Alzheimer Disease: Engelhardt E

Engelhardt E, Brucki SM, Cavalcanti JL, Forlenza OV, Laks J, Vale FA, Anonymous00032. · Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, RJ, Brasil. · Arq Neuropsiquiatr. · Pubmed #16400437 links to  free full text

Abstract: The present recommendations and suggestions on "Treatment of Alzheimer's Disease" were elaborated by a work group constituted by participants of the IV Meeting of Researchers on Alzheimer's Disease and Related Disorders, sponsored by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. They comprise topics on pharmacological and non-pharmacological treatment of cognitive impairment and functional decline, as well as of behavioral and psychological symptoms of this dementing disease. Several levels of evidence and of recommendations and suggestions are used for the various proposed drugs, as well as for non-pharmacological treatment, underpinned by a wide national and international bibliographical review.

Laks J, Engelhardt E. · School of Medical Sciences, State University of Rio de Janeiro, Center for Alzheimer's Disease, Institute of Psychiatry, Rio de Janeiro, Brazil. · Curr Opin Psychiatry. · Pubmed #18852563 No free full text.

Abstract: PURPOSE OF REVIEW: Dementia and depression are serious causes of global impairment in the elderly. This review is aimed at finding pharmacological reports from 2007-2008 so as to examine whether new guidance is available to treat these patients. RECENT FINDINGS: Studies on Alzheimer's disease and Lewy body dementias show that cholinesterase inhibitors are still first line treatment for these diseases and memantine is indicated in moderate/severe Alzheimer's disease, whereas there is as yet no standard available treatment for frontotemporal dementias. Treatment of depression in the elderly shows the same results as in younger individuals, and cerebrovascular pathology is important for treatment resistance. SUMMARY: There is a need for new drugs that focus on treatment resistant and nonresponder individuals. Most studies are confirmation of previous reported results.

Engelhardt E, Moreira DM, Laks J, Marinho VM, Rozenthal M, Oliveira AC. · Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto, Universidade Federal do Rio de Janeiro, Brasil. · Arq Neuropsiquiatr. · Pubmed #11733829 links to  free full text

Abstract: OBJECTIVE: Acquisition of data of magnetic resonance metabolite spectrum of the hippocampal formation (hippocampus-hc) in the elderly, normal and with Alzheimer's disease (AD). METHOD: Subjects matched for age: a. normal sample (n=20), CDR=0, and b. AD sample (n=40), CDR 1 and 2. Technique: Signa Horizon LX-GE, 1.5T, 1H-MRS with automated software PROBE/SV, VOI: hc (right and left); single voxel (2x2x2cm); TR 1500ms/TE 50ms; PRESS; metabolites: N-acetylaspartate (Naa), choline (Cho), creatine (Cr), myo-inositol (mI). RESULTS: The present data relate to the ratios of Naa, Cho and mI, with Cr taken as reference, and the mI/Naa ratio. The study showed reduction of Naa, increase of mI and of the mI/Naa ratio, and not consistent results for Cho. The results of the whole sample of AD patients compared to the pooled normal mean +/- sd were significant for Naa, mI and mI/Naa (p<0.01). Accuracy in relation to the individual values of both samples showed satisfactory levels of sensitivity, specificity and positive predictive value. CONCLUSION: The present results can be used as a helpful tool to detect pathologic changes of the hippocampus in AD, and allowing greater accuracy and an earlier diagnosis of this disease.

Caramelli P, Chaves ML, Engelhardt E, Machado JC, Schultz RR, Vale FA, Charchat-Fichman H, Anonymous00245. · Department of Neurology, University of São Paulo, São Paulo, SP, Brazil. · Arq Neuropsiquiatr. · Pubmed #15273830 links to  free full text

