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Montmorency Tart cherries (Prunus cerasus L.) modulate vascular function acutely, in the absence of improvement in cognitive performance. Br J Nutr 2016; 116:1935-1944. [PMID: 27989253 DOI: 10.1017/s0007114516004177] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cerebral blood volume and metabolism of oxygen decline as part of human ageing, and this has been previously shown to be related to cognitive decline. There is some evidence to suggest that polyphenol-rich foods can play an important role in delaying the onset or halting the progression of age-related health disorders such as CVD and Alzheimer's disease and to improve cognitive function. In the present study, an acute, placebo-controlled, double-blinded, cross-over, randomised Latin-square design study with a washout period of at least 14 d was conducted on twenty-seven, middle-aged (defined as 45-60 years) volunteers. Participants received either a 60 ml dose of Montmorency tart cherry concentrate (MC), which contained 68·0 (sd 0·26) mg cyanidin-3-glucoside/l, 160·75 (sd 0·55) mean gallic acid equivalent/l and 0·59 (sd 0·02) mean Trolox equivalent/l, respectively, or a placebo. Cerebrovascular responses, cognitive performance and blood pressure were assessed at baseline and 1, 2, 3 and 5 h following consumption. There were significant differences in concentrations of total Hb and oxygenated Hb during the task period 1 h after MC consumption (P≤0·05). Furthermore, MC consumption significantly lowered systolic blood pressure (P≤0·05) over a period of 3 h, with peak reductions of 6±2 mmHg at 1 h after MC consumption relative to the placebo. Cognitive function and mood were not affected. These results show that a single dose of MC concentrate can modulate certain variables of vascular function; however, this does not translate to improvements in cognition or mood.
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von Gunten A, Schlaefke S, Überla K. Efficacy of Ginkgo biloba extract EGb 761 ® in dementia with behavioural and psychological symptoms: A systematic review. World J Biol Psychiatry 2016. [PMID: 26223956 DOI: 10.3109/15622975.2015.1066513] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To review current evidence of efficacy of Ginkgo biloba extract EGb 761® in dementia with behavioural and psychological symptoms (BPSD). METHODS Randomized, placebo-controlled trials assessing the effects of EGb 761® in dementia patients with BPSD were included if the diagnosis was made in accordance with internationally accepted criteria, the treatment period was at least 22 weeks, outcome measures covered BPSD and at least two of the following domains of assessment, i.e. cognition, activities of daily living and clinical global assessment, and methodological quality was adequate. An analysis of covariance (ANCOVA) model was used to calculate the pooled effect estimates and to compare effects of EGb 761® and placebo; furthermore, combined risk differences of response rates were calculated. RESULTS Four published trials were identified, involving altogether 1,628 outpatients with mild to moderate dementia. Least-square mean differences for change from baseline in cognition, BPSD (including caregiver distress rating), activities of daily living, clinical global impression, and quality of life favoured EGb 761® (P < 0.001 for all comparisons). CONCLUSIONS The pooled analyses provide evidence of efficacy of EGb 761® at a daily dose of 240 mg in the treatment of out-patients suffering from Alzheimer's, vascular or mixed dementia with BPSD.
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Affiliation(s)
- Armin von Gunten
- a Service Universitaire de Psychiatrie de l'Age Avancé (SUPAA), Department of Psychiatry , Centre Hospitalier Universitaire Vaudois , Prilly , Switzerland
| | | | - Karl Überla
- c Prof. em. for Epidemiology, Ludwig-Maximilian-University , Munich , Germany
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Zhu J, Shi R, Chen S, Dai L, Shen T, Feng Y, Gu P, Shariff M, Nguyen T, Ye Y, Rao J, Xing G. The Relieving Effects of BrainPower Advanced, a Dietary Supplement, in Older Adults with Subjective Memory Complaints: A Randomized, Double-Blind, Placebo-Controlled Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:7898093. [PMID: 27190539 PMCID: PMC4842387 DOI: 10.1155/2016/7898093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/27/2016] [Accepted: 02/29/2016] [Indexed: 01/11/2023]
Abstract
Subjective memory complaints (SMCs) are common in older adults that can often predict further cognitive impairment. No proven effective agents are available for SMCs. The effect of BrainPower Advanced, a dietary supplement consisting of herbal extracts, nutrients, and vitamins, was evaluated in 98 volunteers with SMCs, averaging 67 years of age (47-88), in a randomized, double-blind, placebo-controlled trial. Subjective hypomnesis/memory loss (SML) and attention/concentration deficits (SAD) were evaluated before and after 12-week supplementation of BrainPower Advanced capsules (n = 47) or placebo (n = 51), using a 5-point memory questionnaire (1 = no/slight, 5 = severe). Objective memory function was evaluated using 3 subtests of visual/audio memory, abstraction, and memory recall that gave a combined total score. The BrainPower Advanced group had more cases of severe SML (severity ⩾ 3) (44/47) and severe SAD (43/47) than the placebo group (39/51 and 37/51, < 0.05, < 0.05, resp.) before the treatment. BrainPower Advanced intervention, however, improved a greater proportion of the severe SML (29.5%)(13/44) (P < 0.01) and SAD (34.9%)(15/43)(P < 0.01) than placebo (5.1% (2/39) and 13.5% (5/37), resp.). Thus, 3-month BrainPower Advanced supplementation appears to be beneficial to older adults with SMCs.
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Affiliation(s)
- Jingfen Zhu
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Rong Shi
- School of Public Health, Shanghai University of TCM, Shanghai 201203, China
| | - Su Chen
- Si-Tang Community Health Service Center of Shanghai, Shanghai 200431, China
| | - Lihua Dai
- Department of Emergency Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Tian Shen
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Yi Feng
- Department of Community Health and Family Medicine, School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Pingping Gu
- Southern California Kaiser Sunset, 4867 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Mina Shariff
- Department of Research, DRM Resources, 1683 Sunflower Avenue, Costa Mesa, CA 92626, USA
| | - Tuong Nguyen
- Department of Research, DRM Resources, 1683 Sunflower Avenue, Costa Mesa, CA 92626, USA
| | - Yeats Ye
- Maryland Population Research Center, University of Maryland, College Park, MD 20742, USA
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Guoqiang Xing
- Imaging Institute of Rehabilitation and Development of Brain Function, North Sichuan Medical University, Nanchong Central Hospital, Nanchong 637000, China
- Lotus Biotech.com LLC, John Hopkins University-MCC, 9601 Medical Center Drive, Rockville, MD 20850, USA
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Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H, Fratiglioni L, Frisoni GB, Gauthier S, Georges J, Graff C, Iqbal K, Jessen F, Johansson G, Jönsson L, Kivipelto M, Knapp M, Mangialasche F, Melis R, Nordberg A, Rikkert MO, Qiu C, Sakmar TP, Scheltens P, Schneider LS, Sperling R, Tjernberg LO, Waldemar G, Wimo A, Zetterberg H. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol 2016; 15:455-532. [DOI: 10.1016/s1474-4422(16)00062-4] [Citation(s) in RCA: 1001] [Impact Index Per Article: 125.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/06/2015] [Accepted: 02/09/2016] [Indexed: 12/15/2022]
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Subramanyam A, Singh S. Mild cognitive decline: Concept, types, presentation, and management. JOURNAL OF GERIATRIC MENTAL HEALTH 2016. [DOI: 10.4103/2348-9995.181910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abd-Eldayem A, Farghaly HM, Abdel-Zaher A. The nephroprotective effects of ginkgo biloba extract (EGb761) against l-NG-nitroarginine methyl ester-induced hypertension in rats: role of oxidative stress and inflammatory markers. ACTA ACUST UNITED AC 2016. [DOI: 10.4103/2357-0121.199358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wang Y, Wang R, Wang Y, Peng R, Wu Y, Yuan Y. Ginkgo biloba extract mitigates liver fibrosis and apoptosis by regulating p38 MAPK, NF-κB/IκBα, and Bcl-2/Bax signaling. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:6303-17. [PMID: 26664050 PMCID: PMC4671772 DOI: 10.2147/dddt.s93732] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Liver fibrosis is the consequence of diverse liver injuries and can eventually develop into liver cirrhosis. Ginkgo biloba extract (GBE) is an extract from dried ginkgo leaves that has many pharmacological effects because of its various ingredients and has been shown to be hepatoprotective. Purpose and methods Aimed to investigate the underlying protective mechanisms of GBE on carbon tetrachloride (CCl4)-induced liver fibrosis in rats. Male Sprague Dawley rats were randomly divided into four groups: control group (C), model group (M), low-dose group (L), and high-dose group (H). Liver fibrosis was induced by CCl4 groups M, L, and H: group C was administered saline. In addition, GBE at different doses was used to treat groups L and H. Results The results of hematoxylin and eosin staining, Masson’s trichrome staining, a liver function index, and a liver fibrosis index showed that GBE application noticeably mitigated fibrosis and improved the function of the liver. The western blotting and immunohistochemistry analyses indicated that GBE reduced liver fibrosis not only by inhibiting p38 MAPK and NF-κBp65 via inhibition of IκBα degradation but also by inhibiting hepatocyte apoptosis via downregulation of Bax, upregulation of Bcl-2, and subsequent inhibition of caspase-3 activation. Inflammation-associated factors and hepatic stellate cell (HSC)-activation markers further demonstrated that GBE could effectively inhibit HSC activation and inflammation as a result of its regulation of p38 MAPK and nuclear factor-kappa B/IκBα signaling. Conclusion Our findings indicated a novel role for GBE in the treatment of liver fibrosis. The potential mechanisms may be associated with the following signaling pathways: 1) the p38 MAPK and nuclear factor-kappa B/IκBα signaling pathways (inhibiting inflammation and HSCs activation) and 2) the Bcl-2/Bax signaling pathway (inhibiting the apoptosis of hepatocytes).
