.

Identifying Those at Risk

Highly intelligent older people who are at risk for developing AD or who are in the early stages of AD may not be identified when using the currently accepted criteria for mild cognitive impairment (MCI). Dorene Rentz, PsyD, instructor of neurology at Harvard Medical School, follows a group of high-functioning elderly patients and assesses their risk of MCI based on intelligence quotient (IQ)-adjusted norms. The premise of Dr. Rentz's study is that highly intelligent older patients would need to drop several standard deviations from the IQ norm of the general population before their dementia is diagnosed. As the imaging studies show, this patient population may have suffered irreversible damage by the time they are diagnosed. Dr. Rentz questions whether the MCI criteria should be revised for high-functioning/highly intelligent elderly patients.

Howard Chertkow, MD, FRCP(C), director of the McGill Centre for Studies in Aging, in his plenary speech, discussed his latest data regarding the identification of risk factors for MCI. Dr. Chertkow's algorithm seeks to stratify as many patients as possible into low-risk and high-risk groups using low-tech procedures as a first step. Those patients who are not able to be stratified would require more medium- and high-tech approaches. The ultimate goal is to identify these patients earlier, using easier testing procedures so that therapy can be started earlier.

Innovative Therapeutic Strategies

The benefits of exercise for general health are well known, and Kristine Yaffe, MD, assistant professor, University of California, San Francisco, presented study results showing that walking appears to slow cognitive decline in women. Of particular interest was the dose response between the distance walked and the reduced risk of cognitive decline.

Dr. David Wilkinson, MRCGP, FRCPsych, Southampton University, Southampton, England, director of the Memory Assessment Centre, and Rachelle Doody, MD, PhD, assistant professor, Baylor College of Medicine, Houston, presented their results on the further understanding and optimization of acetylcholinesterase (AChE) inhibitors. Dr. Wilkinson describes a direct comparison of the usability and tolerability of the AChE inhibitors donepezil and galantamine. Head-to-head comparisons are increasingly important, especially with the number and availability of different therapies for treating AD and other neurological and neuropsychiatric disorders.

And finally, the long-term benefits of galantamine, a relative newcomer on the AD market, are described in the study presented by Dr. Doody. Long-term studies of AChE inhibitors and their ability to prolong cognitive decline are among the challenges for researchers interested in AD pharmacotherapy.

While many questions remain unanswered regarding AD and the dementias, each exciting new development brings clinicians a step closer to providing better care at an earlier point in disease progression for patients with AD. The economic and social consequences for decreased burden from AD, on patients and caregivers, is almost unimaginable.

1 Professor of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.