Alzheimer Disease: Adler G

Adler G, Silverstein NM. · Graduate College of Social Work, University of Houston, Houston, Texas 77204-4013, USA. · Traffic Inj Prev. · Pubmed #18696385 No free full text.

Abstract: OBJECTIVE: This manuscript addresses the following questions for licensing authorities: 1) Are drivers with Alzheimer's disease (AD) an issue that should concern licensing authorities? 2) What critical driving skills impacted by AD should authorities recognize? 3) What should their response be? 4) Do licensing authorities have a role in providing information about or referral to community agencies that offer alternative transportation options and other services? METHODS: To address issues important to licensing authorities the authors reviewed pertinent driving and dementia literature. RESULTS: Drivers with AD have unique impairments that should be recognized and responded to early on in the disease process, with sensitivity and respect for continued mobility. As the disease progresses and they must stop driving, former drivers and their families could benefit from resource referrals that provide information about transportation alternatives and support services in their communities. CONCLUSIONS: The authors believe that drivers with AD should be a concern for licensing authorities. Licensing decisions and policies to assess and regulate drivers are in the end made individually by each state. Policymakers will make their decisions based upon current research and concerns of their constituency and need to consider a seamless approach to addressing safe mobility. Licensing authorities are an important partner along with individuals, family members, health care professionals, social service providers, researchers, and policymakers in assuring public safety and individual mobility. All of the partners should confront the concern directly-none should "look the other way." The goal is to keep people driving safely for as long as possible. The responsibility is to recognize, respond, and refer when driving safely is no longer assured.

Oertel W, Ross JS, Eggert K, Adler G. · Philipps-University Marburg, Marburg, Germany. · Neurology. · Pubmed #17646621 No free full text.

Abstract: Transdermal patches are used for the treatment of various diseases including neurologic and psychiatric disorders such as Parkinson disease (PD), major depression, and attention deficit hyperactivity disorder. They are believed to offer many advantages over conventional oral therapies. By providing smoother, continuous drug delivery and steadier plasma levels, patches may reduce the incidence of side effects, thus making optimal therapeutic doses easier to attain and potentially improving treatment efficacy and compliance. Drug delivery systems such as patches that are more patient- and caregiver-friendly may enable patients to continue treatment for longer periods and to attain greater, more sustained treatment benefits. To date, approved therapies for Alzheimer disease (AD), including cholinesterase inhibitors and memantine, are orally administered. Potential advantages associated with patches provide a therapeutic rationale to offer additional benefits in AD patients. Rivastigmine is well suited to patch administration because it is a small, potent molecule that is both lipophilic and hydrophilic. A rivastigmine patch has been developed and may provide a promising new approach to dementia therapy.

Adler G. · Altentagesklinik am Zentralinstitut für Seelische Gesundheit, Mannheim. · Internist (Berl). · Pubmed #14671807 No free full text.

Abstract: In recent years, psychopharmacotherapy in the elderly has been advanced by the introduction of newly developed drugs with high effectiveness and good tolerability. However, up to now these advances have not yet led to a broad change in the psychopharmacological treatment of elderly patients. Elderly patients with psychiatric disorders are frequently treated with older drugs, which have a high risk of side effects and drug interactions. The consequences are severe complications, such as falls or delirious episodes. In this article, general aspects of psychopharmacotherapy in the elderly will be briefly summarized. Special aspects of the treatment with antidepressants, antipsychotics, benzodiazepines, phase prophylactics and antidementives will be discussed in detail and recommendations for treatment will be given.

Adler G. · Altentagesklinik am Zentralinstitut für Seelische Gesundheit, Mannheim. · Fortschr Neurol Psychiatr. · Pubmed #11006862 No free full text.

Abstract: There are tight relationships between the EEG and the activity of the cholinergic system. The excitability of cortical neurons is increased by the ascending cholinergic projections of the nucleus basalis of Meynert. Cholinergic deafferentiation of the cortex leads to an increase of slow-wave EEG activity. Cholinergic deficit is a typical feature of Alzheimer's disease. It is goes along with characteristic EEG alterations, mainly increased activity in the slow frequency bands. The amount of EEG alterations increases as the disease progresses. It is correlated with the severity of symptoms, neuropsychological performance, cerebral perfusion, cerebral glucose utilization and the extent of histopathological changes. EEG alterations are a valuable diagnostic tool in Alzheimer's disease. They may be suited for early diagnosis and may allow the prediction of the therapeutic response to cholinergic drugs.

Riepe MW, Adler G, Ibach B, Weinkauf B, Tracik F, Gunay I. · Department of Psychiatry, Charité Universitatsmedizin Berlin, Berlin, Germany. · Dement Geriatr Cogn Disord. · Pubmed #17356273 No free full text.

