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Yang Y, Wang Z, Hu Q, Liu L, Ma G, Yang C. Enhancing the clinical value of single-phase computed tomography angiography in the assessment of collateral circulation in acute ischemic stroke: A narrative review. Brain Circ 2024; 10:35-41. [PMID: 38655435 PMCID: PMC11034444 DOI: 10.4103/bc.bc_54_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 04/26/2024] Open
Abstract
Acute ischemic stroke (AIS) condition assessment and clinical prognosis are significantly influenced by the compensatory state of cerebral collateral circulation. A standard clinical test known as single-phase computed tomography angiography (sCTA) is useful for quickly and accurately assessing the creation or opening of cerebral collateral circulation, which is crucial for the diagnosis and treatment of AIS. To improve the clinical application of sCTA in the clinical assessment of collateral circulation, we examine the present use of sCTA in AIS in this work.
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Affiliation(s)
- Yunqiu Yang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Intelligent Equipment Research Center, Zhuhai Institutes of Advanced Technology,Chinese Academy of Sciences, Zhuhai,Guangdong Province, China
| | - Zhen Wang
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Intelligent Equipment Research Center, Zhuhai Institutes of Advanced Technology,Chinese Academy of Sciences, Zhuhai,Guangdong Province, China
| | - Qingmao Hu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Libo Liu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Guorui Ma
- Intelligent Equipment Research Center, Zhuhai Institutes of Advanced Technology,Chinese Academy of Sciences, Zhuhai,Guangdong Province, China
| | - Chen Yang
- Obstetric Ward Center, Shenzhen Futian District Maternity & Child Healthcare Hospital,Shenzhen, China
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MacLean MA, Muradov JH, Greene R, Van Hameren G, Clarke DB, Dreier JP, Okonkwo DO, Friedman A. Memantine inhibits cortical spreading depolarization and improves neurovascular function following repetitive traumatic brain injury. SCIENCE ADVANCES 2023; 9:eadj2417. [PMID: 38091390 PMCID: PMC10848720 DOI: 10.1126/sciadv.adj2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023]
Abstract
Cortical spreading depolarization (CSD) is a promising target for neuroprotective therapy in traumatic brain injury (TBI). We explored the effect of NMDA receptor antagonism on electrically triggered CSDs in healthy and brain-injured animals. Rats received either one moderate or four daily repetitive mild closed head impacts (rmTBI). Ninety-three animals underwent craniectomy with electrocorticographic (ECoG) and local blood flow monitoring. In brain-injured animals, ketamine or memantine inhibited CSDs in 44 to 88% and 50 to 67% of cases, respectively. Near-DC/AC-ECoG amplitude was reduced by 44 to 75% and 52 to 67%, and duration by 39 to 87% and 61 to 78%, respectively. Daily memantine significantly reduced spreading depression and oligemia following CSD. Animals (N = 31) were randomized to either memantine (10 mg/kg) or saline with daily neurobehavioral testing. Memantine-treated animals had higher neurological scores. We demonstrate that memantine improved neurovascular function following CSD in sham and brain-injured animals. Memantine also prevented neurological decline in a blinded, preclinical randomized rmTBI trial.
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Affiliation(s)
- Mark A. MacLean
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Jamil H. Muradov
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Ryan Greene
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Gerben Van Hameren
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - David B. Clarke
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Jens P. Dreier
- Center for Stroke Research Berlin, Charite University, Berlin, Germany
| | - David O. Okonkwo
- Division of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alon Friedman
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
- Departments of Brain and Cognitive Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Butters E, Srinivasan S, O'Brien JT, Su L, Bale G. A promising tool to explore functional impairment in neurodegeneration: A systematic review of near-infrared spectroscopy in dementia. Ageing Res Rev 2023; 90:101992. [PMID: 37356550 DOI: 10.1016/j.arr.2023.101992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 06/27/2023]
Abstract
This systematic review aimed to evaluate previous studies which used near-infrared spectroscopy (NIRS) in dementia given its suitability as a diagnostic and investigative tool in this population. From 800 identified records which used NIRS in dementia and prodromal stages, 88 studies were evaluated which employed a range of tasks testing memory (29), word retrieval (24), motor (8) and visuo-spatial function (4), and which explored the resting state (32). Across these domains, dementia exhibited blunted haemodynamic responses, often localised to frontal regions of interest, and a lack of task-appropriate frontal lateralisation. Prodromal stages, such as mild cognitive impairment, revealed mixed results. Reduced cognitive performance accompanied by either diminished functional responses or hyperactivity was identified, the latter suggesting a compensatory response not present at the dementia stage. Despite clear evidence of alterations in brain oxygenation in dementia and prodromal stages, a consensus as to the nature of these changes is difficult to reach. This is likely partially due to the lack of standardisation in optical techniques and processing methods for the application of NIRS to dementia. Further studies are required exploring more naturalistic settings and a wider range of dementia subtypes.
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Affiliation(s)
- Emilia Butters
- Department of Electrical Engineering, University of Cambridge, 9 JJ Thomson Avenue, Cambridge CB3 0FA, UK; Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Sruthi Srinivasan
- Department of Electrical Engineering, University of Cambridge, 9 JJ Thomson Avenue, Cambridge CB3 0FA, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Li Su
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK; Department of Neuroscience, University of Sheffield, 385a Glossop Rd, Broomhall, Sheffield S10 2HQ, UK
| | - Gemma Bale
- Department of Physics, University of Cambridge, 19 JJ Thomson Avenue, Cambridge CB3 0FA, UK
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Srinivasan S, Butters E, Collins-Jones L, Su L, O’Brien J, Bale G. Illuminating neurodegeneration: a future perspective on near-infrared spectroscopy in dementia research. NEUROPHOTONICS 2023; 10:023514. [PMID: 36788803 PMCID: PMC9917719 DOI: 10.1117/1.nph.10.2.023514] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
SIGNIFICANCE Dementia presents a global healthcare crisis, and neuroimaging is the main method for developing effective diagnoses and treatments. Yet currently, there is a lack of sensitive, portable, and low-cost neuroimaging tools. As dementia is associated with vascular and metabolic dysfunction, near-infrared spectroscopy (NIRS) has the potential to fill this gap. AIM This future perspective aims to briefly review the use of NIRS in dementia to date and identify the challenges involved in realizing the full impact of NIRS for dementia research, including device development, study design, and data analysis approaches. APPROACH We briefly appraised the current literature to assess the challenges, giving a critical analysis of the methods used. To assess the sensitivity of different NIRS device configurations to the brain with atrophy (as is common in most forms of dementia), we performed an optical modeling analysis to compare their cortical sensitivity. RESULTS The first NIRS dementia study was published in 1996, and the number of studies has increased over time. In general, these studies identified diminished hemodynamic responses in the frontal lobe and altered functional connectivity in dementia. Our analysis showed that traditional (low-density) NIRS arrays are sensitive to the brain with atrophy (although we see a mean decrease of 22% in the relative brain sensitivity with respect to the healthy brain), but there is a significant improvement (a factor of 50 sensitivity increase) with high-density arrays. CONCLUSIONS NIRS has a bright future in dementia research. Advances in technology - high-density devices and intelligent data analysis-will allow new, naturalistic task designs that may have more clinical relevance and increased reproducibility for longitudinal studies. The portable and low-cost nature of NIRS provides the potential for use in clinical and screening tests.