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Affiliation(s)
- Yuanyuan Wang
- Department of Pharmacy, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Rong Wang
- Department of Pharmacy, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yujie Wang
- Department of Pharmacy, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ruqin Peng
- Department of Pharmacy, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yan Wu
- Department of Pharmacy, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yongfang Yuan
- Department of Pharmacy, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Streptozotocin Intracerebroventricular-Induced Neurotoxicity and Brain Insulin Resistance: a Therapeutic Intervention for Treatment of Sporadic Alzheimer's Disease (sAD)-Like Pathology. Mol Neurobiol 2015; 53:4548-62. [PMID: 26298663 DOI: 10.1007/s12035-015-9384-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/10/2015] [Indexed: 02/03/2023]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder that is remarkably characterized by pathological hallmarks which include amyloid plaques, neurofibrillary tangles, neuronal loss, and progressive cognitive loss. Several well-known genetic mutations which are being used for the development of a transgenic model of AD lead to an early onset familial AD (fAD)-like condition. However, these settings are only reasons for a small percentage of the total AD cases. The large majorities of AD cases are considered as a sporadic in origin and are less influenced by a single mutation of a gene. The etiology of sporadic Alzheimer's disease (sAD) remains unclear, but numerous risk factors have been identified that increase the chance of developing AD. Among these risk factors are insulin desensitization/resistance state, oxidative stress, neuroinflammation, synapse dysfunction, tau hyperphosphorylation, and deposition of Aβ in the brain. Subsequently, these risk factors lead to development of sAD. However, the underlying molecular mechanism is not so clear. Streptozotocin (STZ) produces similar characteristic pathology of sAD such as altered glucose metabolism, insulin signaling, synaptic dysfunction, protein kinases such as protein kinase B/C, glycogen synthase-3β (GSK-3β) activation, tau hyperphosphorylation, Aβ deposition, and neuronal apoptosis. Further, STZ also leads to inhibition of Akt/PKB, insulin receptor (IR) signaling molecule, and insulin resistance in brain. These alterations mediated by STZ can be used to explore the underlying molecular and pathophysiological mechanism of AD (especially sAD) and their therapeutic intervention for drug development against AD pathology.
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Fonseca-Santos B, Gremião MPD, Chorilli M. Nanotechnology-based drug delivery systems for the treatment of Alzheimer's disease. Int J Nanomedicine 2015; 10:4981-5003. [PMID: 26345528 PMCID: PMC4531021 DOI: 10.2147/ijn.s87148] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Alzheimer's disease is a neurological disorder that results in cognitive and behavioral impairment. Conventional treatment strategies, such as acetylcholinesterase inhibitor drugs, often fail due to their poor solubility, lower bioavailability, and ineffective ability to cross the blood-brain barrier. Nanotechnological treatment methods, which involve the design, characterization, production, and application of nanoscale drug delivery systems, have been employed to optimize therapeutics. These nanotechnologies include polymeric nanoparticles, solid lipid nanoparticles, nanostructured lipid carriers, microemulsion, nanoemulsion, and liquid crystals. Each of these are promising tools for the delivery of therapeutic devices to the brain via various routes of administration, particularly the intranasal route. The objective of this study is to present a systematic review of nanotechnology-based drug delivery systems for the treatment of Alzheimer's disease.
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Affiliation(s)
- Bruno Fonseca-Santos
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Maria Palmira Daflon Gremião
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Marlus Chorilli
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
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Clinical trials with herbal medicinal products in children: a literature analysis. Wien Med Wochenschr 2015; 165:236-42. [PMID: 26183729 DOI: 10.1007/s10354-015-0373-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
Herbal medicinal products have been used since several decades for the health care of children. Nevertheless, well-controlled clinical studies with herbal medicinal products for children are rare. The authors' objective therefore was to evaluate clinical trials with herbal medicinal products in children, based on a literature search in PubMed and Web of Science. A total of 133 trials were identified. 90 studies were randomized, 32.2% were randomized and double-blinded. Most studies were performed in China, in the age group 6-12 years, and in children with respiratory diseases, most often herbal medicinal products with Hedera helix were tested. The analysis revealed that studies on herbal medicinal products were feasible in children. Although clinical trials have been found, this literature search have limitations and did not cover all studies performed. However, only few clinical trials of high quality were identified. Further studies therefore are urgently needed to support the good empirical findings.
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Wu CY, Hu HY, Chow LH, Chou YJ, Huang N, Wang PN, Li CP. The Effects of Anti-Dementia and Nootropic Treatments on the Mortality of Patients with Dementia: A Population-Based Cohort Study in Taiwan. PLoS One 2015; 10:e0130993. [PMID: 26098910 PMCID: PMC4476616 DOI: 10.1371/journal.pone.0130993] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background Few studies have examined the contribution of treatment on the mortality of dementia based on a population-based study. Objective To investigate the effects of anti-dementia and nootropic treatments on the mortality of dementia using a population-based cohort study. Methods 12,193 incident dementia patients were found from 2000 to 2010. Their data were compared with 12,193 age- and sex-matched non-dementia controls that were randomly selected from the same database. Dementia was classified into vascular (VaD) and degenerative dementia. Mortality incidence and hazard ratios (HRs) were calculated. Results The median survival time was 3.39 years (95% confidence interval [CI]: 2.88–3.79) for VaD without medication, 6.62 years (95% CI: 6.24–7.21) for VaD with nootropics, 3.01 years (95% CI: 2.85–3.21) for degenerative dementia without medication, 8.11 years (95% CI: 6.30–8.55) for degenerative dementia with anti-dementia medication, 6.00 years (95% CI: 5.73–6.17) for degenerative dementia with nootropics, and 9.03 years (95% CI: 8.02–9.87) for degenerative dementia with both anti-dementia and nootropic medications. Compared to the non-dementia group, the HRs among individuals with degenerative dementia were 2.69 (95% CI: 2.55–2.83) without medication, 1.46 (95% CI: 1.39–1.54) with nootropics, 1.05 (95% CI: 0.82–1.34) with anti-dementia medication, and 0.92 (95% CI: 0.80–1.05) with both nootropic and anti-dementia medications. VaD with nootropics had a lower mortality (HR: 1.25, 95% CI: 1.15–1.37) than VaD without medication (HR: 2.46, 95% CI: 2.22–2.72). Conclusion Pharmacological treatments have beneficial effects for patients with dementia in prolonging their survival.
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Affiliation(s)
- Chen-Yi Wu
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Public Health & Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health & Department of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Lok-Hi Chow
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health & Department of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ning Wang
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- * E-mail: (CPL); (PNW)
| | - Chung-Pin Li
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail: (CPL); (PNW)
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Wübbeler M, Wucherer D, Hertel J, Michalowsky B, Heinrich S, Meyer S, Schaefer-Walkmann S, Hoffmann W, Thyrian JR. Antidementia drug treatment in dementia networks in Germany: use rates and factors associated with treatment use. BMC Health Serv Res 2015; 15:205. [PMID: 25998147 PMCID: PMC4460966 DOI: 10.1186/s12913-015-0855-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 05/05/2015] [Indexed: 01/06/2023] Open
Abstract
Background Dementia networks in Germany constitute a specialised setting for integrated dementia care and have shown benefits on relevant outcomes, including those of drug treatment. National guidelines recommend treatment with acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) or the N-Methyl-D-Aspartate antagonist (memantine) to reduce cognitive symptoms. However, prescription rates are lower than 30 % in general practises. This study aims to describe antidementia drug treatment and the factors that are associated with the treatment in different dementia networks across Germany. Methods We have analysed the socio-demographic, clinical and utilisation data from 560 patients with dementia (PWD), as well as data from their caregivers, in 13 selected dementia networks in Germany. The patients and caregivers were interviewed in their homes or in the network facilities. Multiple logistic regression models were fitted to evaluate the socio-demographic and clinical factors associated with the utilisation of antidementia drug treatment in the various networks. Results In all of the networks in the study, 52 % of the participants received an antidementia drug treatment. Factors associated with the utilisation of the antidementia drug treatment were: formal diagnosis (OR = 16.81, p < 0.001), association with a physician in the network (OR = 3.69, p < 0.001), higher number of comorbidities (OR = 0.88, p = 0.039), living alone (OR = 0.51, p = 0.032) and higher age (OR = 2.97, p = 0.002). Conclusion Medical treatment of PWD with antidementia drugs in dementia networks in Germany is more frequent than in primary and nursing home care settings. Our findings also suggest that participants with a formal diagnosis and a physician in the network have increased rates of receiving antidementia drug treatments. These findings suggest that dementia networks focusing on medical treatment should support diagnostic procedures and incorporate physician specialists.
