Rational drug treatment of dementia?

Byrne, J. Peter; Arie, Tom

doi:10.1136/bmj.290.6485.1845

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…. the lack of stratification of patient's according to the pathogenesis or to distinct subtypes of degenerative dementia (possibly showing a different responsiveness to treatment) as recently described 26–29 …”

Section: Discussionmentioning

confidence: 98%

“…assessing the patient's response by the sole use of the SCAG scale, whose adequacy in measuring cognitive changes and other areas of psychopathology, when used alone, has received a mixed rating in the psychopharmacological literature 3,5,18–25 . the lack of stratification of patient's according to the pathogenesis or to distinct subtypes of degenerative dementia (possibly showing a different responsiveness to treatment) as recently described 26–29 …”

Section: Discussionmentioning

confidence: 99%

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Nicergoline in Mild to Moderate Dementia: A Multicenter, Double‐Blind, Placebo‐Controlled Study

Baroni

Cisbani

Bovi

et al. 1989

J American Geriatrics Society

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In view of some controversies still existing about the real efficacy of ergot derivatives in the management of dementia, a double-blind, randomized, parallel group trial extending up to 6 months was carried out to compare the effects of nicergoline, 60 mg daily, and placebo in 315 patients suffering from mild to moderate dementia. Clinical evaluation was performed by the SCAG scale. The trial, which included a 1-month placebo run-in period, showed that both placebo and nicergoline were associated with some degree of improvement. The effect of nicergoline, however, was significantly greater and more sustained, steadily increasing with time. In particular, the difference between nicergoline and placebo in mean total SCAG score was 5.5 at 3 months (95% confidence interval: 3.6-7.4) and increased to 9.8 at 6 months (95% confidence interval: 7.8-11.8). A comparison of nicergoline versus placebo in the frequencies of changes in each item of the SCAG showed also a significant difference at 6 months, the percent of patients displaying an improvement by at least 2 points ranging from 13.5 (bothersome) to 30.2 (disorientation) in nicergoline group, against 4.1 (self-care) to 14.3 (fatigue) in placebo group. The safety of nicergoline, as judged by hemodynamic changes and drug-related adverse reactions, was quite satisfactory.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Nicergoline in Mild to Moderate Dementia: A Multicenter, Double‐Blind, Placebo‐Controlled Study

Baroni

Cisbani

Bovi

et al. 1989

J American Geriatrics Society

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show abstract

“…Some contend that the underlying pathophysiology is diverse and not amenable to pharmacological manipulation. 1 Most categories of drugs, however, have been developed with some underlying pathophysiology in mind. The cerebral vasodilators were developed when arteriosclerotic dementia was a popular concept.…”

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confidence: 99%

Cognitive Enhancing Agents: Current Status in the Treatment of Alzheimer's Disease

Waters

1988

Can. j. neurol. sci.

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Extensive recent literature on drugs used to enhance cognitive functioning, reflects the growing social problem of dementia. Many clinical trials have been undertaken with variable success. In most cases the disorder studied has been Alzheimer's disease. The pharmacological approach has been designed to rectify the presumed pathophysiological processes characteristic of the condition. Agents tested include cerebral vasodilators, cerebral metabolic enhancers, nootropics, psychostimulants, neuropeptides and neurotransmitters with a special emphasis on drugs used to enhance cholinergic function. Ethical and practical issues concerning clinical drug trials in dementia will be discussed. RESUME: Stimulation cognitive medicamenteuse: etat de la question dans le traitement de la maladie d'Alzheimer La multiplicity des publications recentes sur les medicaments utilises pour stimuler le fonctionnement cognitif est le reflet du probl&me social sans cesse croissant de la d6mence. Plusieurs essais cliniques ont ete tentes avec des resultats variables. Dans la plupart des cas, la maladie etudiee etait la maladie d'Alzheimer. L'approche pharmacologique a ete con^ue pour corriger les processus physiopathologiques caracteristiques de la maladie. Les agents etudies incluent des vasodilatateurs cerebraux, des stimulants metaboliques cerebraux, des agents nootropes, des agents neurotropes, des psychostimulants, des neuropeptides et des neurotransmetteurs, avec une emphase particuliere sur les medicaments utilises pour stimuler la fonction cholinergique. Nous discutons des considerations ethiques et pratiques touchant les essais therapeutiques dans la demence.Can. J. Neurol. Sci. 1988; 15:249-256 Because of the growing elderly population, many with forgetfulness and dementia, there is considerable interest and support for neuropharmacology involving cognitive enhancing agents (Table 1). Although there are many etiologies of dementia, the most studied area has been that of Alzheimer's disease.As the underlying pathophysiology of this disorder becomes clearer, more "rational" approaches to the pharmacology of this disorder are being discovered and tested. Interest is mainly directed towards improving the brain function or delaying the cognitive deterioration associated with Alzheimer's disease, although other dementing illnesses (such as alcoholic dementia) many benefit from these therapeutic strategies.Some contend that the underlying pathophysiology is diverse and not amenable to pharmacological manipulation.1 Most categories of drugs, however, have been developed with some underlying pathophysiology in mind. The cerebral vasodilators were developed when arteriosclerotic dementia was a popular concept.2 Neuropeptide substrates for memory were based mainly on animal models of memory loss. But, there is some evidence that the extinction of conditioned avoidance response employed in these studies is not analogous to human memory loss.3 General metabolic enhancers were developed to improve glucose utilization. Subsequently...

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Drug Treatment of Alzheimer's Disease

Cooper

1991

Arch Intern Med

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Rational drug treatment of dementia?

Cited by 7 publications

References 15 publications

Nicergoline in Mild to Moderate Dementia: A Multicenter, Double‐Blind, Placebo‐Controlled Study

Nicergoline in Mild to Moderate Dementia: A Multicenter, Double‐Blind, Placebo‐Controlled Study

Cognitive Enhancing Agents: Current Status in the Treatment of Alzheimer's Disease

Drug Treatment of Alzheimer's Disease

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