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Affiliation(s)
- Sruthi Srinivasan
- University of Cambridge, Department of Engineering, Electrical Engineering, Cambridge, United Kingdom
| | - Emilia Butters
- University of Cambridge, Department of Engineering, Electrical Engineering, Cambridge, United Kingdom
- University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom
| | - Liam Collins-Jones
- University College London, Department of Medical Physics, London, United Kingdom
| | - Li Su
- University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom
- University of Sheffield, Department of Neuroscience, Sheffield, United Kingdom
| | - John O’Brien
- University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom
| | - Gemma Bale
- University of Cambridge, Department of Engineering, Electrical Engineering, Cambridge, United Kingdom
- University of Cambridge, Department of Physics, Cambridge, United Kingdom
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Abstract
IMPORTANCE Alzheimer's disease (AD) is a complex neurodegenerative disorder and the most prevalent cause of dementia. In spite of the urgent need for more effective AD drug therapy strategies, evidence of the efficacy of combination therapy with existing drugs remains unclear. OBJECTIVE To assess the efficacy of combined drug therapy on cognition and progress in patients with AD in comparison to single agent drug therapy. METHODS The electronic databases MEDLINE and EMBASE were systematically searched to identify relevant publications. Only randomized controlled clinical trials were included, but no limits were applied to language or time published. Data were extracted from May 27th until December 29th, 2020. RESULTS Three trials found that a combination of ChEI with additional memantine provides a slight benefit for patients with moderate to severe AD over ChEI monotherapy and placebo. However, a further 4 trials could not replicate this effect. One trial reported benefits of add-on Gingko biloba in donepezil-treated patients with moderate AD (using a formula containing Gingko and other antioxidants) compared to donepezil with placebo. A further trial found no significant effect of combining EGb 761® and donepezil in patients with probable AD over donepezil with placebo. Approaches with idalopirdine, atorvastatin or vitamin supplementation in combination with ChEI have not proven effective and have not been retried since. Fluoxetine and ST101 have shown partial benefits in combination with ChEI over ChEI monotherapy and placebo. However, these effects must be replicated by further research. CONCLUSION Additional memantine in combination with ChEI might be of slight benefit in patients with moderate to severe AD, but evidence is ambiguous. Longer trials are needed. No major cognitive benefit is missed, if solely appropriate ChEI monotherapy is initiated.
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Affiliation(s)
- Adrian L. Knorz
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Campus Benjamin Franklin, Berlin, Germany,Adrian L. Knorz, Charité-Universitätsmedizin Campus Benjamin Franklin, Hindenburgdamm 30, Berlin 12200, Germany.
| | - Arnim Quante
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Campus Benjamin Franklin, Berlin, Germany,Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh Klinik, Berlin, Germany
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Marcolini S, Frentz I, Sanchez-Catasus CA, Mondragon JD, Feltes PK, van der Hoorn A, Borra RJ, Ikram MA, Dierckx RA, De Deyn PP. Effects of interventions on cerebral perfusion in the Alzheimer's disease spectrum: A systematic review. Ageing Res Rev 2022; 79:101661. [PMID: 35671869 DOI: 10.1016/j.arr.2022.101661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/22/2022] [Accepted: 05/31/2022] [Indexed: 11/01/2022]
Abstract
Cerebral perfusion dysfunctions are seen in the early stages of Alzheimer's disease (AD). We systematically reviewed the literature to investigate the effect of pharmacological and non-pharmacological interventions on cerebral hemodynamics in randomized controlled trials involving AD patients or Mild Cognitive Impairment (MCI) due to AD. Studies involving other dementia types were excluded. Data was searched in April 2021 on MEDLINE, Embase, and Web of Science. Risk of bias was assessed using Cochrane Risk of Bias Tool. A meta-synthesis was performed separating results from MCI and AD studies. 31 studies were included and involved 310 MCI and 792 CE patients. The MCI studies (n = 8) included physical, cognitive, dietary, and pharmacological interventions. The AD studies (n = 23) included pharmacological, physical interventions, and phytotherapy. Cerebral perfusion was assessed with PET, ASL, Doppler, fNIRS, DSC-MRI, Xe-CT, and SPECT. Randomization and allocation concealment methods and subject characteristics such as AD-onset, education, and ethnicity were missing in several papers. Positive effects on hemodynamics were seen in 75 % of the MCI studies, and 52 % of the AD studies. Inserting cerebral perfusion outcome measures, together with established AD biomarkers, is fundamental to target all disease mechanisms and understand the role of cerebral perfusion in AD.
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Du C, Hua Y, Clare K, Park K, Allen CP, Volkow ND, Hu XT, Pan Y. Memantine Attenuates Cocaine and neuroHIV Neurotoxicity in the Medial Prefrontal Cortex. Front Pharmacol 2022; 13:895006. [PMID: 35694269 PMCID: PMC9174902 DOI: 10.3389/fphar.2022.895006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Individuals with substance use disorder are at a higher risk of contracting HIV and progress more rapidly to AIDS as drugs of abuse, such as cocaine, potentiate the neurotoxic effects of HIV-associated proteins including, but not limited to, HIV-1 trans-activator of transcription (Tat) and the envelope protein Gp120. Neurotoxicity and neurodegeneration are hallmarks of HIV-1-associated neurocognitive disorders (HANDs), which are hypothesized to occur secondary to excitotoxicity from NMDA-induced neuronal calcium dysregulation, which could be targeted with NMDA antagonist drugs. Multiple studies have examined how Gp120 affects calcium influx and how cocaine potentiates this influx; however, they mostly focused on single cells and did not analyze effects in neuronal and vascular brain networks. Here, we utilize a custom multi-wavelength imaging platform to simultaneously study the neuronal activity (detected using genetically encoded Ca2+ indicator, GcaMP6f, expressed in neurons) and hemodynamic changes (measured by total hemoglobin and oxygenated hemoglobin within the tissue) in the prefrontal cortex (PFC) of HIV-1 Tg rats in response to cocaine and evaluate the effects of the selective NMDA antagonist drug memantine on cocaine and HIV neurotoxicity compared to those of non-HIV-1 Tg animals (controls). Our results show that memantine improved cocaine-induced deficit in cerebral blood volume while also attenuating an abnormal increase of the neuronal calcium influx and influx duration in both control rats and HIV-1 Tg rats. Cocaine-induced neuronal and hemodynamic dysregulations were significantly greater in HIV-1 Tg rats than in control rats. With memantine pretreatment, HIV-1 Tg rats showed attenuated cocaine’s effects on neuronal and hemodynamic responses, with responses similar to those observed in control rats. These imaging results document an enhancement of neuronal Ca2+ influx, hypoxemia, and ischemia with cocaine in the PFC of HIV-1 Tg rats that were attenuated by memantine pretreatment. Thus, the potential utility of memantine in the treatment of HAND and of cocaine-induced neurotoxicity deserves further investigation.