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Affiliation(s)
- Markus Wübbeler
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Interventional Health Care Research", Site Rostock/Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Steffen Heinrich
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Care Structures" Site Witten, Stockumer Str. 12, Witten, D-58453, Germany.
| | - Saskia Meyer
- Department of Human and Health Science, University of Bremen, Grazer Str. 4, Bremen, D-28359, Germany.
| | | | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany. .,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Research Group "Interventional Health Care Research", Site Rostock/Greifswald, Ellernholzstr. 1-2, Greifswald, D-17487, Germany.
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Hashiguchi M, Ohta Y, Shimizu M, Maruyama J, Mochizuki M. Meta-analysis of the efficacy and safety of Ginkgo biloba extract for the treatment of dementia. J Pharm Health Care Sci 2015; 1:14. [PMID: 26819725 PMCID: PMC4729005 DOI: 10.1186/s40780-015-0014-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The benefit of Ginkgo biloba for the treatment of dementia remains controversial. The aim of this study was to evaluate the efficacy and safety of Ginkgo biloba in patients with dementia in whom administration effects were reported using meta-analysis. METHODS We searched MEDLINE, Embase, the Cochrane databases, and Ichushi for controlled trials of Ginkgo biloba for the treatment dementia. Clinical characteristics and outcomes were extracted. Meta-analysis results were expressed as standard mean differences (SMDs) in scores of the Syndrome Kurztest (SKT), Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) for cognition efficacy, or odds ratios (ORs) for dropouts and adverse drug reactions. RESULTS Thirteen studies using the extract EGb761 met our inclusion criteria, which were duration of 12 to 52 weeks and daily dose of more than 120 mg, and included a total of 2381 patients. Meta-analysis was performed by using 9 of 13 studies, 7 of which used the SKT and 2 ADAS-Cog (dose 120 mg, 26 weeks) scores as efficacy parameters. In meta-analysis of all patients, SMDs (95% confidence interval [CI]) in the change in SKT scores (7 studies) were in favor of Ginkgo biloba over placebo (SMD = -0.90 [-1.46, -0.34]), but 2 studies that used ADAS-Cog did not show a statistically significant difference from placebo for ADAS-Cog (-0.06 [-0.41, 0.30]). For Alzheimer's disease (AD) and vascular dementia (VaD) subgroups, SMDs [95% CI] in SKT in the combined AD and VaD subgroup (-1.07 [-1.66, -0.47]) and AD subgroup (-1.36 [-2.27, -0.46]) were in favor of Ginkgo biloba over placebo. In terms of daily dose of Ginkgo biloba in the combined AD and VaD subgroup, SMD in SKT score in 240-mg daily dose groups was significantly greater than with placebo (-0.71 [-1.28, -0.14]). Dropout rates for any reason did not differ between two groups, but dropout rates due to side effects were significantly lower in Ginkgo biloba groups compared with placebo groups (OR = 1.72 [1.06, 2.80]). CONCLUSIONS Taking a 240-mg daily dose of Ginkgo biloba extract is effective and safe in the treatment of dementia.
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Affiliation(s)
- Masayuki Hashiguchi
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512 Japan
| | - Yuriko Ohta
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512 Japan
| | - Mikiko Shimizu
- Department of Hygienic Chemistry, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512 Japan
| | - Junya Maruyama
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512 Japan
| | - Mayumi Mochizuki
- Division for Evaluation and Analysis of Drug Information, Faculty of Pharmacy, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo 105-8512 Japan
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Determination of Pesticides and Transformation Products in Ginkgo biloba Nutraceutical Products by Chromatographic Techniques Coupled to Mass Spectrometry. FOOD ANAL METHOD 2015. [DOI: 10.1007/s12161-015-0103-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Heinonen T, Gaus W. Cross matching observations on toxicological and clinical data for the assessment of tolerability and safety of Ginkgo biloba leaf extract. Toxicology 2015; 327:95-115. [DOI: 10.1016/j.tox.2014.10.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/13/2014] [Accepted: 10/27/2014] [Indexed: 12/22/2022]
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Nagraj SK, Naresh S, Srinivas K, Renjith George P, Shrestha A, Levenson D, Ferraiolo DM. Interventions for the management of taste disturbances. Cochrane Database Syst Rev 2014:CD010470. [PMID: 25425011 DOI: 10.1002/14651858.cd010470.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The sense of taste is very much essential to the overall health of the individual. It is a necessary component to enjoying one's food, which in turn provides nutrition to an individual. Any disturbance in taste perception can hamper the quality of life in such patients by influencing their appetite, body weight and psychological well-being. Taste disorders have been treated using different modalities of treatment and there is no consensus for the best intervention. Hence this Cochrane systematic review was undertaken. OBJECTIVES To assess the effects of interventions for the management of patients with taste disturbances. SEARCH METHODS We searched the Cochrane Oral Health Group Trials Register (to 5 March 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2014), MEDLINE via OVID (1948 to 5 March 2014), EMBASE via OVID (1980 to 5 March 2014), CINAHL via EBSCO (1980 to 5 March 2014) and AMED via OVID (1985 to 5 March 2014). We also searched the relevant clinical trial registries and conference proceedings from the International Association of Dental Research/American Association of Dental Research (to 5 March 2014), Association for Research in Otolaryngology (to 5 March 2014), the US National Institutes of Health Trials Register (to 5 March 2014), metaRegister of Controlled Trials (mRCT) (to 5 March 2014), World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) (to 5 March 2014) and International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) Clinical Trials Portal (to 5 March 2014). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing any pharmacological agent with a control intervention or any non-pharmacological agent with a control intervention. We also included cross-over trials in the review. DATA COLLECTION AND ANALYSIS Two authors independently, and in duplicate, assessed the quality of trials and extracted data. Wherever possible, we contacted study authors for additional information. We collected adverse events information from the trials. MAIN RESULTS We included nine trials (seven parallel and two cross-over RCTs) with 566 participants. We assessed three trials (33.3%) as having a low risk of bias, four trials (44.5%) at high risk of bias and two trials (22.2%) as having an unclear risk of bias. We only included studies on taste disorders in this review that were either idiopathic, or resulting from zinc deficiency or chronic renal failure.Of these, eight trials with 529 people compared zinc supplements to placebo for patients with taste disorders. The participants in two trials were children and adolescents with respective mean ages of 10 and 11.2 years and the other six trials had adult participants. Out of these eight, two trials assessed the patient reported outcome for improvement in taste acuity using zinc supplements (RR 1.45, 95% CI 1.0 to 2.1; very low quality evidence). We included three trials in the meta-analysis for overall taste improvement (effect size 0.44, 95% CI 0.23 to 0.65; moderate quality evidence). Two other trials described the results as taste acuity improvement and we conducted subgroup analyses due to clinical heterogeneity. One trial described the results as taste recognition improvement for each taste sensation and we analysed this separately. We also analysed one cross-over trial separately using the first half of the results. None of the zinc trials tested taste discrimination. Only one trial tested taste discrimination using acupuncture (effect size 2.80, 95% CI -1.18 to 6.78; low quality evidence).Out of the eight trials using zinc supplementation, four reported adverse events like eczema, nausea, abdominal pain, diarrhoea, constipation, decrease in blood iron, increase in blood alkaline phosphatase, and minor increase in blood triglycerides. No adverse events were reported in the acupuncture trial.None of the included trials could be included in the meta-analysis for health-related quality of life in taste disorder patients. AUTHORS' CONCLUSIONS We found very low quality evidence that was insufficient to conclude on the role of zinc supplements to improve taste perception by patients, however we found moderate quality evidence that zinc supplements improve overall taste improvement in patients with zinc deficiency/idiopathic taste disorders. We also found low quality evidence that zinc supplements improve taste acuity in zinc deficient/idiopathic taste disorders and very low quality evidence for taste recognition improvement in children with taste disorders secondary to chronic renal failure. We did not find any evidence to conclude the role of zinc supplements for improving taste discrimination, or any evidence addressing health-related quality of life due to taste disorders.We found low quality evidence that is not sufficient to conclude on the role of acupuncture for improving taste discrimination in cases of idiopathic dysgeusia (distortion of taste) and hypogeusia (reduced ability to taste). We were unable to draw any conclusions regarding the superiority of zinc supplements or acupuncture as none of the trials compared these interventions.