Abstract: OBJECTIVE: To investigate the effects of galantamine on the performance of patients with mild to moderate Alzheimer's disease (AD) in a computerized neuropsychological test battery (CNTB). METHOD: Thirty-three patients with probable AD were treated with galantamine for three months and evaluated in a prospective, open-label, multi-center study. The CNTB and the ADAS-Cog were administered at baseline and after 12 weeks. The CNTB includes reaction time tests to evaluate attention, implicit and episodic memory for faces and words. Statistical comparisons were performed between the results in week 12 versus baseline. Patients who did not reach the therapeutic doses were excluded from the efficacy analysis. RESULTS: Four patients (12.1%) were excluded from the analysis either because of treatment discontinuation (n=3) or because a therapeutic dose was not reached (n=1). The remaining 29 patients were treated with doses of 24 mg/day (n=22) and 16 mg/day (n=7). After 12 weeks, significant reductions in reaction time were seen in the test of episodic memory for faces (p=0.023) and in the test of two-choice reaction time (p=0.039) of the CNTB. CONCLUSION: Treatment with galantamine produced improvement in computerized tests of attention and episodic memory after 12 weeks, leading to statistically significant reduction in the reaction times.

Laks J, Engelhardt E, Marinho V, Rozenthal M, Souza FC, Bacaltchuk J, Stoppe A, Ferreira RC, Bottino C, Scalco M. · Psychogeriatric Unit, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. · Arq Neuropsiquiatr. · Pubmed #11733828 links to  free full text

Abstract: BACKGROUND: Behavioral and psychological symptoms in dementia (BPSD) contribute to caregiver burden and institutionalization of elderly. Neuroleptics are prescribed to control agitation. Side effects of typical neuroleptics are harmful, making atypical neuroleptics an indication. OBJECTIVES: To evaluate efficacy and tolerability of risperidone oral solution (ROS) given once daily to demented elderly outpatients with BPSD (agitation). METHOD: Patients (n=26), 76.35+/-8.63 years, Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) criteria for dementia. RSO was given, starting dose of 0.25 mg and increments of 0.25 mg every week. Mini-Mental State Examination (MMSE) assessed cognitive status, Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) and Clinical Global Impression (CGI) measured BPSD, Extrapiramidal Symptom Rating Scale (ESRS) evaluated extrapyramidal symptoms. Cardiovascular side effects were evaluated clinically. RESULTS: There was a 26% reduction in agitation and no cardiovascular side effects in the range from 1.0 to 1.25 mg. Side effects were more prevalent above 2.5 mg. CONCLUSION: Risperidone oral solution improved agitation with good tolerability from 0.5 to 1.25 mg. A single dose with increments of 0.25 mg may be more acceptable to patients and caregivers.

Dourado M, Marinho V, Soares C, Engelhardt E, Laks J. · Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil. · Int Psychogeriatr. · Pubmed #17521471 No free full text.

Abstract: BACKGROUND: Impairment of deficit awareness is a clinically relevant feature of dementia affecting the maintenance of decision capacities, management and safety of patients with risk behaviors, and caregiver burden. This study assessed awareness of disease of patient/caregiver dyads and the relationship between unawareness on various domains and sociodemographic variables among elderly Brazilians with Alzheimer's disease (AD). METHODS: The dyads (n=52), stratified by clinical severity and age groups, responded to the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD). Statistical tests were used to compare clinical and sociodemographic variables and to calculate differences in rates of discrepant responses among mild and moderate dyads and between age groups, rates of discrepant responses among the ASPIDD domains, and association between awareness and age/age at onset. RESULTS: Awareness of deficits did not differ significantly among mild patients, whereas moderate patients showed impaired recognition on all domains. Older moderate dyads showed more discrepant responses, as compared to younger dyads at both severity stages. Mild patients could associate the disease with the cognitive deficits and recognized impairments on other domains. There was no significant relation of awareness with age at onset. CONCLUSION: Mild AD patients could associate the disease process with the presence of cognitive deficits, and also the changes in the emotional response with difficulties in social, family, and affective relations. Moderate AD patients were less aware of the symptoms and did not attribute them to the disease.

Laks J, Miotto R, Marinho V, Engelhardt E. · Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro, RJ, Brazil. · Int Psychogeriatr. · Pubmed #16255839 No free full text.

Abstract: We report the case of an elderly woman with Alzheimer's disease, risk factors for vascular dementia, and atrium-ventricular blockade, who presented with severe agitation and psychosis. She was treated with aripiprazole and assessed with the Neuropsychiatric Inventory (NPI) over the course of 14 weeks. NPI scores showed a marked decrease in psychosis and agitation at week 4, and complete recovery at week 14, except for depression.