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Affiliation(s)
- Congwu Du
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
- *Correspondence: Congwu Du, ; Nora D. Volkow, ; Xiu-Ti Hu,
| | - Yueming Hua
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Kevin Clare
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Kicheon Park
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Craig P. Allen
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
| | - Nora D. Volkow
- National Institute on Drug Abuse, Bethesda, MD, United States
- *Correspondence: Congwu Du, ; Nora D. Volkow, ; Xiu-Ti Hu,
| | - Xiu-Ti Hu
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Congwu Du, ; Nora D. Volkow, ; Xiu-Ti Hu,
| | - Yingtian Pan
- Department of Biomedical Engineering, Stony Brook University, New York, NY, United States
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Ho TKK, Kim M, Jeon Y, Kim BC, Kim JG, Lee KH, Song JI, Gwak J. Deep Learning-Based Multilevel Classification of Alzheimer’s Disease Using Non-invasive Functional Near-Infrared Spectroscopy. Front Aging Neurosci 2022; 14:810125. [PMID: 35557842 PMCID: PMC9087351 DOI: 10.3389/fnagi.2022.810125] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/01/2022] [Indexed: 12/28/2022] Open
Abstract
The timely diagnosis of Alzheimer’s disease (AD) and its prodromal stages is critically important for the patients, who manifest different neurodegenerative severity and progression risks, to take intervention and early symptomatic treatments before the brain damage is shaped. As one of the promising techniques, functional near-infrared spectroscopy (fNIRS) has been widely employed to support early-stage AD diagnosis. This study aims to validate the capability of fNIRS coupled with Deep Learning (DL) models for AD multi-class classification. First, a comprehensive experimental design, including the resting, cognitive, memory, and verbal tasks was conducted. Second, to precisely evaluate the AD progression, we thoroughly examined the change of hemodynamic responses measured in the prefrontal cortex among four subject groups and among genders. Then, we adopted a set of DL architectures on an extremely imbalanced fNIRS dataset. The results indicated that the statistical difference between subject groups did exist during memory and verbal tasks. This presented the correlation of the level of hemoglobin activation and the degree of AD severity. There was also a gender effect on the hemoglobin changes due to the functional stimulation in our study. Moreover, we demonstrated the potential of distinguished DL models, which boosted the multi-class classification performance. The highest accuracy was achieved by Convolutional Neural Network-Long Short-Term Memory (CNN-LSTM) using the original dataset of three hemoglobin types (0.909 ± 0.012 on average). Compared to conventional machine learning algorithms, DL models produced a better classification performance. These findings demonstrated the capability of DL frameworks on the imbalanced class distribution analysis and validated the great potential of fNIRS-based approaches to be further contributed to the development of AD diagnosis systems.
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Affiliation(s)
- Thi Kieu Khanh Ho
- Department of Software, Korea National University of Transportation, Chungju, South Korea
| | - Minhee Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Younghun Jeon
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Byeong C. Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae Gwan Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Kun Ho Lee
- Gwangju Alzheimer’s Disease and Related Dementias Cohort Research Center, Chosun University, Gwangju, South Korea
- Department of Biomedical Science, Chosun University, Gwangju, South Korea
- Korea Brain Research Institute, Daegu, South Korea
| | - Jong-In Song
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Jeonghwan Gwak
- Department of Software, Korea National University of Transportation, Chungju, South Korea
- Department of Biomedical Engineering, Korea National University of Transportation, Chungju, South Korea
- Department of AI Robotics Engineering, Korea National University of Transportation, Chungju, South Korea
- Department of IT and Energy Convergence (BK21 FOUR), Korea National University of Transportation, Chungju, South Korea
- *Correspondence: Jeonghwan Gwak, ;
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Azhar L, Kusumo RW, Marotta G, Lanctôt KL, Herrmann N. Pharmacological Management of Apathy in Dementia. CNS Drugs 2022; 36:143-165. [PMID: 35006557 DOI: 10.1007/s40263-021-00883-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 12/11/2022]
Abstract
Apathy is a highly prevalent symptom of dementia. Despite its association with faster cognitive and functional decline, decreased quality of life and increased mortality, no therapies are currently approved to treat apathy. The objective of this review was to summarize the drugs that have been studied for apathy treatment in patients with dementia (specifically Alzheimer's disease [AD], Huntington's disease [HD] and Parkinson's disease [PD] dementia; dementia with Lewy bodies [DLB]; vascular dementia [VaD]; and frontotemporal dementia [FTD]) based on their putative mechanisms of action. A search for relevant studies was performed using ClinicalTrials.gov and PubMed. Eligible studies were randomized controlled trials that were available in English and included at least one drug intervention and an apathy measure scale. A total of 52 studies that included patients with AD (n = 33 studies), PD (n = 5), HD (n = 1), DLB (n = 1), FTD (n = 3), VaD (n = 1), VaD and AD (n = 4), VaD and mixed dementia (n = 1), and AD, VaD and mixed dementia (n = 3) were eligible for inclusion. These studies showed that methylphenidate, olanzapine, cholinesterase inhibitors, choline alphoscerate, citalopram, memantine, and mibampator are the only beneficial drugs in AD-related apathy. For PD-related apathy, only methylphenidate, rotigotine and rivastigmine showed benefits. Regarding FTD- and DLB-related apathy, initial studies with agomelatine and rivastigmine showed benefits, respectively. As for HD- and only-VaD-related apathy, no drugs demonstrated benefits. With regards to mixed populations, memantine, galantamine and gingko biloba showed effects on apathy in the AD plus VaD populations and nimodipine in the VaD plus mixed dementia populations. Of the drugs with positive results, some are already prescribed to patients with dementia to target other symptoms, some have characteristics-such as medical contraindications (e.g., cardiovascular) and adverse effects (e.g., gastrointestinal disturbances)-that limit their clinical use and some require further study. Future studies should investigate apathy as a primary outcome, making use of appropriate sample sizes and study durations to ensure durability of results. There should also be a consensus on using scales with high test/retest and interrater reliabilities to limit the inconsistencies between clinical trials. In conclusion, there are currently no US FDA-approved drugs that target apathy in dementia, so there is an ongoing need for the development of such drugs.
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Affiliation(s)
- Laiba Azhar
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Raphael W Kusumo
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Giovanni Marotta
- Geriatric Medicine Division, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Youn H, Lee KJ, Kim SG, Cho SJ, Kim WJ, Lee WJ, Hwang JY, Han C, Shin C, Jung HY. The Behavioral Effects of Combination Therapy of Memantine and Acetylcholinesterase Inhibitors Compared with Acetylcholinesterase Inhibitors Alone in Patients with Moderate Alzheimer's Dementia: A Double-Blind Randomized Placebo-Controlled Trial. Psychiatry Investig 2021; 18:233-240. [PMID: 33685036 PMCID: PMC8016683 DOI: 10.30773/pi.2020.0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/13/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer's dementia (AD). METHODS This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician's Interview-Based Impression of Change plus caregiver input, Gottfries-Bråne-Steen Scale, and Zarit Burden Interview were used as assessment scales. RESULTS There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks. CONCLUSION Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.
