Alzheimer Disease: US Eastern Zone

Baranov D, Bickler PE, Crosby GJ, Culley DJ, Eckenhoff MF, Eckenhoff RG, Hogan KJ, Jevtovic-Todorovic V, Palotás A, Perouansky M, Planel E, Silverstein JH, Wei H, Whittington RA, Xie Z, Zuo Z, Anonymous00067. · Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. · Anesth Analg. · Pubmed #19372347 No free full text.

Abstract: In order to review the current status of the potential relationship between anesthesia and Alzheimer's disease, a group of scientists recently met in Philadelphia for a full day of presentations and discussions. This special article represents a consensus view on the possible link between Alzheimer's disease and anesthesia and the steps required to test this more definitively.

Fillit HM, Doody RS, Binaso K, Crooks GM, Ferris SH, Farlow MR, Leifer B, Mills C, Minkoff N, Orland B, Reichman WE, Salloway S. · Alzheimer's Drug Discovery Foundation and Institute for the Study of Aging New York, New York 10019, USA. · Am J Geriatr Pharmacother. · Pubmed #17157793 No free full text.

Abstract: BACKGROUND: Alzheimer's disease and related dementias (ADRDs) are increasingly recognized as important causes of impaired cognition, function, and quality of life, as well as excess medical care utilization and costs in the elderly Medicare managed care population. Evidence-based clinical practice guidelines for ADRDs were published in 2001. More recent studies have resulted in the approval of new agents and demonstrated an expanded role for antidementia therapy in various types of dementia, settings of care, stages of disease, and the use of combination therapy. However, these clinical guidelines have not been updated in the past few years. OBJECTIVE: The goal of this article was to provide practical recommendations developed by a panel of experts that address issues of early diagnosis, treatment, and care management of ADRDs. The panel also addressed the societal and managed care implications. METHODS: A panel of leading experts was convened to develop consensus recommendations for the treatment and management of dementia based on currently available evidence and the panel's informed expert opinion. The panel comprised 12 leading experts, including clinical investigators and practitioners in geriatric medicine, neurology, psychiatry, and psychology; managed care medical and pharmacy directors; a health systems medical director; and a health policy expert. In addition, articles were collected based on PubMed searches (2000-2005) that were relevant to the key issues identified. Search terms included Alzheimer's disease, dementia, clinical practice guidelines, clinical trials, screening and assessment, and managed care. RESULTS: ADRDs represent a significant clinical and economic burden to individuals and society, including Medicare managed care organizations (MCOs). Appropriate utilization of antidementia therapy and care management is vitally important to achieving quality of life and care for dementia patients and their caregivers, and for managing the excess costs of Alzheimer's disease. The recommendations address relevant, practical, and timely concerns that are faced on a daily basis by practitioners and by Medicare MCO medical management programs in the care of dementia patients. These consensus recommendations attempt to describe a reasonable current standard for the provision of quality care for patients with dementia. The panel recommendations support the use of screening for cognitive impairment and the use of antidementia therapy for ADRDs in different stages of disease and types of dementia in all clinical settings. The panel members evaluated the use of the 3 marketed cholinesterase inhibitors-donepezil, galantamine, and rivastigmine-as well as the N-methyl-D-aspartate antagonist memantine. Recommendations for using these medications are made with an appreciation of the difficulties in translating the results from investigational clinical trials into clinical practice. CONCLUSIONS: The recommendations of the expert panel represent a clear consensus that nihilism in the diagnosis, treatment, and management of ADRDs is unwarranted, impairs quality of care, and is ultimately not costeffective.

Modi S, Moore C, Shah K, Anonymous00115. · Department of Family Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA. · J Fam Pract. · Pubmed #16266605 No free full text.

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McKhann GM, Albert MS, Grossman M, Miller B, Dickson D, Trojanowski JQ, Anonymous00019. · Department of Neurology, Zanvyl Krieger Mind/Brain Institute, Johns Hopkins University School of Medicine, 338 Krieger Hall, 3400 N Charles St, Baltimore, MD 21218-2685, USA. · Arch Neurol. · Pubmed #11708987 links to  free full text

Abstract: An international group of clinical and basic scientists participated in the Frontotemporal Dementia and Pick's Disease Criteria Conference at the National Institutes of Health in Bethesda, Md, on July 7, 2000, to reassess clinical and neuropathological criteria for the diagnosis of frontotemporal dementia (FTD). Previous criteria for FTD have primarily been designed for research purposes. The goal of this meeting was to propose guidelines that would enable clinicians (particularly neurologists, psychiatrists, and neuropsychologists) to recognize patients with FTD and, if appropriate, to expedite their referral to a diagnostic center. In addition, recommendations for the neuropathological criteria of FTD were reviewed, relative to classical neuropathology and modern molecular biology.