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Affiliation(s)
- Sumanth Kumbargere Nagraj
- Department of Oral Medicine & Oral Radiology, Faculty Of Dentistry, Melaka-Manipal Medical College, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
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Franke AG, Bagusat C, Rust S, Engel A, Lieb K. Substances used and prevalence rates of pharmacological cognitive enhancement among healthy subjects. Eur Arch Psychiatry Clin Neurosci 2014; 264 Suppl 1:S83-90. [PMID: 25214391 DOI: 10.1007/s00406-014-0537-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/01/2014] [Indexed: 01/05/2023]
Abstract
Pharmacological "cognitive enhancement" (CE) is defined as the use of any psychoactive drug with the purpose of enhancing cognition, e.g. regarding attention, concentration or memory by healthy subjects. Substances commonly used as CE drugs can be categorized into three groups of drugs: (1) over-the-counter (OTC) drugs such as coffee, caffeinated drinks/energy drinks, caffeine tablets or Ginkgo biloba; (2) drugs being approved for the treatment of certain disorders and being misused for CE: drugs to treat attention-deficit/hyperactivity disorder (ADHD) such as the stimulants methylphenidate (MPH, e.g. Ritalin(®)) or amphetamines (AMPH, e.g. Attentin(®) or Adderall(®)), to treat sleep disorders such as modafinil or to treat Alzheimer's disease such as acetylcholinesterase inhibitors; (3) illicit drugs such as illicit AMPH, e.g. "speed", ecstasy, methamphetamine (crystal meth) or others. Evidence from randomized placebo-controlled trials shows that the abovementioned substances have limited pro-cognitive effects as demonstrated, e.g. regarding increased attention, increased cognitive speed or shortening of reaction times, but on the same time poses considerable safety risks on the consumers. Prevalence rates for the use of CE drugs among healthy subjects show a broad range from less than 1 % up to more than 20 %. The range in prevalence rates estimates results from several factors which are chosen differently in the available survey studies: type of subjects (students, pupils, special professions, etc.), degree of anonymity in the survey (online, face-to-face, etc.), definition of CE and substances used/misused for CE, which are assessed (OTC drugs, prescription, illicit drugs) as well as time periods of use (e.g. ever, during the past year/month/week, etc.). A clear and comprehensive picture of the drugs used for CE by healthy subjects and their adverse events and safety risks as well as comprehensive and comparable international data on the prevalence rates of CE among healthy subjects are of paramount importance for informing policy makers and healthcare professionals about CE.
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Affiliation(s)
- Andreas G Franke
- Department of Social Work and Education, University of Neubrandenburg, University of Applied Sciences, Brodaer Str. 2, 17033, Neubrandenburg, Germany,
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Mörike K, Gleiter CH. [Herbal medicines: when to use or not to use?]. Internist (Berl) 2014; 55:1361-6. [PMID: 25301027 DOI: 10.1007/s00108-014-3590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Herbal medicines are popular. It is frequently assumed that they are effective and safe. Sound knowledge of existing, or lacking, data on the efficacy and safety is required for advice and for the decision whether or not to use a particular herbal drug. Cochrane reviews are available for some herbal remedies. Most of them indicate either insufficient knowledge or weak or lacking efficacy. Numerous studies on interactions, some of which are clinically significant, for St. John's wort with conventional drugs are available. Overall, although knowledge about herbal drugs has grown in recent years, it is generally still unsatisfactory. The active recommendation to use an herbal drug is usually not advisable. However, a patient's request for a licensed herbal drug may be acceptable if there is no conventional concomitant comedication that is known or expected to interact, no contra-indication, and no other (conventional) treatment with better, or better known, benefit-risk ratio.
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Affiliation(s)
- K Mörike
- Abteilung Klinische Pharmakologie, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Universitätsklinikum Tübingen, Auf der Morgenstelle 8, 72076, Tübingen, Deutschland,
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Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging 2014; 31:131-40. [PMID: 24353033 PMCID: PMC3907693 DOI: 10.1007/s40266-013-0146-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Multimorbidity and polypharmacy represent a major problem for elderly patients; improvement of medication schemes is important and listing approaches (e.g. Beers list) are considered to be potentially useful. Objectives The aim of this study was to perform expert consensus validation of the FORTA (Fit fOR The Aged) List, a drug classification combining positive and negative labelling of drugs chronically prescribed to elderly patients. Methods A two-round Delphi procedure was conducted involving 20 experts, 17 geriatric internists and 3 geriatric psychiatrists from Germany and Austria, evaluating the labels assigned to 190 substances or substance groups. These labels ranged from A (indispensable), B (beneficial), C (questionable) to D (avoid), depending on the state of evidence for safety, efficacy and overall age-appropriateness. The experts were also requested to suggest additional substances and indication areas for assessment and possible inclusion in the FORTA List. A weighted (corrected) consensus coefficient was generated for each substance to reflect (1) agreement with the original label, and (2) distribution among raters’ labels. Results The overall consensus for all items and raters was 92 % (corrected). For 54/190 items (28.4 %), a unanimous response was achieved as to the original author-based FORTA label choice. Twenty-four substances (12.6 %) fell short of the consensus cutoff and were re-evaluated in a second round. This yielded confirmation of 171/190, or 90 %, of the original author-based FORTA labels. A total of 35 new substances were also accepted for the FORTA List. Drugs used for dementia and dementia syndromes provoked particular response heterogeneity. Conclusion The FORTA List now reflects a wider consensus among experts, increasing its validity for clinical use. It represents a tool to improve the quality of drug prescription in older patients by identifying both inappropriate and omitted drugs, and thus overtreatment and undertreatment. The validation of FORTA’s impact on clinical endpoints has yielded promising preliminary results, to be corroborated in ongoing larger trials. Electronic supplementary material The online version of this article (doi:10.1007/s40266-013-0146-0) contains supplementary material, which is available to authorized users.
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Siddiqui MJ, Min CS, Verma RK, Jamshed SQ. Role of complementary and alternative medicine in geriatric care: A mini review. Pharmacogn Rev 2014; 8:81-7. [PMID: 25125879 PMCID: PMC4127825 DOI: 10.4103/0973-7847.134230] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 10/28/2013] [Accepted: 06/10/2014] [Indexed: 11/04/2022] Open
Abstract
Since time immemorial homo sapiens are subjected to both health and diseases states and seek treatment for succor and assuagement in compromised health states. Since last two decades the progressive rise in the alternative form of treatment cannot be ignored and population seems to be dissatisfied with the conventional treatment modalities and therefore, resort to other forms of treatment, mainly complementary and alternative medicine (CAM). The use of CAM is predominantly more popular in older adults and therefore, numerous research studies and clinical trials have been carried out to investigate the effectiveness of CAM in the management of both communicable and non-communicable disease. In this current mini review, we attempt to encompass the use of CAM in chronic non-communicable diseases that are most likely seen in geriatrics. The current review focuses not only on the reassurance of good health practices, emphasizing on the holistic development and strengthening the body's defense mechanisms, but also attempts to construct a pattern of self-care and patient empowerment in geriatrics. The issues of safety with CAM use cannot be sidelined and consultation with a health care professional is always advocated to the patient. Likewise, responsibility of the health care professional is to inform the patient about the safety and efficacy issues. In order to substantiate the efficacy and safety of CAMs, evidence-based studies and practices with consolidated standards should be planned and executed.
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Affiliation(s)
- Mohammad Jamshed Siddiqui
- Department of Pharmaceutical Chemistry, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Chan Sze Min
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Faculty of Science, University of Stratchlyde, United Kingdom
| | - Rohit Kumar Verma
- Department of Pharamcy Practice, School of Pharmacy, International Medical University, Bukit Jalil Campus, Kuala Lumpur, Malaysia
| | - Shazia Qasim Jamshed
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
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Mecocci P, Tinarelli C, Schulz RJ, Polidori MC. Nutraceuticals in cognitive impairment and Alzheimer's disease. Front Pharmacol 2014; 5:147. [PMID: 25002849 PMCID: PMC4066843 DOI: 10.3389/fphar.2014.00147] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/03/2014] [Indexed: 12/31/2022] Open
Abstract
Several chemical substances belonging to classes of natural dietary origin display protective properties against some age-related diseases including neurodegenerative ones, particularly Alzheimer's disease (AD). These compounds, known as nutraceuticals, differ structurally, act therefore at different biochemical and metabolic levels and have shown different types of neuroprotective properties. The aim of this review is to summarize data from observational studies, clinical trials, and randomized clinical trials (RCTs) in humans on the effects of selected nutraceuticals against age-related cognitive impairment and dementia. We report results from studies on flavonoids, some vitamins and other natural substances that have been studied in AD and that might be beneficial for the maintenance of a good cognitive performance. Due to the substantial lack of high-level evidence studies there is no possibility for recommendation of nutraceuticals in dementia-related therapeutic guidelines. Nevertheless, the strong potential for their neuroprotective action warrants further studies in the field.
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Affiliation(s)
- P. Mecocci
- Section of Gerontology and Geriatrics, Department of Medicine, University of PerugiaPerugia, Italy
| | - C. Tinarelli
- Section of Gerontology and Geriatrics, Department of Medicine, University of PerugiaPerugia, Italy
| | - R. J. Schulz
- Geriatrics Department, Medical Faculty, University of CologneCologne, Germany
| | - M. C. Polidori
- Geriatrics Department, Medical Faculty, University of CologneCologne, Germany
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Benzoate, a D-amino acid oxidase inhibitor, for the treatment of early-phase Alzheimer disease: a randomized, double-blind, placebo-controlled trial. Biol Psychiatry 2014; 75:678-85. [PMID: 24074637 DOI: 10.1016/j.biopsych.2013.08.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/25/2013] [Accepted: 08/05/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND N-methyl-D-aspartate receptor (NMDAR)-mediated neurotransmission is vital for learning and memory. Hypofunction of NMDAR has been reported to play a role in the pathophysiology of Alzheimer disease (AD), particularly in the early phase. Enhancing NMDAR activation might be a novel treatment approach. One of the methods to enhance NMDAR activity is to raise the levels of NMDA coagonists by blocking their metabolism. This study examined the efficacy and safety of sodium benzoate, a D-amino acid oxidase inhibitor, for the treatment of amnestic mild cognitive impairment and mild AD. METHODS We conducted a randomized, double-blind, placebo-controlled trial in four major medical centers in Taiwan. Sixty patients with amnestic mild cognitive impairment or mild AD were treated with 250-750 mg/day of sodium benzoate or placebo for 24 weeks. Alzheimer's Disease Assessment Scale-cognitive subscale (the primary outcome) and global function (assessed by Clinician Interview Based Impression of Change plus Caregiver Input) were measured every 8 weeks. Additional cognition composite was measured at baseline and endpoint. RESULTS Sodium benzoate produced a better improvement than placebo in Alzheimer's Disease Assessment Scale-cognitive subscale (p = .0021, .0116, and .0031 at week 16, week 24, and endpoint, respectively), additional cognition composite (p = .007 at endpoint) and Clinician Interview Based Impression of Change plus Caregiver Input (p = .015, .016, and .012 at week 16, week 24, and endpoint, respectively). Sodium benzoate was well-tolerated without evident side-effects. CONCLUSIONS Sodium benzoate substantially improved cognitive and overall functions in patients with early-phase AD. The preliminary results show promise for D-amino acid oxidase inhibition as a novel approach for early dementing processes.