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Affiliation(s)
- HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Kang Joon Lee
- Department of Psychiatry, Ilsanpaik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Won Joon Lee
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae Yeon Hwang
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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11
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Mohd Murshid N, Aminullah Lubis F, Makpol S. Epigenetic Changes and Its Intervention in Age-Related Neurodegenerative Diseases. Cell Mol Neurobiol 2020; 42:577-595. [DOI: 10.1007/s10571-020-00979-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023]
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12
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Yu X, Yu W, Yang W, Lü Y. Usage and adherence of antidementia drugs in a memory clinic cohort in Chongqing, Southwest China. Psychogeriatrics 2020; 20:706-712. [PMID: 32500567 DOI: 10.1111/psyg.12568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To investigate the use and adherence of antidementia drugs in elderly patients with dementia from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University. METHODS Patients were recruited from the Memory Clinic of The First Affiliated Hospital of Chongqing Medical University from December 2010 to December 2018. Medical charts were reviewed, including diagnosis, dosage of antidementia medicines, neuropsychological testing scores, and the further questionnaires were conducted via face-to-face or telephone, included duration of treatment, types of antidementia drugs, and reasons for treatment discontinuation. RESULTS The data from 422 patients were analysed retrospectively for this study. Three hundred and fifteen were diagnosed with Alzheimer's disease (AD), 67 with mild cognitive impairment (MCI), and 40 with other types of dementia. From the 422 patients, 26.8% were treated with original donepezil (n = 113), 11.6% with generic donepezil (n = 49), 24.6% with memantine (n = 104), 13.3% with huperzine A (n = 56), and 23.7% with a combination of drugs (n = 100). However, 73% of patients discontinued treatment within 1 year of initiation. Patients treated for more than 36 months (37.8%) were more likely to choose combined medication, as compared with patients treated for less than 36 months. Patients with less than 9 years of education (odds ratio (OR): 2.394; 95% CI: 1.508-3.801) were more likely to discontinue treatment than patients with more than 9 years of education. Patients with elevated physical self-maintenance scale (PSMS) scores (OR: 1.195; 95% CI: 1.086-1.316) had a high risk of discontinuation. CONCLUSIONS Overall treatment compliance is relatively poor in memory clinics in Chongqing. Our study demonstrates that higher education may lead to better treatment adherence in dementia care. Combination therapy may increase treatment time. However, poorer PSMS scores are a significant risk factor for treatment discontinuation.
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Affiliation(s)
- Xingyan Yu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weihua Yu
- Institute of Neuroscience, Chongqing Medical University, Chongqing, China
| | - Wenkai Yang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Lü
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bonilauri A, Sangiuliano Intra F, Pugnetti L, Baselli G, Baglio F. A Systematic Review of Cerebral Functional Near-Infrared Spectroscopy in Chronic Neurological Diseases-Actual Applications and Future Perspectives. Diagnostics (Basel) 2020; 10:E581. [PMID: 32806516 PMCID: PMC7459924 DOI: 10.3390/diagnostics10080581] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The management of people affected by age-related neurological disorders requires the adoption of targeted and cost-effective interventions to cope with chronicity. Therapy adaptation and rehabilitation represent major targets requiring long-term follow-up of neurodegeneration or, conversely, the promotion of neuroplasticity mechanisms. However, affordable and reliable neurophysiological correlates of cerebral activity to be used throughout treatment stages are often lacking. The aim of this systematic review is to highlight actual applications of functional Near-Infrared Spectroscopy (fNIRS) as a versatile optical neuroimaging technology for investigating cortical hemodynamic activity in the most common chronic neurological conditions. METHODS We reviewed studies investigating fNIRS applications in Parkinson's Disease (PD), Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI) as those focusing on motor and cognitive impairment in ageing and Multiple Sclerosis (MS) as the most common chronic neurological disease in young adults. The literature search was conducted on NCBI PubMed and Web of Science databases by PRISMA guidelines. RESULTS We identified a total of 63 peer-reviewed articles. The AD spectrum is the most investigated pathology with 40 articles ranging from the traditional monitoring of tissue oxygenation to the analysis of functional resting-state conditions or cognitive functions by means of memory and verbal fluency tasks. Conversely, applications in PD (12 articles) and MS (11 articles) are mainly focused on the characterization of motor functions and their association with dual-task conditions. The most investigated cortical area is the prefrontal cortex, since reported to play an important role in age-related compensatory mechanism and neurofunctional changes associated to these chronic neurological conditions. Interestingly, only 9 articles applied a longitudinal approach. CONCLUSION The results indicate that fNIRS is mainly employed for the cross-sectional characterization of the clinical phenotypes of these pathologies, whereas data on its utility for longitudinal monitoring as surrogate biomarkers of disease progression and rehabilitation effects are promising but still lacking.
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Affiliation(s)
- Augusto Bonilauri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (A.B.); (G.B.)
| | - Francesca Sangiuliano Intra
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy; (L.P.); (F.B.)
- Faculty of Education, Free University of Bozen-Bolzano, 39100 Bolzano, Italy
| | - Luigi Pugnetti
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy; (L.P.); (F.B.)
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (A.B.); (G.B.)
| | - Francesca Baglio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, CADITER, 20148 Milan, Italy; (L.P.); (F.B.)
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Yeung MK, Chan AS. Functional near-infrared spectroscopy reveals decreased resting oxygenation levels and task-related oxygenation changes in mild cognitive impairment and dementia: A systematic review. J Psychiatr Res 2020; 124:58-76. [PMID: 32120065 DOI: 10.1016/j.jpsychires.2020.02.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
Nuclear medicine and functional magnetic resonance imaging studies have shown that mild cognitive impairment (MCI) and dementia, including Alzheimer's disease (AD), are characterized by changes in cerebral blood flow. This article reviews the application of an alternative method, functional near-infrared spectroscopy (fNIRS), to the study of cerebral oxygenation changes in MCI and dementia. We synthesized 36 fNIRS studies that examined hemodynamic changes during both the resting state and the execution of tasks of word retrieval, memory, motor control, and visuospatial perception in MCI and dementia. This qualitative review reveals that (amnestic) MCI and AD patients have disrupted frontal and long-range connectivity in the resting state compared to individuals with normal cognition (NC). These patients also exhibit reduced frontal oxygenation changes in various cognitive domains. The review also shows that disrupted connectivity and decreased frontal oxygenation levels/changes are more severe in AD than in (amnestic) MCI, confirming that MCI is an intermediate stage between NC and dementia. Thus, there is reduced resting frontal perfusion, which is greater than expected for age, and a lack of frontal compensatory responses to functional decline across cognitive operations (i.e., word retrieval and memory functioning) in MCI and AD. These indices might potentially serve as perfusion- or oxygenation-based biomarkers for MCI/dementia. To expand the utility of fNIRS for MCI and dementia, further studies that measure tissue oxygenation in a wider range of brain regions and cognitive domains, compare different MCI and dementia types, and correlate changes in cerebral oxygenation over time with disease progression are needed.