Laks J, Batista EM, Guilherme ER, Contino AL, Faria ME, Rodrigues CS, de Paula E, Engelhardt E. · Center for Alzheimer Disease and Related Disorders, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. · Arq Neuropsiquiatr. · Pubmed #16100963 No free full text.

Abstract: The study aims to evaluate the prevalence of cognitive/functional impairment in community-dwelling elderly above 60 years of age (n = 870; m = 297, f = 573) and the relationship of age, gender, and functional impairment with cognitive impairment using Mini-Mental State Examination (MMSE) and Pfeffer Functional Activities Questionnaire (PFAQ). Chi-square and Student's tests were used to compare cognitive and functional deficits. Linear regression assessed MMSE/PFAQ relationship. Stratified analysis assessed confounding factors. Logistic regression assessed the relationship among age/gender/functional status with cognitive impairment (p < 0.05). Prevalence of cognitive/functional impairment was 19.2%. Functional and cognitive impairment are negatively correlated (Pearson = 0.737), despite educational level (illiterate/literate: OR = 15.60; p = 0/OR = 16.40; p = 0). Age and gender (female) were associated with cognitive/functional impairment. Functional impairment is highly correlated to cognitive impairment. Family/health professionals may recognize functional impairment more easily than cognitive impairment. Thus, the use in combination of cognitive and functional scales is important when screening for dementia.

Engelhardt E, Moreira DM, Laks J, Cavalcanti JL. · Division of Cognitive and Behavioral Neurology, Instituto de Neurologia Deolindo Couto, Federal University of Rio de Janeiro, Rio de Janeiro RJ, Brazil. · Arq Neuropsiquiatr. · Pubmed #16100961 No free full text.

Abstract: OBJECTIVE: To compare magnetic resonance proton spectroscopic with clinical data and to propose a spectroscopic staging of Alzheimer's disease (AD). METHOD: Subjects (n = 46), normals (12) and with AD (34), paired to age (CDR0-CDR3); AD diagnosis according to DSM-IV/NINCDS-ADRDA criteria; 1H-MRS with Signa Horizon LX-GE, 1.5T; single voxel at hippocampal region/HCR and posterior cingulate area/PCA. RESULTS: Statistically significant decrease (p < 0.01) only of Naa/Cr--at HCR among the CDR0, CDR1+CDR2, and CDR3, and at PCA between CDR0 and CDR1+CDR2 in relation to CDR3. CONCLUSION: The HCR is the first to show Naa reduction (CDR1). The PCA suffers later (CDR3). These values decline progressively according to the severity stages. Considering the disparities between the HCR and PCA it is possible to suggest a spectroscopic (metabolite) staging (MS) of AD, as follows: MS0 (-CDR0) = both normal HCR and PCA, MS1-2 (approximately CDR1-2) = abnormal HCR and normal PCA, and MS3 (approximately CDR3) = both abnormal HCR and PCA. These results make possible the early diagnosis, to follow the degenerative process throughout the course, and to suggest a spectroscopic staging related to the clinical stages of AD.

Dourado M, Laks J, Rocha M, Soares C, Leibing A, Engelhardt E. · IPUB, Universidade Federal do Rio de Janeiro, RJ, Brazil. · Arq Neuropsiquiatr. · Pubmed #15830076 links to  free full text

Abstract: OBJECTIVE: To evaluate the presence and the level of awareness of disease in mild and moderate Alzheimer's disease (AD). METHOD: Cross-sectional evaluation of patients with mild/moderate AD (n=42) assessed by Assessment of Psychosocial Impact of the Dementia Diagnosis (APSID), Mini-mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). RESULTS: Awareness of disease and its consequences were present in 66.7% patients with mild AD (n=18). In moderate AD (n=24), 20.8% presented total awareness, 45.8% presented only awareness of cognitive symptoms. Unawareness of disease was observed in 33.3%. CONCLUSIONS: The present data show association between awareness and level of severity of disease. CDR 1 patients show a better recognition of cognitive and daily life activity symptoms, whereas CDR 2 patients recognized their cognitive symptoms but failed to appraise their severity and consequences in daily life activities.

Marinho V, Laks J, Engelhardt E, Conn D. · No affiliation provided · J Clin Psychopharmacol. · Pubmed #17110839 No free full text.

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