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73
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Dew TP, Wang G, Williamson G. Urinary excretion of ginkgolide terpene lactones following acute consumption of Ginkgo biloba extract. Biofactors 2014; 40:268-74. [PMID: 24255015 DOI: 10.1002/biof.1151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/29/2013] [Indexed: 11/11/2022]
Abstract
Urinary biomarkers of plant food supplement (PFS) exposure/intake represent an accurate, objective tool for determining PFS consumption in humans with applications ranging from epidemiology to subject compliance in clinical trials. Ginkgo biloba remains one of the worlds most popular PFS, yet few studies have investigated the uptake and metabolism of its primary unique bioactives: the terpene lactones. To this end, we conducted a dual-dose, acute crossover intervention using G. biloba supplements in healthy participants (n = 12). Pooled 24-H urine samples were analyzed by triple quadrupole LC-MS-MS. We observed that bilobalide and ginkgolides A and B were passed into urine intact and in a dose-dependent manner. Low levels of intact ginkgolides C and J were also excreted. To our knowledge, this is the first study to report intact ginkgolide J in urine following oral consumption of ginkgo supplements and is also the first to account for excreted terpene lactones as a proportion of dose.
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Affiliation(s)
- Tristan P Dew
- School of Food Science and Nutrition, University of Leeds, Leeds, UK; Bradford School of Pharmacy, School of Life Sciences, University of Bradford, Bradford, UK
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74
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Franke AG, Heinrich I, Lieb K, Fellgiebel A. The use of Ginkgo biloba in healthy elderly. AGE (DORDRECHT, NETHERLANDS) 2014; 36:435-44. [PMID: 23736956 PMCID: PMC3889903 DOI: 10.1007/s11357-013-9550-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 05/23/2013] [Indexed: 06/02/2023]
Abstract
To promote health-conscious behavior in the aging society and gain insight into the sources of knowledge on which preventive strategies are based, analyzing the behavior of elderly people who are recognized as highly health conscious may be useful. We focused on the use of Ginkgo biloba, which is commonly considered to be effective in preventing cognitive decline and dementia, among elderly adults. A total of 1,672 questionnaires were distributed among geriatric participants (60-94 years) who attended university lectures at 22 universities throughout Germany. Response rate was 36.1 %. We collected data on demographic characteristics, preventive strategies (use of Ginkgo and other supplements), health-conscious behavior, sources of knowledge concerning health behavior, and factors associated with the participants' concept of aging. The prevalence of Ginkgo use was 15.3 %. Ginkgo was assumed to be effective for cognitive enhancement and the treatment of cognitive decline by two thirds of the surveyed participants and one third believed Ginkgo to be effective for preventing dementia. Ginkgo use was significantly higher among participants using natural remedies and herbal and food supplements. The use of Ginkgo was recommended by physicians (57.3 %), chemists (16 %), and healthcare magazines (10.7 %). Food supplements were taken by 65.8 % of the sample: this percentage was significantly higher among subjects who exhibited health-conscious behavior. "Knowledge" about strategies to enhance cognition or prevent cognitive decline among the elderly do not appear to be evidence based. Thus, there is a need to establish reliable and independent sources of scientific information for healthcare professionals and the general public.
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Affiliation(s)
- Andreas G Franke
- Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany,
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Abstract
BACKGROUND More people are presenting with mild cognitive impairment (MCI), frequently a precursor to dementia, but we do not know how to reduce deterioration. AIMS To systematically review randomised controlled trials (RCTs) evaluating the effects of any intervention for MCI on cognitive, neuropsychiatric, functional, global outcomes, life quality or incident dementia. METHOD We reviewed 41 studies fitting predetermined criteria, assessed validity using a checklist, calculated standardised outcomes and prioritised primary outcome findings in placebo-controlled studies. RESULTS The strongest evidence was that cholinesterase inhibitors did not reduce incident dementia. Cognition improved in single trials of: a heterogeneous psychological group intervention over 6 months; piribedil, a dopamine agonist over 3 months; and donepezil over 48 weeks. Nicotine improved attention over 6 months. There was equivocal evidence that Huannao Yicong improved cognition and social functioning. CONCLUSIONS There was no replicated evidence that any intervention was effective. Cholinesterase inhibitors and rofecoxib are ineffective in preventing dementia. Further good-quality RCTs are needed and preliminary evidence suggests these should include trials of psychological group interventions and piribedil.
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Affiliation(s)
- Claudia Cooper
- Mental Health Sciences Unit, University College London, Holborn Union Building, Highgate Hill, London N19 5LW, United Kingdom
| | - Ryan Li
- Mental Health Sciences Unit, University College London, Holborn Union Building, Highgate Hill, London N19 5LW, United Kingdom
| | - Constantine Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine and Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gill Livingston
- Mental Health Sciences Unit, University College London, Holborn Union Building, Highgate Hill, London N19 5LW, United Kingdom
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Gillette-Guyonnet S, Secher M, Vellas B. Nutrition and neurodegeneration: epidemiological evidence and challenges for future research. Br J Clin Pharmacol 2013; 75:738-55. [PMID: 23384081 DOI: 10.1111/bcp.12058] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 11/20/2012] [Indexed: 12/15/2022] Open
Abstract
The prevention of dementias, such as Alzheimer's disease (AD), is a growing public health concern, due to a lack of effective curative treatment options and a rising global prevalence. Various potential risk or preventive factors have been suggested by epidemiological research, including modifiable lifestyle factors such as diet. Current epidemiological data are in favour of a protective role of certain micronutrients (B vitamins related to homocysteine metabolism, the anti-oxidant vitamins C and E, flavonoids, polyunsatured omega-3 fatty acids, vitamin D) and macronutrients (fish) in the prevention of cognitive decline and dementia/AD. Some factors have been targeted by interventions tested in randomized controlled trials (RCTs), but many of the results are conflicting with observational evidence. Epidemiological analysis of the relations between nutrient consumption and cognitive decline is complex and it is highly unlikely that a single component plays a major role. In addition, since multiple factors across the life course influence brain function in late life, multidomain interventions might be more promising in the prevention of cognitive decline and dementia/AD. Designing such trials remains very challenging for researchers. The main objective of this paper is to review the epidemiologic data linking potential protective factors to cognitive decline or dementia/AD, focusing particularly on the roles of adiposity, caloric restriction, micro (group B vitamins related to homocysteine metabolism, the anti-oxidant vitamins C and E, flavonoids, polyunsatured omega-3 fatty acids, vitamin D) and macronutrients (fish). Limitations of the current data, divergence with results of interventional prevention studies and challenges for future research are discussed.
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Affiliation(s)
- Sophie Gillette-Guyonnet
- Gerontopole, Toulouse University Hospital, Department of Internal Medicine and Geriatrics, Purpan University Hospital, Toulouse F-31059, France.
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Mi XS, Zhong JX, Chang RCC, So KF. Research advances on the usage of traditional Chinese medicine for neuroprotection in glaucoma. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2013; 11:233-40. [DOI: 10.3736/jintegrmed2013037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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A Systematic Review and Meta-Analysis of Ginkgo biloba in Neuropsychiatric Disorders: From Ancient Tradition to Modern-Day Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:915691. [PMID: 23781271 PMCID: PMC3679686 DOI: 10.1155/2013/915691] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 02/25/2013] [Accepted: 03/24/2013] [Indexed: 11/18/2022]
Abstract
Ginkgo biloba (Gb) has demonstrated antioxidant and vasoactive properties as well as clinical benefits in several conditions such as ischemia, epilepsy, and peripheral nerve damage. Additionally, Gb is supposed to act as potential cognitive enhancer in dementia. So far, several trials have been conducted to investigate the potential effectiveness of Gb in neuropsychiatric conditions. However, the results of these studies remain controversial. We conducted a systematic review and a meta-analysis of three randomised controlled trials in patients with schizophrenia and eight randomised controlled trials in patients with dementia. Gb treatment reduced positive symptoms in patients with schizophrenia and improved cognitive function and activities of daily living in patients with dementia. No effect of Gb on negative symptoms in schizophrenic patients was found. The general lack of evidence prevents drawing conclusions regarding Gb effectiveness in other neuropsychiatric conditions (i.e., autism, depression, anxiety, attention-deficit hyperactivity disorder, and addiction). Our data support the use of Gb in patients with dementia and as an adjunctive therapy in schizophrenic patients.