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Affiliation(s)
- Michael K Yeung
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, QC, H3A 2B4, Canada
| | - Agnes S Chan
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China; Chanwuyi Research Center for Neuropsychological Well-being, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Cao Y, Qian L, Yu W, Li T, Mao S, Han G. Donepezil plus memantine versus donepezil alone for treatment of concomitant Alzheimer's disease and chronic obstructive pulmonary disease: a retrospective observational study. J Int Med Res 2020; 48:300060520902895. [PMID: 32046559 PMCID: PMC7111061 DOI: 10.1177/0300060520902895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the clinical outcomes of donepezil plus memantine (DM) and donepezil (DO) alone in Asian patients with a concomitant diagnosis of moderate-to-severe Alzheimer’s disease and mild-to-moderate chronic obstructive pulmonary disease (AD-COPD). Methods We conducted a retrospective analysis of patients with AD-COPD who received either DM or DO for 6 months, or until the occurrence of unacceptable adverse events or disease progression, between June 2012 and May 2016. The primary endpoint was the score on the Standardized Mini-Mental State Examination (SMMSE). Secondary endpoints were scores on the caregiver-rated Bristol Activities of Daily Living Scale, Neuropsychiatric Inventory, Dementia Quality of Life (DEMQOL)-Proxy, and General Health Questionnaire 12. Results In total, 154 eligible patients received DM, whereas 156 received DO. Compared with patients who received DO, patients who received DM had significantly higher mean scores on the SMMSE by 2.1 points (95% confidence interval, 1.3–2.5). Significant between-group heterogeneity was not detected in outcomes over time. The benefits of treatment with DM were greater than those of treatment with DO, in terms of the primary endpoint. Significant differences were also detected in terms of secondary endpoints. Conclusion DM is more effective than DO alone for Asian patients with AD-COPD.
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Affiliation(s)
- Yangyi Cao
- Department of Treatment Center For Traumatic Injuries, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Liang Qian
- Department of Anesthesiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Weiguang Yu
- Department of Orthopeadics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuai Mao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guowei Han
- Department of Orthopeadics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Theleritis CG, Siarkos KT, Politis AM. Unmet Needs in Pharmacological Treatment of Apathy in Alzheimer's Disease: A Systematic Review. Front Pharmacol 2019; 10:1108. [PMID: 31680942 PMCID: PMC6797825 DOI: 10.3389/fphar.2019.01108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/29/2019] [Indexed: 01/15/2023] Open
Abstract
Background: Apathy is one of the most prevalent neuropsychiatric symptoms encountered in Alzheimer’s disease (AD) and may be an early sign in the development of dementia persisting over the disease course. It has been associated with poor disease outcome, impaired daily functioning, and significant caregiver distress. Early diagnosis and timely treatment of apathy in AD are of great importance. However, approved agents for apathy are still missing. Methods: Within this context, we conducted an extensive electronic search in the databases included in the National Library of Medicine, PsychInfo, and Google Scholar for studies that have investigated the effect of pharmacological treatments in apathy in AD. There were no limitations regarding study design and all care settings were considered for inclusion. Structured measures for level of evidence and study quality were employed to evaluate the results. Results: A total of 1,607 records were identified; 1,483 records remained after the removal of duplicates and were screened; 166 full-text articles were selected and assessed for eligibility and a remaining 90 unique studies and relevant reviews were included in the qualitative synthesis. Acetylcholinesterase inhibitors, gingko biloba, and methylphenidate were found to be successful in reducing apathy in patients with AD. Methodological heterogeneity in the studies and the small amount of studies where apathy was the primary outcome are limiting factors to assess for group effects. Conclusions: Pharmacological treatment of apathy in AD is an underexplored field. Standardized and systematic efforts are needed to establish a possible treatment benefit. Elucidating the pathophysiology of apathy and its components or subtypes will inform disease models and mechanistic drug studies that can quantify a benefit from specific agents for specific AD groups.
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Affiliation(s)
- Christos G Theleritis
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas T Siarkos
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios M Politis
- Division of Geriatric Psychiatry, First Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States
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Ghafoor U, Lee JH, Hong KS, Park SS, Kim J, Yoo HR. Effects of Acupuncture Therapy on MCI Patients Using Functional Near-Infrared Spectroscopy. Front Aging Neurosci 2019; 11:237. [PMID: 31543811 PMCID: PMC6730485 DOI: 10.3389/fnagi.2019.00237] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/16/2019] [Indexed: 01/25/2023] Open
Abstract
Acupuncture therapy (AT) is a non-pharmacological method of treatment that has been applied to various neurological diseases. However, studies on its longitudinal effect on the neural mechanisms of patients with mild cognitive impairment (MCI) for treatment purposes are still lacking in the literature. In this clinical study, we assess the longitudinal effects of ATs on MCI patients using two methods: (i) Montreal Cognitive Assessment test (MoCA-K, Korean version), and (ii) the hemodynamic response (HR) analyses using functional near-infrared spectroscopy (fNIRS). fNIRS signals of a working memory (WM) task were acquired from the prefrontal cortex. Twelve elderly MCI patients and 12 healthy people were recruited as target and healthy control (HC) groups, respectively. Each group went through an fNIRS scanning procedure three times: The initial data were obtained without any ATs, and subsequently a total of 24 AT sessions were conducted for MCI patients (i.e., MCI-0: the data prior to ATs, MCI-1: after 12 sessions of ATs for 6 weeks, MCI-2: another 12 sessions of ATs for 6 weeks). The mean HR responses of all MCI-0–2 cases were lower than those of HCs. To compare the effects of AT on MCI patients, MoCA-K results, temporal HR data, and spatial activation patterns (i.e., t-maps) were examined. In addition, analyses of functional connectivity (FC) and graph theory upon WM tasks were conducted. With ATs, (i) the averaged MoCA-K test scores were improved (MCI-1, p = 0.002; MCI-2, p = 2.9e–4); (ii) the mean HR response of WM tasks was increased (p < 0.001); and (iii) the t-maps of MCI-1 and MCI-2 were enhanced. Furthermore, an increased FC in the prefrontal cortex in both MCI-1/MCI-2 cases in comparison to MCI-0 was obtained (p < 0.01), and an increasing trend in the graph theory parameters was observed. All these findings reveal that ATs have a positive impact on improving the cognitive function of MCI patients. In conclusion, ATs can be used as a therapeutic tool for MCI patients as a non-pharmacological method (Clinical trial registration number: KCT 0002451 https://cris.nih.go.kr/cris/en/).