Abstract: OBJECTIVE: Cholinergic therapy is used in mild-to-moderate Alzheimer's disease (AD) and antiglutamatergic therapy in moderate-to-severe AD. Global scales, as commonly used in clinical trials, blur specifics of disease progression and drug effects. The objective was to assess combination therapy of rivastigmine plus memantine by specific neuropsychological tests in patients with mild-to-moderate AD. METHODS: 12-week-short multicenter open-label pilot study. Ninety patients with mild-to-moderate AD already on stable medication with rivastigmine (3-6 mg b.i.d.) additionally received memantine for 12 weeks. Subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini-Mental State Examination (MMSE) and additional neuropsychological tests (e.g. span tasks, semantic fluency) were assessed. RESULTS: The scores in the ADAS-cog memory subscale, the MMSE score, and digit span and semantic fluency significantly improved on combination therapy. CONCLUSION: Memory improvement was correlated with ADAS-cog memory score at baseline and inversely with age at onset of treatment. The data suggest that improvement on combination therapy results from an improvement of attention/executive function with secondary memory improvement, which will need to be confirmed in a subsequent double-blind study on a larger number of patients.

Adler G, Brassen S, Chwalek K, Dieter B, Teufel M. · Day Clinic for the Elderly and Clinical Neurophysiology Service, Zentralinstitut für Seelische Gesundheit, Mannheim, Germany. · J Neurol Neurosurg Psychiatry. · Pubmed #14742608 links to  free full text

Abstract: OBJECTIVES: To predict the treatment response to rivastigmine in patients with Alzheimer's dementia using neuropsychological and EEG data. METHODS: A neuropsychological examination and a quantitative EEG study were done in 20 patients with Alzheimer's dementia before initiating treatment with rivastigmine. After one week of treatment a second EEG examination was done. Therapeutic efficacy was determined six months after treatment initiation. Treatment response was defined as improvement in short term memory after six months of rivastigmine treatment. RESULTS: For the group of patients as a whole, there was a significant improvement in short term memory and orientation during rivastigmine treatment. The mini-mental state score improved from 20.2 to 21.7 (NS). In the EEG, theta power decreased significantly after one week of treatment. Treatment responders had a greater decrease in theta power after one week of treatment and a better short term memory at baseline than non-responders. Decrease in theta power during rivastigmine treatment and baseline short term memory were good predictors of treatment response. CONCLUSIONS: Generally available neuropsychological and EEG data may be useful for predicting response to rivastigmine in patients with Alzheimer's disease.

Brassen S, Adler G. · Day Clinic for the Elderly and Clinical Neurophysiology Service, Central Institute of Mental Health, Mannheim, Germany. · Pharmacopsychiatry. · Pubmed #14663655 No free full text.

Abstract: INTRODUCTION: Acetylcholinesterase inhibitor treatment enhances cholinergic neurotransmission and may thus partially reverse EEG slowing and memory impairment in Alzheimer patients within short time. METHODS: We studied the short-term effects of treatment with either rivastigmine or donepezil on EEG and memory performance in a group of 35 Alzheimer patients in an open, controlled design. RESULTS: Under a 1- or 2-week acetylcholinesterase inhibitor treatment, a decrease of global theta power and an improvement in the ADAS memory score were observed. However, compared to the control condition, only the theta power decrease remained significant and can be definitely considered a medication effect. DISCUSSION: EEG spectral analysis could be shown to rapidly reflect the cerebral cholinergic action of short-term acetylcholinesterase inhibitor treatment. Whether this action is related to the therapeutic efficacy of this type of drug must be determined in further longitudinal studies.

Adler G, Brassen S. · Day Clinic for the Elderly and Clinical Neurophysiology Service, Central Institute of Mental Health, Mannheim, Germany. · Neuropsychobiology. · Pubmed #11340368 No free full text.

Abstract: The effects of a 5-day treatment with rivastigmine on the resting EEG power spectrum were studied in 15 mildly to moderately ill Alzheimer patients. In these patients, beta power was positively correlated with cognitive performance and negatively correlated with functional impairment. Rivastigmine produced a decrease in delta and theta power with no effect of hemisphere and electrode position. Delta power decrease reflects the cerebral cholinergic action of rivastigmine and may thus allow a quantitative assessment of its CNS effects.

Brassen S, Braus DF, Weber-Fahr W, Tost H, Moritz S, Adler G. · NeuroImage Nord, Department of Psychiatry, University of Hamburg, Hamburg, Germany. · Dement Geriatr Cogn Disord. · Pubmed #15286459 No free full text.

Abstract: Mild cognitive impairment (MCI) is present in up to 60% of patients with late-onset depression and constitutes a major diagnostic problem in geriatric psychiatry. Searching for sensitive markers for the detection of early brain changes suggestive of dementia, we compared this depressive risk population with mildly to moderately demented patients and cognitively unimpaired depressed patients using EEG power and coherence. We found a considerable similarity between Alzheimer's disease patients and cognitively impaired depressed patients regarding the cognitive profile and EEG pattern. Changes in EEG power and coherence at frontotemporal leads in depressive patients with MCI thereby allowed discrimination from cognitively unimpaired patients with a sensitivity of 88% and a specifity of 81%.

Burns T, McCarten JR, Adler G, Bauer M, Kuskowski MA. · Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA. · Am J Alzheimers Dis Other Demen. · Pubmed #15002344 No free full text.