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Ude C, Schubert-Zsilavecz M, Wurglics M. Ginkgo biloba Extracts: A Review of the Pharmacokinetics of the Active Ingredients. Clin Pharmacokinet 2013; 52:727-49. [DOI: 10.1007/s40262-013-0074-5] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jiang L, Su L, Cui H, Ren J, Li C. Ginkgo biloba extract for dementia: a systematic review. SHANGHAI ARCHIVES OF PSYCHIATRY 2013; 25:10-21. [PMID: 24991128 PMCID: PMC4054525 DOI: 10.3969/j.issn.1002-0829.2013.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Given the increasing burden of dementia internationally and the lack of effective treatments, several countries are already recommending the use of ginkgo biloba extract (GbE) in the treatment of dementia, despite the inconsistent research results about its effectiveness. AIM Conduct a meta-analysis of studies about the effect of GbE on cognition and daily functioning in persons with dementia. METHODS Searches of various English and Chinese databases identified reports of placebo controlled, randomized trials of ginkgo biloba treatment (lasting a minimum of 22 weeks) for dementia that were published from January 1982 to September 2012. Data extraction and critical appraisal of studies were conducted using the GRADE system. Heterogeneity, sensitivity and potential publication bias of the studies were evaluated using RevMan 5.1. Pooled results of the metaanalysis were presented as forest plots using standardized mean differences (SMD) in scores for continuous variables and relative risk (RR) for categorical variables. RESULTS Nine studies with a total of 2578 patients met the inclusion and exclusion criteria. Pooled results from the six studies that were included in the meta-analysis (total n=1917) found that GbE was superior to placebo in preventing deterioration in cognitive functioning and in activities of daily living, but these results were only valid for studies with younger subjects (with a mean age below 75). There were no significant differences in the dropout rates between groups or in the overall rates of adverse events during treatment. However, there was considerable heterogeneity in the results between the studies (primarily based on the age of the subjects) and there were several potential biases in the reports (most of which were supported by pharmaceutical firms), so the overall evidence was considered of 'low quality'. CONCLUSION This meta-analysis highlights serious weaknesses in the available studies about this important problem. GbE may be effective in persons under 75 years of age with dementia, but large, placebo controlled, randomized trials focused on milder forms of dementia (including mild cognitive impairment) that compare different doses of GbE and that follow subjects for prolonged periods (at least one year) are needed to confirm this result.
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Affiliation(s)
- Lijuan Jiang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijie Su
- Department of Emergency Medicine, Tongji Hospital of Tongji University, Shanghai, China
| | - Huiru Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanjuan Ren
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
BACKGROUND Ginkgo is used in the treatment of peripheral vascular disease and 'cerebral insufficiency'. It is thought to have several potential mechanisms of action including increased blood flow, platelet activating factor antagonism, and prevention of membrane damage caused by free radicals. Vascular factors and oxidative damage are thought to be two potential mechanisms in the pathology of age-related macular degeneration (AMD). OBJECTIVES The objective of this review was to determine the effect of Ginkgo biloba extract on the progression of AMD. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2012), EMBASE (January 1980 to October 2012), Allied and Complementary Medicine Database (AMED) (January 1985 to October 2012), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 5 October 2012. We searched the reference lists of identified reports and the Science Citation Index. We also contacted investigators of included studies for additional information. SELECTION CRITERIA All randomised trials in people with AMD where Ginkgo biloba extract had been compared to control were included. DATA COLLECTION AND ANALYSIS The review author extracted data using a standardised form. The data were verified with the trial investigators. Trial quality was assessed. MAIN RESULTS Two published trials were identified that randomised a total of 119 people. In one study conducted in France, 20 people were randomly allocated to Gingko biloba extract EGb 761 80 mg twice daily or placebo. In the other study conducted in Germany, 99 people were randomly allocated to two different doses of Ginkgo biloba extract EGb 761 (240 mg per day and 60 mg per day). Treatment duration in both studies was six months. Both trials reported some positive effects of Ginkgo biloba on vision however their results could not be pooled. Adverse effects and quality of life for people with AMD were not reported. AUTHORS' CONCLUSIONS The question as to whether people with AMD should take Ginkgo biloba extract to prevent progression of the disease has not been answered by research to date. Two small trials have suggested possible benefit of Gingko biloba on vision and further trials are warranted. Ginkgo biloba is widely used in China, Germany, and France. Future trials should be larger, and last longer, in order to provide a more robust measure of the effect of Gingko biloba extract on AMD.
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Affiliation(s)
- Jennifer R Evans
- Cochrane Eyes and Vision Group, ICEH, London School of Hygiene & Tropical Medicine, London, UK.
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Chan ESY, Bautista D, You Y, Long JT, Ling L, Li W, Chen C. Traditional Chinese herbal medicine for vascular dementia. Hippokratia 2013. [DOI: 10.1002/14651858.cd010284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Edwin SY Chan
- Office of Clinical Sciences, Duke-NUS Graduate Medical School; Centre for Quantitative Medicine; Nanos Building #02-01 31 Biopolis Way Singapore Singapore 138669
| | - Dianne Bautista
- Singapore Clinical Research Institute; Epidemiology; 31 Biopolis Way, Nanos #02-01 Singapore Singapore 138669
| | - Yong You
- First Affiliated Hospital of Nanhua University; Neurology; 69 Chan Shuan Road Hengyang Hunan China 421001
| | - Jian Ting Long
- 1st Affiliated Hospital, Nanhua University; Department of Neurology; Nanhua China
| | - Lu Ling
- 1st Affiliated Hospital, Nanhua University; Department of Neurology; Nanhua China
| | - Wenyun Li
- Office of Clinical Sciences, Duke-NUS Graduate Medical School; Centre for Quantitative Medicine,; Singapore Singapore
| | - Christopher Chen
- Yong Loo Lin School of Medicine, National University of Singapore; Department of Pharmacology; Clinical Research Center Bldng MD11, Level 5 10 Medical Drive Singapore Singapore 117597
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83
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Karakaya T, Fußer F, Schröder J, Pantel J. Pharmacological Treatment of Mild Cognitive Impairment as a Prodromal Syndrome of Alzheimer´s Disease. Curr Neuropharmacol 2013; 11:102-8. [PMID: 23814542 PMCID: PMC3580783 DOI: 10.2174/157015913804999487] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 07/24/2012] [Accepted: 08/06/2012] [Indexed: 01/08/2023] Open
Abstract
Mild cognitive impairment (MCI) is a syndrome which, depending on various neurobiological, psychological and social factors, carries a high risk of developing into dementia. As far as diagnostic uncertainty and the heterogeneous underlying pathophysiological mechanisms are concerned, only limited therapeutic options are currently available. Clinical trials involving a wide range of substances have failed to show efficacy on primary and secondary outcome parameters. Most results reflect not only a lack of effectiveness of drug therapy but also methodological constraints in true prodromal Alzheimer´s disease (AD) based on clinical criteria. Biomarkers may help to identify MCI as a prodromal phase of dementia, so it is important to use them to improve specificity of case selection in future studies. For MCI as a prodromal syndrome of AD, clinical trials with disease modifying drugs that target underlying pathological mechanisms such as amyloid-beta accumulation and neurofibrillary tangle formation may help develop effective treatment options in the future. Alternative pharmacological approaches are currently being evaluated in ongoing phase 1 and phase 2 studies. Nevertheless, a lack of approved pharmacotherapeutic options has led to specific interventions that focus on patient education and life-style related factors receiving increasing attention.
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Affiliation(s)
- Tarik Karakaya
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Frankfurt am Main, Germany
| | - Fabian Fußer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe-University, Frankfurt am Main, Germany
| | - Johannes Schröder
- Department of Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Johannes Pantel
- Institute of General Practice, Geriatric Medicine, Goethe-University, Frankfurt am Main, Germany
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Pharmacological Neuroenhancement: Substances and Epidemiology. TRENDS IN AUGMENTATION OF HUMAN PERFORMANCE 2013. [DOI: 10.1007/978-94-007-6253-4_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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de Oliveira MA, Francisco PMSB, Costa KS, Barros MBDA. [Self-medication in the elderly population of Campinas, São Paulo State, Brazil: prevalence and associated factors]. CAD SAUDE PUBLICA 2012; 28:335-45. [PMID: 22331159 DOI: 10.1590/s0102-311x2012000200012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/03/2011] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the prevalence and causative factors associated with self-medication in the elderly and identify the main drugs consumed without prescription. A cross-sectional population-based study with stratified clustered two-stage sampling was performed in Campinas, São Paulo, Brazil in 2008 and 2009. Of the 1,515 elderly studied, 80.4% reported using at least one drug during the three days preceding the survey. Of these, 91.1% reported the use of prescription drugs only and the remainder (8.9%) reported simultaneous use of prescribed and non prescribed drugs. After adjustment, a negative association between age ≥ 80 years, hypertension, chronic diseases, use of health services, dental consultations and adherence to a medical plan,and self-medication was found, whereas a positive association was found with per capita income. Dipyrone, acetylsalicylic acid, diclofenac, Ginkgo biloba, paracetamol and homeopathic medicines were among the most used non-prescribed drugs. Pharmaceutical assistance should be provided as a priority to the elderly, to avoid the misuse of medicines and ensure access to the correct drugs.