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Affiliation(s)
- Usman Ghafoor
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Keum-Shik Hong
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Sang-Soo Park
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Daejeon University, Daejeon, South Korea
| | - Jieun Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ho-Ryong Yoo
- Department of Neurology Disorders, Dunsan Hospital, Daejeon University, Daejeon, South Korea
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McShane R, Westby MJ, Roberts E, Minakaran N, Schneider L, Farrimond LE, Maayan N, Ware J, Debarros J. Memantine for dementia. Cochrane Database Syst Rev 2019; 3:CD003154. [PMID: 30891742 PMCID: PMC6425228 DOI: 10.1002/14651858.cd003154.pub6] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Memantine is a moderate affinity uncompetitive antagonist of glutamate NMDA receptors. It is licensed for use in moderate and severe Alzheimer's disease (AD); in the USA, it is also widely used off-label for mild AD. OBJECTIVES To determine efficacy and safety of memantine for people with dementia. To assess whether memantine adds benefit for people already taking cholinesterase inhibitors (ChEIs). SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register of trials (http://www.medicine.ox.ac.uk/alois/) up to 25 March 2018. We examined clinical trials registries, press releases and posters of memantine manufacturers; and the web sites of the FDA, EMEA and NICE. We contacted authors and companies for missing information. SELECTION CRITERIA Double-blind, parallel group, placebo-controlled, randomised trials of memantine in people with dementia. DATA COLLECTION AND ANALYSIS We pooled and analysed data from four clinical domains across different aetiologies and severities of dementia and for AD with agitation. We assessed the impact of study duration, severity and concomitant use of ChEIs. Consequently, we restricted analyses to the licensed dose (20 mg/day or 28 mg extended release) and data at six to seven months duration of follow-up, and analysed separately results for mild and moderate-to-severe AD.We transformed results for efficacy outcomes into the difference in points on particular outcome scales. MAIN RESULTS Across all types of dementia, data were available from almost 10,000 participants in 44 included trials, most of which were at low or unclear risk of bias. For nearly half the studies, relevant data were obtained from unpublished sources. The majority of trials (29 in 7885 participants) were conducted in people with AD.1. Moderate-to-severe AD (with or without concomitant ChEIs). High-certainty evidence from up to 14 studies in around 3700 participants consistently shows a small clinical benefit for memantine versus placebo: clinical global rating (CGR): 0.21 CIBIC+ points (95% confidence interval (CI) 0.14 to 0.30); cognitive function (CF): 3.11 Severe Impairment Battery (SIB) points (95% CI 2.42 to 3.92); performance on activities of daily living (ADL): 1.09 ADL19 points (95% CI 0.62 to 1.64); and behaviour and mood (BM): 1.84 Neuropsychiatric Inventory (NPI) points (95% CI 1.05 to 2.76). There may be no difference in the number of people discontinuing memantine compared to placebo: risk ratio (RR) 0.93 (95% CI 0.83 to 1.04) corresponding to 13 fewer people per 1000 (95% CI 31 fewer to 7 more). Although there is moderate-certainty evidence that fewer people taking memantine experience agitation as an adverse event: RR 0.81 (95% CI 0.66 to 0.99) (25 fewer people per 1000, 95% CI 1 to 44 fewer), there is also moderate-certainty evidence, from three additional studies, suggesting that memantine is not beneficial as a treatment for agitation (e.g. Cohen Mansfield Agitation Inventory: clinical benefit of 0.50 CMAI points, 95% CI -3.71 to 4.71) .The presence of concomitant ChEI does not impact on the difference between memantine and placebo, with the possible exceptions of the BM outcome (larger effect in people taking ChEIs) and the CF outcome (smaller effect).2. Mild AD (Mini Mental State Examination (MMSE) 20 to 23): mainly moderate-certainty evidence based on post-hoc subgroups from up to four studies in around 600 participants suggests there is probably no difference between memantine and placebo for CF: 0.21 ADAS-Cog points (95% CI -0.95 to 1.38); performance on ADL: -0.07 ADL 23 points (95% CI -1.80 to 1.66); and BM: -0.29 NPI points (95% CI -2.16 to 1.58). There is less certainty in the CGR evidence, which also suggests there may be no difference: 0.09 CIBIC+ points (95% CI -0.12 to 0.30). Memantine (compared with placebo) may increase the numbers of people discontinuing treatment because of adverse events (RR 2.12, 95% CI 1.03 to 4.39).3. Mild-to-moderate vascular dementia. Moderate- and low-certainty evidence from two studies in around 750 participants indicates there is probably a small clinical benefit for CF: 2.15 ADAS-Cog points (95% CI 1.05 to 3.25); there may be a small clinical benefit for BM: 0.47 NOSGER disturbing behaviour points (95% CI 0.07 to 0.87); there is probably no difference in CGR: 0.03 CIBIC+ points (95% CI -0.28 to 0.34); and there may be no difference in ADL: 0.11 NOSGER II self-care subscale points (95% CI -0.35 to 0.54) or in the numbers of people discontinuing treatment: RR 1.05 (95% CI 0.83 to 1.34).There is limited, mainly low- or very low-certainty efficacy evidence for other types of dementia (Parkinson's disease and dementia Lewy bodies (for which CGR may show a small clinical benefit; four studies in 319 people); frontotemporal dementia (two studies in 133 people); and AIDS-related Dementia Complex (one study in 140 people)).There is high-certainty evidence showing no difference between memantine and placebo in the proportion experiencing at least one adverse event: RR 1.03 (95% CI 1.00 to 1.06); the RR does not differ between aetiologies or severities of dementia. Combining available data from all trials, there is moderate-certainty evidence that memantine is 1.6 times more likely than placebo to result in dizziness (6.1% versus 3.9%), low-certainty evidence of a 1.3-fold increased risk of headache (5.5% versus 4.3%), but high-certainty evidence of no difference in falls. AUTHORS' CONCLUSIONS We found important differences in the efficacy of memantine in mild AD compared to that in moderate-to-severe AD. There is a small clinical benefit of memantine in people with moderate-to-severe AD, which occurs irrespective of whether they are also taking a ChEI, but no benefit in people with mild AD.Clinical heterogeneity in AD makes it unlikely that any single drug will have a large effect size, and means that the optimal drug treatment may involve multiple drugs, each having an effect size that may be less than the minimum clinically important difference.A definitive long-duration trial in mild AD is needed to establish whether starting memantine earlier would be beneficial over the long term and safe: at present the evidence is against this, despite it being common practice. A long-duration trial in moderate-to-severe AD is needed to establish whether the benefit persists beyond six months.
