lMedscape Neurology This is the Medscape Neurology Minute. I am Dr Alan Jacobs. Researchers from the Washington University School of Medicine in St. Louis have published a case series studying behavioral changes that precede the onset of memory loss in early Alzheimer disease.[1] They analyzed data from 2416 people aged 50 years or older who underwent regular evaluations of cognitive functions and mental health over 7 years. All participants were cognitively normal at the start. Over the course of the study, 1218 people developed dementia. Four years into the study, 30% of these patients had developed depression. Only 15% of the patents who did not develop dementia within 4 years developed depression. The individuals who went on to develop dementia were 12 times more likely to have delusions in the first 4 years. The researchers caution that a better understanding of how these mood and behavioral changes are connected to Alzheimer disease will be needed before we can use these changes as pre-dementia markers. This has been the Medscape Neurology Minute. I'm Dr Alan Jacobs.
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Anxiety: Speeding the Decline to Alzheimer's?
This is the Medscape Neurology Minute. I am Dr Alan Jacobs. Researchers from the Baycrest Health Sciences Rotman Research Institute have published a study[1] showing that in individuals with mild cognitive impairment (MCI), having anxiety significantly speeds the decline to dementia from Alzheimer's disease. The researchers assessed data from the Alzheimer's Disease Neuroimaging Initiative to analyze anxiety, depression, cognitive function, and brain structural change in 376 adults aged 55-91 every 6 months over a 3-year period. All patients had a clinical diagnosis of amnestic MCI and a low score on a depression rating scale. The results showed that in patients with MCI and mild, moderate, or severe anxiety, the risk of progressing to Alzheimer's dementia was increased by 33%, 78%, and 135%, respectively. Moreover, they found that patients with MCI who reported anxiety symptoms at any time during the follow-up period had greater rates of atrophy in the medial-temporal lobes. The researchers concluded that there is strong evidence that anxiety is a predictive factor of whether an individual with MCI will convert to Alzheimer's over a 3-year period.
Cognitive Enhancers for Mild Cognitive Impairment: Any Value?
Peter M. Yellowlees, MBBS, MD This is the Medscape Psychiatry Minute. I'm Dr. Peter Yellowlees. Cognitive enhancers, including cholinesterase inhibitors and memantine, are used to treat dementia, but their effectiveness for mild cognitive impairment is unclear. Now a team of investigators[1] from Toronto, Canada, have conducted a systematic review to examine the efficacy and safety of cognitive enhancers for mild cognitive impairment. The investigators screened 15,554 titles and abstracts and 1384 full-text articles for studies of the effects of donepezil, rivastigmine, galantamine, or memantine on mild cognitive impairment. From this extensive literature, only 8 randomized clinical trials and 3 companion reports met inclusion criteria. In these studies, the investigators found no significant effects of cognitive enhancers on cognition or function. Cognitive enhancers were associated with higher risks for nausea, diarrhea, and vomiting than placebo. Although much more research is needed into the overall value of cognitive enhancers, the findings from this study do not support their use in patients with mild cognitive impairment. This article is selected from Medscape Best Evidence. I'm Dr. Peter Yellowlees.
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