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Blonk M, Colbers A, Poirters A, Schouwenberg B, Burger D. Effect of ginkgo biloba on the pharmacokinetics of raltegravir in healthy volunteers. Antimicrob Agents Chemother 2012; 56:5070-5. [PMID: 22802250 PMCID: PMC3457394 DOI: 10.1128/aac.00672-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/07/2012] [Indexed: 01/11/2023] Open
Abstract
Medicinal herbs may cause clinically relevant drug interactions with antiretroviral agents. Ginkgo biloba extract is a popular herbal product among HIV-infected patients because of its positive effects on cognitive function. Raltegravir, an HIV integrase inhibitor, is increasingly being used as part of combined antiretroviral therapy. Clinical data on the potential inhibitory or inductive effect of ginkgo biloba on the pharmacokinetics of raltegravir were lacking, and concomitant use was not recommended. We studied the effect of ginkgo biloba extract on the pharmacokinetics of raltegravir in an open-label, randomized, two-period, crossover phase I trial in 18 healthy volunteers. Subjects were randomly assigned to a regimen of 120 mg of ginkgo biloba twice daily for 15 days plus a single dose of raltegravir (400 mg) on day 15, a washout period, and 400 mg of raltegravir on day 36 or the test and reference treatments in reverse order. Pharmacokinetic sampling of raltegravir was performed up to 12 h after intake on an empty stomach. All subjects (9 male) completed the trial, and no serious adverse events were reported. Geometric mean ratios (90% confidence intervals) of the area under the plasma concentration-time curve from dosing to infinity (AUC(0-∞)) and the maximum plasma concentration (C(max)) of raltegravir with ginkgo biloba versus raltegravir alone were 1.21 (0.93 to 1.58) and 1.44 (1.03 to 2.02). Ginkgo biloba did not reduce raltegravir exposure. The potential increase in the C(max) of raltegravir is probably of minor importance, given the large intersubject variability of raltegravir pharmacokinetics and its reported safety profile.
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Affiliation(s)
- Maren Blonk
- Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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87
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Lovera JF, Kim E, Heriza E, Fitzpatrick M, Hunziker J, Turner AP, Adams J, Stover T, Sangeorzan A, Sloan A, Howieson D, Wild K, Haselkorn J, Bourdette D. Ginkgo biloba does not improve cognitive function in MS: a randomized placebo-controlled trial. Neurology 2012; 79:1278-84. [PMID: 22955125 PMCID: PMC3440446 DOI: 10.1212/wnl.0b013e31826aac60] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 05/01/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether Ginkgo biloba extract (ginkgo) improves cognitive function in persons with multiple sclerosis (MS). METHODS Persons with MS from the Seattle and Portland VA clinics and adjacent communities who scored 1 SD or more below the mean on one of 4 neuropsychological tests (Stroop Test, California Verbal Learning Test II [CVLT-II], Controlled Oral Word Association Test [COWAT], and Paced Auditory Serial Addition Task [PASAT]) were randomly assigned to receive either one 120-mg tablet of ginkgo (EGb-761; Willmar Schwabe GmbH & Co, Germany) or one placebo tablet twice a day for 12 weeks. As the primary outcome, we compared the performance of the 2 groups on the 4 tests at exit after adjusting for baseline performance. RESULTS Fifty-nine subjects received placebo and 61 received ginkgo; 1 participant receiving placebo and 3 receiving ginkgo were lost to follow-up. Two serious adverse events (AEs) (myocardial infarction and severe depression) believed to be unrelated to the treatment occurred in the ginkgo group; otherwise, there were no significant differences in AEs. The differences (ginkgo - placebo) at exit in the z scores for the cognitive tests were as follows: PASAT -0.2 (95% confidence interval [CI] -0.5 to 0.1); Stroop Test -0.5 (95% CI -0.9 to -0.1); COWAT 0.0 (95% CI -0.2 to 0.3); and CVLT-II 0.0 (95% CI -0.3 to 0.3); none was statistically significant. CONCLUSIONS Treatment with ginkgo 120 mg twice a day did not improve cognitive performance in persons with MS. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that treatment with ginkgo 120 mg twice a day for 12 weeks does not improve cognitive performance in people with MS.
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Affiliation(s)
- Jesus F Lovera
- Department of Neurology, Louisiana State University Health Sciences Center, New Orleans, USA.
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88
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Affiliation(s)
- Lon S Schneider
- Department of Psychiatry, California Alzheimer's Disease Center, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA.
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89
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Affiliation(s)
- Richard W Weber
- National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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90
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The role of inflammatory processes in Alzheimer's disease. Inflammopharmacology 2012; 20:109-26. [PMID: 22535513 DOI: 10.1007/s10787-012-0130-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Accepted: 03/05/2012] [Indexed: 02/07/2023]
Abstract
It has become increasingly clear that inflammatory processes play a significant role in the pathophysiology of Alzheimer's disease (AD). Neuroinflammation is characterized by the activation of astrocytes and microglia and the release of proinflammatory cytokines and chemokines. Vascular inflammation, mediated largely by the products of endothelial activation, is accompanied by the production and the release of a host of inflammatory factors which contribute to vascular, immune, and neuronal dysfunction. The complex interaction of these processes is still only imperfectly understood, yet as the mechanisms continue to be elucidated, targets for intervention are revealed. Although many of the studies to date on therapeutic or preventative strategies for AD have been narrowly focused on single target therapies, there is accumulating evidence to suggest that the most successful treatment strategy will likely incorporate a sequential, multifactorial approach, addressing direct neuronal support, general cardiovascular health, and interruption of deleterious inflammatory pathways.
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Abstract
Vitamin supplements are commonly consumed by elderly patients. This article reviews the evidence behind vitamin supplementation in preventing disease states common in older age, with an emphasis on randomized controlled trials. In addition to vitamins, some commonly used supplements, such as ginkgo, DHEA, and omega-3 fatty acids, are also discussed.
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Affiliation(s)
- Robert Skully
- Grant Medical Center Geriatric Fellowship Program, 285 East State Street, Columbus, OH 43215, USA.
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92
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Abstract
Advancing age is a major risk factor for cognitive impairment and dementia. Currently, there are no effective preventive strategies for cognitive decline. Since physicians have no drug therapies to offer, patients and families may turn to complementary and alternative medicine to preserve cognition. Dietary supplements are one of the most common forms of complementary and alternative medicine that patients use and although limited, evidence for their potential interactions with other treatments has been documented. Considering the insufficient evidence for their efficacy, potential for interaction with other therapies and costs to patients, physicians should be aware of the use of dietary supplements among their patients so that they can advise their patients on the potential benefits and harms.
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Affiliation(s)
- MK Gestuvo
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - WW Hung
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY, USA
- Geriatric Research, Education and Clinical Center, James J Peters VA Medical Center, Bronx, NY, USA
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Roland PD, Nergård C. Ginkgo biloba - effekt, bivirkninger og interaksjoner. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:956-9. [DOI: 10.4045/tidsskr.11.0780] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Hu J, Zhang J, Zhao W, Zhang Y, Zhang L, Shang H. Cochrane systematic reviews of Chinese herbal medicines: an overview. PLoS One 2011; 6:e28696. [PMID: 22174870 PMCID: PMC3235143 DOI: 10.1371/journal.pone.0028696] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 11/14/2011] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES our study had two objectives: a) to systematically identify all existing systematic reviews of Chinese herbal medicines (CHM) published in Cochrane Library; b) to assess the methodological quality of included reviews. METHODOLOGY/PRINCIPAL FINDINGS We performed a systematic search of the Cochrane Database of Systematic Reviews (CDSR, Issue 5, 2010) to identify all reviews of CHM. A total of fifty-eight reviews were eligible for our study. Twenty-one of the included reviews had at least one Traditional Chinese Medicine (TCM) practitioner as its co-author. 7 reviews didn't include any primary study, the remaining reviews (n = 51) included a median of 9 studies and 936 participants. 50% of reviews were last assessed as up-to-date prior to 2008. The questions addressed by 39 reviews were broad in scope, in which 9 reviews combined studies with different herbal medicines. For OQAQ, the mean of overall quality score (item 10) was 5.05 (95% CI; 4.58-5.52). All reviews assessed the methodological quality of primary studies, 16% of included primary studies used adequate sequence generation and 7% used adequate allocation concealment. Of the 51 nonempty reviews, 23 reviews were reported as being inconclusive, while 27 concluded that there might be benefit of CHM, which was limited by the poor quality or inadequate quantity of included studies. 58 reviews reported searching a median of seven electronic databases, while 10 reviews did not search any Chinese database. CONCLUSIONS Now CDSR has included large numbers of CHM reviews, our study identified some areas which could be improved, such as almost half of included reviews did not have the participation of TCM practitioners and were not up-to-date according to Cochrane criteria, some reviews pooled the results of different herbal medicines and ignored the searching of Chinese databases.