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Affiliation(s)
- Rupert McShane
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
| | - Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Emmert Roberts
- King's College LondonDepartment of Psychological Medicine and National Addiction CentreWeston Education CentreLondonLondonUKSE5 9RJ
| | - Neda Minakaran
- Moorfields Eye Hospital NHS Foundation TrustDepartment of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Lon Schneider
- Keck School of Medicine of the University of Southern California1540 Alcazar Street, CHP 216Los AngelesCAUSA90033
| | - Lucy E Farrimond
- Oxford University Hospitals NHS Foundation TrustNeurosciences DepartmentJohn Radcliffe HospitalOxfordUKOX3 9DU
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Jennifer Ware
- University of OxfordCochrane Dementia and Cognitive Improvement GroupOxfordUKOX3 9DU
| | - Jean Debarros
- University of OxfordNuffield Department of Clinical Neurosciences (NDCN)Level 6, West Wing, John Radcliffe HospitalOxfordUKOX3 9DU
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San-Juan-Rodriguez A, Zhang Y, He M, Hernandez I. Association of Antidementia Therapies With Time to Skilled Nursing Facility Admission and Cardiovascular Events Among Elderly Adults With Alzheimer Disease. JAMA Netw Open 2019; 2:e190213. [PMID: 30821828 PMCID: PMC6484658 DOI: 10.1001/jamanetworkopen.2019.0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE To date, no study has compared time to skilled nursing facility (SNF) admission and cardiovascular events across medications available to treat Alzheimer disease. OBJECTIVE To compare time to SNF admission and cardiovascular events between acetylcholinesterase inhibitor (AChEI) monotherapy, memantine hydrochloride monotherapy, and combination therapy with an AChEI and memantine in treating elderly adults with Alzheimer disease. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study uses January 1, 2006, to December 31, 2014, claims data from a 5% random sample of Medicare beneficiaries who had received a new diagnosis of Alzheimer disease between January 1, 2007, and December 31, 2013, and who initiated AChEI monotherapy, memantine monotherapy, or combination therapy with an AChEI and memantine (N = 73 475). Patients were followed up until discontinuation of treatment, switch of treatment, death, or the end of the study period. Statistical analysis was conducted from February 15, 2018, to June 15, 2018. EXPOSURES Acetylcholinesterase inhibitor monotherapy (n = 44 424), memantine monotherapy (n = 11 809), and combination therapy with an AChEI and memantine (n = 17 242). MAIN OUTCOMES AND MEASURES Primary outcomes were time to SNF admission and the composite of the following cardiovascular events: acute myocardial infarction, bradycardia, syncope, atrioventricular block, QT interval prolongation, and ventricular tachycardia. Cox proportional hazards regression models were constructed to compare outcomes between each pair of treatment groups, controlling for a comprehensive list of patient characteristics. RESULTS The study population included 73 475 participants (53 068 women and 20 407 men; mean [SD] age, 81.8 [8.3] years); 25.5% of the participants initiating AChEI monotherapy, 25.6% of participants initiating memantine monotherapy, and 29.7% of participants initiating combination therapy with an AChEI and memantine were admitted to an SNF. Similarly, 22.2% of the participants initiating AChEI monotherapy, 20.0% of those initiating memantine monotherapy, and 24.5% of those initiating combination therapy experienced at least 1 cardiovascular event. No difference in time to SNF admission was found across the 3 treatment groups. The risk of the composite measure of any cardiovascular event did not differ between the combination therapy and AChEI monotherapy groups (adjusted hazard ratio [aHR], 0.99; 95% CI, 0.96-1.03); however, it was higher for both AChEI monotherapy (aHR, 1.07; 95% CI, 1.02-1.12) and combination therapy (aHR, 1.07; 95% CI, 1.01-1.12), relative to memantine monotherapy. This result was mainly driven by the lower risk of bradycardia and syncope observed for the memantine monotherapy group relative to both AChEI monotherapy (bradycardia: aHR, 0.88; 95% CI, 0.82-0.95; and syncope: aHR, 0.92; 95% CI, 0.86-0.97) and combination therapy (bradycardia: aHR, 0.89; 95% CI, 0.82-0.97; and syncope: aHR, 0.87; 95% CI, 0.83-0.94). CONCLUSIONS AND RELEVANCE Time to SNF admission did not differ across treatment groups, but memantine monotherapy was associated with a lower risk of cardiovascular events compared with both AChEI monotherapy and combination therapy with an AChEI and memantine.
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Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yuting Zhang
- Melbourne Institute, Faculty of Business and Economics, University of Melbourne, Melbourne, Victoria, Australia
| | - Meiqi He
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Fernandez Rojas R, Liao M, Romero J, Huang X, Ou KL. Cortical Network Response to Acupuncture and the Effect of the Hegu Point: An fNIRS Study. SENSORS 2019; 19:s19020394. [PMID: 30669377 PMCID: PMC6359459 DOI: 10.3390/s19020394] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 11/16/2022]
Abstract
Acupuncture is a practice of treatment based on influencing specific points on the body by inserting needles. According to traditional Chinese medicine, the aim of acupuncture treatment for pain management is to use specific acupoints to relieve excess, activate qi (or vital energy), and improve blood circulation. In this context, the Hegu point is one of the most widely-used acupoints for this purpose, and it has been linked to having an analgesic effect. However, there exists considerable debate as to its scientific validity. In this pilot study, we aim to identify the functional connectivity related to the three main types of acupuncture manipulations and also identify an analgesic effect based on the hemodynamic response as measured by functional near-infrared spectroscopy (fNIRS). The cortical response of eleven healthy subjects was obtained using fNIRS during an acupuncture procedure. A multiscale analysis based on wavelet transform coherence was employed to assess the functional connectivity of corresponding channel pairs within the left and right somatosensory region. The wavelet analysis was focused on the very-low frequency oscillations (VLFO, 0.01–0.08 Hz) and the low frequency oscillations (LFO, 0.08–0.15 Hz). A mixed model analysis of variance was used to appraise statistical differences in the wavelet domain for the different acupuncture stimuli. The hemodynamic response after the acupuncture manipulations exhibited strong activations and distinctive cortical networks in each stimulus. The results of the statistical analysis showed significant differences (p<0.05) between the tasks in both frequency bands. These results suggest the existence of different stimuli-specific cortical networks in both frequency bands and the anaesthetic effect of the Hegu point as measured by fNIRS.
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Affiliation(s)
- Raul Fernandez Rojas
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia.
| | - Mingyu Liao
- Department of Industrial Engineering and Management, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan.
| | - Julio Romero
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia.
| | - Xu Huang
- Human-Centred Technology Research Centre, Faculty of Science and Technology, University of Canberra, Canberra 2617, Australia.
| | - Keng-Liang Ou
- Department of Dentistry, Taipei Medical University Hospital, Taipei 110, Taiwan.
- Department of Dentistry, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan.
- School of Dentistry, Health Sciences University of Hokkaido, Hokkaido 061-0293, Japan.
- Department of Prosthodontics, Faculty of Dentistry, Hasanuddin University, Makassar 90245, Indonesia.
- Department of Prosthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia.
- Department of Oral Hygiene Care, Ching Kuo Institute of Management and Health, Keelung 203, Taiwan.
- 3D Global Biotech Inc., New Taipei City 221, Taiwan.