Fillit H, Cummings J. · Mount Sinai Medical Center, New York City, USA. · Manag Care Interface. · Pubmed #10747691 No free full text.

Abstract: The progressive loss of social and physical functioning associated with Alzheimer's disease (AD) results in extensive social and economic costs to society. The early diagnosis and treatment of AD may reduce cognitive and behavioral symptoms of this disease and may slow disease progression, thereby alleviating some of these social and economic costs. The Alzheimer's Disease Managed Care Advisory Council, a panel of experts from managed care, academic medicine, and the Los Angeles chapter of the Alzheimer's Association was convened to synthesize current evidence-based recommendations for AD diagnostic and treatment guidelines and to integrate these guidelines for use in MCOs. This paper presents conclusions from this panel and provides an algorithm for the treatment of AD specifically for managed care settings. When combined with other necessary efforts to educate providers, these guidelines should improve the cost-effectiveness and quality of care for individuals with dementia in managed care.

Snyder PJ, Pearn AM. · Clinical Division, Department of Psychology, University of Connecticut, Storrs, CT, USA; Child Study Center, Yale University School of Medicine, New Haven, CT, USA. · Alzheimers Dement. · Pubmed #19595928 No free full text.

Abstract: In February 1871, the great naturalist Charles Darwin received a letter from Dr. James-Crichton Browne, who was serving as Director of the largest lunatic asylum in England. Darwin had been introduced to Crichton-Browne 2 years earlier by Henry Maudsley, who believed that the young psychiatrist could provide Darwin with clinical examples of extreme emotional expression, to aid him in preparing to write Expression of the Emotions in Man and Animals (1872). This particular letter from Crichton-Browne contained the first and only reference to "premature dotage" or "senile decay" found anywhere in Darwin's entire corpus of correspondence, which amounted to more than 80,000 pages of handwritten letters to nearly 2,000 individuals throughout his lifetime. Moreover, this letter from Crichton-Browne, received by Darwin 36 years before the first case report of senile dementia by Professor Alois Alzheimer, explicitly noted that such premature dotage is the result of "brain wasting." Crichton-Browne believed that senile dementia was the result of a central nervous system disease, with the emotional lability observed in his patients linked inextricably to the disease process. This early hypothesis, of interest to Darwin in 1871, anticipated the groundbreaking neurohistopathologic research and case description by Alzheimer 36 years later, and has been confirmed by all clinical research in this field since 1907. This concordance between psychological symptoms and Alzheimer's disease continues to be an important area of study, leading to recent advances in our understanding of the genetics, neurobiology, and neurochemistry of psychiatric illness in older adults.

Van Lee R, Meagher B, Fritz P, Penfield S. · Booz Allen Hamilton, McLean, VA, USA. · Alzheimers Dement. · Pubmed #19328452 No free full text.

Abstract: There are many groups and organizations across the government, private, and nonprofit sectors that are passionately engaged in the fight against Alzheimer's disease (AD), but they have constraints on their funding and scope and, therefore, cannot tackle the problem holistically. Addressing the complexities of this epidemic strategically will require the collective efforts of committed stakeholders. Individuals and organizations must work together to identify mutual interests and forge new relationships and partnerships. Through this network of stakeholders, known as a megacommunity, individual members can support and expand their objectives and impact through the combined knowledge and resources in the megacommunity network. Leaders Engaged on Alzheimer's Disease (LEAD) is an example of a megacommunity tackling the toughest issues facing AD patients and their families. LEAD is currently comprised of more that thirty individuals and organizations committed to sharing information and coordinating action across organizational boundaries.

Reisberg B, Shulman MB. · Aging and Dementia Research Center, New York University School of Medicine, New York, NY, USA. · Alzheimers Dement. · Pubmed #19328449 No free full text.