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Affiliation(s)
- Jing Hu
- Research Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Junhua Zhang
- Research Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wei Zhao
- Research Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yongling Zhang
- Research Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Li Zhang
- Research Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongcai Shang
- Research Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Lang D, Kiewert C, Mdzinarishvili A, Schwarzkopf TM, Sumbria R, Hartmann J, Klein J. Neuroprotective effects of bilobalide are accompanied by a reduction of ischemia-induced glutamate release in vivo. Brain Res 2011; 1425:155-63. [PMID: 22032877 PMCID: PMC3217178 DOI: 10.1016/j.brainres.2011.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 09/28/2011] [Accepted: 10/03/2011] [Indexed: 11/23/2022]
Abstract
Neuroprotective properties of bilobalide, a specific constituent of Ginkgo extracts, were tested in a mouse model of stroke. After 24h of middle cerebral artery occlusion (MCAO), bilobalide reduced infarct areas in the core region (striatum) by 40-50% when given at 10mg/kg 1h prior to MCAO. Neuroprotection was also observed at lower doses, or when the drug was given 1h past stroke induction. Sensorimotor function in mice was improved by bilobalide as shown by corner and chimney tests. When brain metabolism in situ was monitored by microdialysis, MCAO caused a rapid disappearance of extracellular glucose in the striatum which returned to baseline levels after reperfusion. Extracellular levels of glutamate were increased by more than ten-fold in striatal tissue, and by four- to fivefold in hippocampal tissue (penumbra). Bilobalide did not affect glucose levels but strongly attenuated glutamate release in both core and penumbra regions. Bilobalide was equally active when given locally via the microdialysis probe and also reduced ischemia-induced glutamate release in vitro in brain slices. We conclude that bilobalide is a strong neuroprotectant in vivo at doses that can be used therapeutically in humans. The mechanism of action evidently involves reduction of glutamate release, thereby reducing excitotoxicity.
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Affiliation(s)
- Dorothee Lang
- Department of Pharmacology, College of Pharmacy, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438 Frankfurt, Germany
| | - Cornelia Kiewert
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Science Center, 1300 Coulter Dr, Amarillo, TX 79106, USA
| | - Alexander Mdzinarishvili
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Science Center, 1300 Coulter Dr, Amarillo, TX 79106, USA
- Department of Pharmaceutical Sciences, Northeastern Ohio University School of Pharmacy, 4209 State Road 44, Rootstown, OH 44272, USA
| | - Tina Maria Schwarzkopf
- Department of Pharmacology, College of Pharmacy, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438 Frankfurt, Germany
| | - Rachita Sumbria
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Science Center, 1300 Coulter Dr, Amarillo, TX 79106, USA
| | - Joachim Hartmann
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Science Center, 1300 Coulter Dr, Amarillo, TX 79106, USA
| | - Jochen Klein
- Department of Pharmacology, College of Pharmacy, Goethe University Frankfurt, Max-von-Laue-Str. 9, 60438 Frankfurt, Germany
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Science Center, 1300 Coulter Dr, Amarillo, TX 79106, USA
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do Vale FDAC, Corrêa Neto Y, Bertolucci PHF, Machado JCB, da Silva DJ, Allam N, Balthazar MLF. Treatment of Alzheimer's disease in Brazil: I. Cognitive disorders. Dement Neuropsychol 2011; 5:178-188. [PMID: 29213742 PMCID: PMC5619477 DOI: 10.1590/s1980-57642011dn05030005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article reports the recommendations of the Scientific Department of
Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the
treatment of Alzheimer’s disease (AD) in Brazil, with special focus on cognitive
disorders. It constitutes a revision and broadening of the 2005 guidelines based
on a consensus involving researchers (physicians and non-physicians) in the
field. The authors carried out a search of articles published since 2005 on the
MEDLINE, LILACS and Cochrane Library databases. The search criteria were
pharmacological and non-pharmacological treatment of cognitive disorders in AD.
Studies retrieved were categorized into four classes, and evidence into four
levels, based on the 2008 recommendations of the American Academy of Neurology.
The recommendations on therapy are pertinent to the dementia phase of AD.
Recommendations are proposed for the treatment of cognitive disorders
encompassing both pharmacological (including acetyl-cholinesterase inhibitors,
memantine and other drugs and substances) and non-pharmacological (including
cognitive rehabilitation, physical activity, occupational therapy, and music
therapy) approaches. Recommendations for the treatment of behavioral and
psychological symptoms of dementia due to Alzheimer’s disease are included in a
separate article of this edition.
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Affiliation(s)
| | - Ylmar Corrêa Neto
- Federal University of Santa Catarina (UFSC), Department of Internal Medicine, Florianópolis SC, Brazil
| | | | - João Carlos Barbosa Machado
- Aurus IEPE - Institute of Research and Education on Aging of Belo Horizonte; Faculty of Medical Sciences of Minas Gerais (FCMMG), Department of Geriatric Medicine of Hospital Mater Dei, Belo Horizonte MG, Brazil
| | - Delson José da Silva
- Neurosciences Center of Hospital das Clinicas of the Federal University of Goiás (UFG). Integrated Institute of Neurosciences (IINEURO), Goiânia GO, Brazil
| | - Nasser Allam
- University of Brasilia (UnB), Laboratory of Neurosciences and Behavior, Brasília DF, Brazil
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Janssen IM, Sturtz S, Skipka G, Zentner A, Velasco Garrido M, Garrido MV, Busse R. Ginkgo biloba in Alzheimer's disease: a systematic review. Wien Med Wochenschr 2011; 160:539-46. [PMID: 21170694 DOI: 10.1007/s10354-010-0844-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 10/11/2010] [Indexed: 11/28/2022]
Abstract
This systematic review determines the benefit of treatment with Ginkgo biloba (Ginkgo) in Alzheimer's disease (AD) concerning patient-relevant outcomes. Bibliographic databases, clinical trial and study result registries were searched for randomized controlled trials (RCTs) in patients with AD (follow-up ≥16 weeks) comparing Ginkgo to placebo or a different treatment option. Manufacturers were asked to provide unpublished data. If feasible, data were pooled by meta-analysis. Six studies were eligible; overall, high heterogeneity was shown for most outcomes, except safety aspects. Among studies administering high-dose Ginkgo (240 mg), all studies favour treatment though effects remain heterogeneous. In this subgroup, a benefit of Ginkgo exists for activities of daily living. Cognition and accompanying psychopathological symptoms show an indication of a benefit. A harm of Ginkgo is not evident. An estimation of the effect size was not possible for any outcome. Further evidence is needed which focuses especially on subgroups of AD patients.
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Affiliation(s)
- Inger M Janssen
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
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Abstract
Drugs currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of Alzheimer's disease include acetylcholinesterase inhibitor drugs (tacrine [Cognex®], donepezil [Aricept®], rivastigmine [Exelon®, Exelon Patch®], and galantamine [Reminyl®, Razadyne®]) and glutamate-modulating drugs (memantine [Namenda®]). They do not halt the underlying degenerative process but can slow disease progression. Piracetam is a nonprescription noot ropic drug designated by the FDA as an orphan drug for myoclonic seizures. Clinical trials in a diverse group of patients with age-related dementia or cognitive impairment demonstrated a significant benefit, but the methodology of these studies is poor, and long-term effects are unknown. Other therapies discussed in this article include Ginkgo biloba, a nonprescription natural supplement, and Axona", designated by the FDA as a medical food.
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Affiliation(s)
- Robert H Howland
- Psychiatry, University of Pittburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA.
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Ho YS, So KF, Chang RCC. Drug discovery from Chinese medicine against neurodegeneration in Alzheimer's and vascular dementia. Chin Med 2011; 6:15. [PMID: 21513513 PMCID: PMC3097009 DOI: 10.1186/1749-8546-6-15] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 04/22/2011] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease and vascular dementia are two major diseases associated with dementia, which is common among the elderly. While the etiology of dementia is multi-factorial and complex, neurodegeneration may be the major cause of these two diseases. Effective drugs for treating dementia are still to be discovered. Current western pharmacological approaches against neurodegeneration in dementia develop symptom-relieving and disease-modifying drugs. Current integrative and holistic approaches of Chinese medicine to discovering drugs for neurodegeneration in dementia include (1) single molecules from the herbs, (2) standardized extracts from a single herb, and (3) herbal formula with definite composition. This article not only reviews the concept of dementia in western medicine and Chinese medicine but also evaluates the advantages and disadvantages of these approaches.
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Affiliation(s)
- Yuen-Shan Ho
- Laboratory of Neurodegenerative Diseases, Department of Anatomy, The University of Hong Kong Pokfulam, Hong Kong SAR, China.
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Jacobson SA, Sabbagh MN. Investigational drugs for the treatment of AD: what can we learn from negative trials? ALZHEIMERS RESEARCH & THERAPY 2011; 3:14. [PMID: 21539725 PMCID: PMC3226276 DOI: 10.1186/alzrt73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Given the level of interest and activity in the race to find a treatment for Alzheimer's disease, it is expected that a reasonably safe and effective drug will be identified within the next decade. It may be worthwhile to pause periodically during the course of this race to take stock of what we have learned. Over the past few years, a number of trials have been conducted with promising new compounds (including some with novel mechanisms of action) that failed to meet primary endpoints and so were discontinued from clinical development. This article reviews a set of molecules with a range of mechanisms that have been trialed but with negative results. This article also examines the reasons for the negative findings and summarizes some of what we have learned from these experiences.
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Affiliation(s)
- Sandra A Jacobson
- The Cleo Roberts Center for Clinical Research, Banner Sun Health Research Institute, 10515 W, Santa Fe Drive, Sun City, AZ 85351, USA.
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