Abstract: The effects of repetitive work on Alzheimer's disease (AD) patient functioning were examined when nine veterans were moved from a work program to a traditional adult day care program. Subjects were reassessed four months after the move with the Mini-Mental State Examination (MMSE), Cognitive Performance Test (CPT), and Geriatric Depression Scale (GDS). Individual slopes were calculated for seven subjects who had longitudinal scores, and expected scores were predicted based on the rate of decline. Observed scores at reassessment were significantly lower than expected scores. The MMSE was on average 4.9 points lower, and the CPT .64 points lower than expected. The GDS did not change. The spouses of all nine patients reported declines in daily living activities. Compared to traditional day care activities, work activities involve sequencing skills and practice may translate to self-care activities at home.

Adler G, Brassen S, Jajcevic A. · Clinical Neurophysiology Service, Central Institute of Mental Health, Mannheim, Germany. · J Neural Transm. · Pubmed #12928837 No free full text.

Abstract: In Alzheimer's dementia (AD) axonal disruption and cholinergic deficit lead to impaired cortical connectivity and to a decrease in EEG alpha coherence. The aim of the present study was to assess the usefulness of coherence parameters of the EEG for the diagnostics of AD. Quantitative EEG analyses were performed in 31 AD patients and 17 cognitively unimpaired depressive controls, both groups without psychopharmacological treatment. Differences between groups were examined and the diagnostic significance of EEG parameters was assessed by means of stepwise logistic regression analyses. In the AD patients global theta power was increased, left temporal alpha coherence and interhemispheric theta coherence were decreased. Left temporal alpha coherence and global theta power allowed an identification of AD patients with a sensitivity of 87% and a specificity of 77%. Quantitative analyses, especially the determination of left temporal alpha coherence, may enhance the usefulness of the EEG in the diagnostics of AD.

Kohler J, Riepe MW, Jendroska K, Pilartz H, Adler G, Berger FM, Calabrese P, Frölich L, Gertz HJ, Hampel H, Haupt M, Mielke R, Paulus HJ, Zedlick D. · Neurologische Universitätsklinik, Ulm. · Fortschr Med Orig. · Pubmed #12613271 No free full text.

Abstract: The efficacy of antidemential agents proven in comprehensive studies and by clinical experience, now justifies an active and positive approach by the general physician to the diagnosis and treatment of patients with dementia. The proposals on how to implement diagnostic and therapeutic measures in the doctor's office comply both with medical quality criteria and the requirements for appropriateness of treatment and considerations of economy stipulated by German law. They therefore provide the basis for a modern diagnostic work-up and treatment strategy, which will also meet economical demands.

Kohler J, Riepe MW, Jendroska K, Pilartz H, Adler G, Berger FM, Calabrese P, Frölich L, Gertz HJ, Hampel H, Haupt M, Mielke R, Paulus HJ, Zedlick D. · Arzt für Neurologie, Cornelia-Passage 8, D-79312 Emmendingen. · MMW Fortschr Med. · Pubmed #12532523 No free full text.

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Thome J, Retz W, Baader M, Pesold B, Hu M, Cowen M, Durany N, Adler G, Henn FA, Rösler M. · Laboratory of Biochemistry, Central Institute of Mental Health, Mannheim, Federal Republic of Germany. · J Neural Transm. · Pubmed #11725820 No free full text.

Abstract: In order to identify gene variants related to the serotonergic neurotransmitter system that possibly represent a hereditary risk factor for sporadic Alzheimer's disease (AD), patients suffering from AD and non-demented psychiatric inpatients without symptoms of dementia were genotyped for polymorphisms of HTR6 (267C/T) and HTR2A (-1438G/A). Although there was a tendency toward an increased number of the genotype TT of the 5-HT6 receptor polymorphism in AD patients when compared to controls (2.8% vs. 1.3%), neither this nor the 5-HT2A promoter polymorphism showed significant differences in their genotypic or allelic distribution among patients and controls. These polymorphisms probably do not represent major genetic risk factors of AD. However, further studies including other genetic variants of the serotonergic neurotransmitter system are needed in order to elucidate their role in AD.

Hu M, Retz W, Baader M, Pesold B, Adler G, Henn FA, Rösler M, Thome J. · Laboratory of Biochemistry, Central Institute of Mental Health, J5, 68159, Mannheim, Germany. · Neurosci Lett. · Pubmed #11044587 No free full text.

Abstract: The role of the deletion/insertion polymorphism within the promoter region of the serotonin transporter gene (5-HTT) is under discussion as a potential genetic risk factor for Alzheimers's disease (AD). Here we report significant differences in the allelic distribution of this polymorphism with a higher frequency of the short variant allele in AD patients when compared to controls. This difference was independent of the apolipoproteinE genotype. Thus, our study supports the notion that genetic alterations in the serontonergic neurotransmitter system may be involved in the etiopathogenesis of AD. However, given the reported negative findings, we are presently trying to identify diagnostic subgroups for which the 5-HTT promoter polymorphism represents a susceptibility locus.