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Fillit H, Nash DT, Shineman D. · Institute for the Study of Aging and Alzheimer's Drug Discovery Foundation, New York, NY, USA. · Alzheimers Dement. · Pubmed #19328448 No free full text.

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Ryan JM, Schneider G, Jacobsen JS. · Neuroscience Global Clinical Research and Development, Wyeth Research, Collegeville, PA, USA. · Alzheimers Dement. · Pubmed #19328445 No free full text.

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Landreth G. · Department of Neurosciences, Case Western Reserve University, Cleveland, OH 44106, USA. · J Neuroimmune Pharmacol. · Pubmed #18040837 No free full text.

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Bales KR. · Neuroscience Discovery Research, Eli Lilly & Co., Indianapolis, IN 46285, USA. · Exp Neurol. · Pubmed #17662278 No free full text.

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Drachman DA. · Department of Neurology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. · Curr Neurol Neurosci Rep. · Pubmed #17618530 No free full text.

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Martin BK, Breitner JC, Evans D, Lyketsos CG, Meinert CL. · Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md, USA. · Am J Med. · Pubmed #17349436 No free full text.

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Janson CG. · UMDNJ-Robert Wood Johnson Medical School, Camden, NJ 08103, USA. · Neurology. · Pubmed #16116144 No free full text.

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Fillit HM, Refolo LM. · The Institute for the Study of Aging, 1414 Avenue of the Americas, Suite 1502, New York, NY, USA. · Curr Alzheimer Res. · Pubmed #15974904 No free full text.

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Refolo LM, Fillit HM. · The Institute for the Study of Aging, New York, NY, USA. · J Mol Neurosci. · Pubmed #15314243 No free full text.

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Geldmacher DS. · Department of Neurology, University of Virginia Health System, P.O. Box 800394, Charlottesville, VA 22908, USA. · Clin Geriatr Med. · Pubmed #15062493 No free full text.

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Pasinetti GM, Pompl PN. · Neuroinflammation Research Laboratories, Department of Psychiatry, The Mount Sinai School of Medicine, New York, NY 10029, USA. · Lancet Neurol. · Pubmed #12849357 No free full text.

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Iadecola C, Gorelick PB. · Division of Neurobiology, Department of Neurology and Neuroscience, Weill Medical College of Cornell University, New York, NY 10021, USA. · Stroke. · Pubmed #12574528 links to  free full text

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Fillit HM, Refolo LM. · The Institute for the Study of Aging, New York, NY, USA. · J Mol Neurosci. · Pubmed #12540049 No free full text.

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Radebaugh TS, Ward-Robinson J. · Khachaturian, Radebaugh & Associates, Inc., Patomac, Maryland 20854-3009, USA. · Alzheimer Dis Assoc Disord. · Pubmed #12351912 No free full text.

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Smith MA, Perry G, Pryor WA. · Institute of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA. · Free Radic Biol Med. · Pubmed #12031888 No free full text.

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Kim D, Tsai LH. · Howard Hughes Medical Institute, MIT Picower Institute for Learning and Memory, Cambridge, MA 02139, USA. · Cell. · Pubmed #19524503 No free full text.

Abstract: The APP-processing pathway is a pathological component of Alzheimer's disease (AD), but there is no consensus regarding the physiological functions of APP and its products. Two studies (Nikolaev et al., 2009; Lauren et al., 2009) link the physiological and pathological aspects of APP processing. They show that the APP products, N-APP and Abeta42, are ligands for death receptor 6 and cellular prion protein, respectively, which are important in nervous system development and synaptic suppression.

Holt J, Stiltner L, Wallace R, Raetz J. · Department of Family Medicine, Quillen College of Medicine, Eastern Tennessee State University, Johnson City, TN, USA. · J Fam Pract. · Pubmed #19508846 No free full text.

Abstract: Yes, but the extent of the benefit is unclear. Treating patients with early-stage Alzheimer's disease yields statistically significant, though perhaps not clinically significant, improvement in cognition and global function. In a few cases, it may delay loss of function and need for long-term care. Treating patients with mild cognitive impairment (MCI)-the most likely precursor to Alzheimer's disease-with cholinesterase inhibitors seems to have an initial, but perhaps unsustained, benefit over no treatment. Withdrawing anticholinergic drugs from patients taking them promises to reduce symptoms of MCI, but is unlikely to reduce rates of Alzheimer's.