Methylphenidate treatment of negative symptoms in patients with dementia

Galynker, Igor; Ieronimo, C.; Miner, Caroline; Rosenblum, J; Vilkas, N.; Rosenthal, Richard N.

doi:10.1176/jnp.9.2.231

Cited by 76 publications

(20 citation statements)

References 52 publications

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“…In contrast, higher doses, by amplifying catecholaminergic tone more globally throughout the brain, are behaviourally activating (Kuczenski et al , 1995). In the dementia population, the presence of irritability, agitation and psychosis reported in trials of patients treated with MPH (Galynker et al , 1997; Herrmann et al , 2008; Padala et al , 2010) could signify behavioural effects in a subset of patients even at low doses. This is also consistent with the previous suggestion that the effects of dopaminergic agents depends on baseline dopaminergic activity (Cools and D’Esposito, 2011).…”

Section: Resultsmentioning

confidence: 99%

Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial

Lanctôt

Chau

Herrmann

et al. 2013

Int. Psychogeriatr.

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Background Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer’s disease (AD). MPH has shown to improve apathy in AD, and both apathy and attention have been related to dopaminergic function. The goal was to investigate MPH effects on attention in AD and assess the relationship between attention and apathy responses. Methods MPH (10mg PO twice daily) or placebo was administered for 6 weeks in a randomized, double-blind trial in mild-to-moderate AD outpatients with apathy (Neuropsychiatric Inventory [NPI] Apathy≥4). Attention was measured with the Wechsler Adult Intelligence Scale - Digit Span (DS) subtest (DS forward, selective attention) and apathy with the Apathy Evaluation Scale (AES). A mixed effects linear regression estimated the difference in change from baseline between treatment groups, defined as δ {[MPH (DS week 6–DS baseline)] - [placebo (DS week 6–DS baseline)]}. Results In 60 patients (37 females, age=76±8, Mini-Mental State Exam [MMSE]=20±5, NPI Apathy=7±2), the change in DS forward (δ=0.87 (95% CI: 0.06–1.68), p=0.03) and DS total (δ=1.01 (95% CI: 0.09–1.93), p=0.03) favoured MPH over placebo. Of 57 completers, 17 patients had improved apathy (≥3.3 points on the AES from baseline to end point) and 40 did not. There were no significant associations between AES and NPI Apathy with DS change scores in the MPH, placebo, AES responder or non-responder groups. DS scores did not predict apathy response to MPH treatment. Conclusion These results suggest MPH can improve attention and apathy in AD; however, the effects appear independent in this population. ClinicalTrials.gov Identifier NCT01117181

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Section: Resultsmentioning

confidence: 99%

Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial

Lanctôt

Chau

Herrmann

et al. 2013

Int. Psychogeriatr.

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“…A recent meta-analysis of stimulant use in dementia suggested that it may reduce apathy, but has little effect on cognition, and the effects on daytime hypersomnolence could not be reliably interpreted [89]. These results appear similar for patients with AD or VaD [92]. One recent study demonstrated the utility of a dextroamphetamine challenge in predicting a response to methylphenidate therapy that could potentially select appropriate patients and lessen the risk of adverse side effects which were greatly increased 3:1 in the study population [94].…”

Section: Shared Treatment Strategiesmentioning

confidence: 99%

Attention-Deficit/Hyperactivity Disorder in Older Adults: Prevalence and Possible Connections to Mild Cognitive Impairment

Ivanchak

Fletcher

Jicha

2012

Curr Psychiatry Rep

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Attentional deficits are frequently seen in isolation as the presenting sign and symptom of neurodegenerative disease, manifest as mild cognitive impairment (MCI). Persistent ADHD in the geriatric population could well be misconstrued as MCI, leading to the incorrect assumption that such persons are succumbing to a neurodegenerative disease process. Alternatively, the molecular, neuroanatomic, or neurochemical abnormalities seen in ADHD may contribute to the development of de novo late life neurodegenerative disease. The present review examines the issue of causality vs confound regarding the association of ADHD with MCI, suggesting that both are tenable hypotheses.

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“…Individuals with this condition may report problems remembering names or appointments or may experience difficulties in solving complex problems.” (American Psychiatric Association, 2000). The off-label prescription of cognition-enhancing psychostimulants for individuals of this age group is increasing (Galynker et al, 1997; Hanlon et al, 2001). This trend necessitates further investigation of the safety and efficacy of such drugs for cognitive enhancement in aging individuals.…”

Section: Introductionmentioning

confidence: 99%

Attention enhancing effects of methylphenidate are age-dependent

Bhattacharya

Shumsky

Waterhouse

2015

Experimental Gerontology

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The psychostimulant methylphenidate (MPH, Ritalin®) is used to treat a variety of cognitive disorders. MPH is also popular among healthy individuals, including the elderly, for its ability to focus attention and improve concentration, but these effects have not been shown to be comparable between aged and adult subjects. Thus, we tested whether MPH would improve performance in sustained attention in both adult and aged rats. In addition, we tested the impact of visual distraction on performance in this task and the ability of MPH to mitigate the effects of distraction. Adult (6–12 months) and aged (18–22 months) male Sprague-Dawley rats were given oral MPH, and their cognitive and motor abilities were tested. Results suggest that while MPH improves task performance in adults; there is no improvement in the aged animals. These outcomes suggest that use of MPH for cognitive enhancement in elderly individuals may be ineffective.

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Methylphenidate treatment of negative symptoms in patients with dementia

Cited by 76 publications

References 52 publications

Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial

Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial

Attention-Deficit/Hyperactivity Disorder in Older Adults: Prevalence and Possible Connections to Mild Cognitive Impairment

Attention enhancing effects of methylphenidate are age-dependent

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