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Li R, Rui G, Chen W, Li S, Schulz PE, Zhang Y. Early Detection of Alzheimer's Disease Using Non-invasive Near-Infrared Spectroscopy. Front Aging Neurosci 2018; 10:366. [PMID: 30473662 PMCID: PMC6237862 DOI: 10.3389/fnagi.2018.00366] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 10/23/2018] [Indexed: 11/13/2022] Open
Abstract
Mild cognitive impairment (MCI) is a cognitive disorder characterized by memory impairment, wherein patients have an increased likelihood of developing Alzheimer’s disease (AD). The classification of MCI and different AD stages is therefore fundamental for understanding and treating the disease. This study aimed to comprehensively investigate the hemodynamic response patterns among various subject groups. Functional near-infrared spectroscopy (fNIRS) was employed to measure signals from the frontal and bilateral parietal cortices of healthy controls (n = 8), patients with MCI (n = 9), mild (n = 6), and moderate/severe AD (n = 7) during a digit verbal span task (DVST). The concentration changes of oxygenated hemoglobin (HbO) in various subject groups were thoroughly explored and tested. Result revealed that abnormal patterns of hemodynamic response were observed across all subject groups. Greater and steeper reductions in HbO concentration were consistently observed across all regions of interest (ROIs) as disease severity developed from MCI to moderate/severe AD. Furthermore, all the fNIRS-derived indexes were found to be significantly and positively correlated to the clinical scores in all ROIs (R ≥ 0.4, P < 0.05). These findings demonstrate the feasibility of utilizing fNIRS for the early detection of AD, suggesting that fNIRS-based approaches hold great promise for exploring the mechanisms underlying the progression of AD.
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Affiliation(s)
- Rihui Li
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States.,Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Guoxing Rui
- Nanjing Ruihaibo Medical Rehabilitation Center, Nanjing, China
| | - Wei Chen
- Nanjing Ruihaibo Medical Rehabilitation Center, Nanjing, China
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Paul E Schulz
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
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Kishi T, Matsunaga S, Oya K, Nomura I, Ikuta T, Iwata N. Memantine for Alzheimer's Disease: An Updated Systematic Review and Meta-analysis. J Alzheimers Dis 2018; 60:401-425. [PMID: 28922160 DOI: 10.3233/jad-170424] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The clinical benefit of memantine for Alzheimer's disease (AD) remains inconclusive. OBJECTIVE We performed an updated systematic review and meta-analysis of the efficacy/safety of memantine in AD. METHODS We included randomized trials of memantine for AD patients. Cognitive function scores (CF), behavioral disturbances scores (BD), and all-cause discontinuation were used as primary measures. Effect size based on a random-effects model was evaluated in the meta-analyses. RESULTS Thirty studies (n = 7,567; memantine versus placebo: N = 11, n = 3,298; memantine + cholinesterase inhibitors (M+ChEIs) versus ChEIs: N = 17, n = 4,175) were identified. Memantine showed a significant improvement in CF [standardized mean difference (SMD) = -0.24, 95% confidence intervals (95% CIs) = -0.34, -0.15, p < 0.00001, I2 = 35% ] and BD (SMD = -0.16, 95% CIs = -0.29, -0.04, p = 0.01, I2 = 52%) compared with placebo. In the sensitivity analysis including only patients with moderate-severe AD, memantine was superior to the placebo in reducing BD without considerable heterogeneity (SMD = -0.20, 95% CIs = -0.34, -0.07, p = 0.003, I2 = 36%). Compared with ChEIs, M+ChEIs showed a greater reduction in BD (SMD = -0.20, 95% CIs = -0.36, -0.03, p = 0.02, I2 = 77%) and a trend of CF improvement (SMD = -0.11, 95% CIs = -0.22, 0.01, p = 0.06, I2 = 56%). However, in the sensitivity analysis of double-blind, placebo-controlled studies only, M+ChEIs showed a significant reduction in BD compared with ChEIs without considerable heterogeneity (SMD = -0.11, 95% CIs = -0.21, -0.01, p = 0.04, I2 = 40%). When performing the sensitivity analysis of donepezil studies only, M+ChEIs was superior to ChEIs in improving CF without considerable heterogeneity (SMD = -0.18, 95% CIs = -0.31, -0.05, p = 0.006, I2 = 49%). No differences were detected in all-cause discontinuation between the groups. CONCLUSIONS The meta-analyses suggest the credible efficacy and safety of memantine in treating AD when used alone or in combination with ChEIs.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Shinji Matsunaga
- Department of Psychiatry, Fujita Health University School of Medicine, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Kazuto Oya
- Department of Psychiatry, Fujita Health University School of Medicine, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Ikuo Nomura
- Department of Psychiatry, Fujita Health University School of Medicine, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Toshikazu Ikuta
- Department of Communication Sciences and Disorders, School of Applied Sciences, University of Mississippi, University MS, USA
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Kutsukake-cho, Toyoake, Aichi, Japan
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Chen R, Chan PT, Chu H, Lin YC, Chang PC, Chen CY, Chou KR. Treatment effects between monotherapy of donepezil versus combination with memantine for Alzheimer disease: A meta-analysis. PLoS One 2017; 12:e0183586. [PMID: 28827830 PMCID: PMC5565113 DOI: 10.1371/journal.pone.0183586] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/07/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This is the first meta-analysis to compare the treatment effects and safety of administering donepezil alone versus a combination of memantine and donepezil to treat patients with moderate to severe Alzheimer Disease, particularly regarding cognitive functions, behavioral and psychological symptoms in dementia (BPSD), and global functions. METHODS PubMed, Medline, Embase, PsycINFO, and Cochrane databases were used to search for English and non-English articles for inclusion in the meta-analysis to evaluate the effect size and incidence of adverse drug reactions of different treatments. RESULTS Compared with patients who received donepezil alone, those who received donepezil in combination with memantine exhibited limited improvements in cognitive functions (g = 0.378, p < .001), BPSD (g = -0.878, p < .001) and global functions (g = -0.585, p = .004). Gradual titration of memantine plus a fixed dose and gradual titration of donepezil as well as a fixed dose and gradual titration of memantine resulted in limited improvements in cognitive functions(g = 0.371, p = .005), BPSD(g = -0.913, p = .001), and global functions(g = -0.371, p = .001). CONCLUSION Both in the 24th week and at the final evaluation point, the combination of donepezil and memantine led to greater improvement in cognitive functions, BPSD, and global functions than did donepezil alone in patients with moderate to severe Alzheimer Disease.
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Affiliation(s)
- Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Pi-Tuan Chan
- Department of Nursing, En Chu Kong Hospital, Taipei, Taiwan
| | - Hsin Chu
- Aviation Physiology Research Laboratory, Kaohsiung Armed Forces General Hospital Gangshan Branch, Kaohsiung, Taiwan
- Institute of Aerospace and Undersea Medicine, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Cih Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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24
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Abstract
In the last few years, exciting properties have emerged regarding the activation, signaling, mechanisms of action, and therapeutic targeting of the two types of neurotrophin receptors: the p75NTR with its intracellular and extracellular peptides, the Trks, their precursors and their complexes. This review summarizes these new developments, with particular focus on neurodegenerative diseases. Based on the evolving knowledge, innovative concepts have been formulated regarding the pathogenesis of these diseases, especially the Alzheimer's and two other, the Parkinson's and Huntington's diseases. The medical progresses include original procedures of diagnosis, started from studies in mice and now investigated for human application, based on innovative classes of receptor agonists and blockers. In parallel, comprehensive studies have been and are being carried out for the development of drugs. The relevance of these studies is based on the limitations of the therapies employed until recently, especially for the treatment of Alzheimer's patients. Starting from well known drugs, previously employed for non-neurodegenerative diseases, the ongoing progress has lead to the development of small molecules that cross rapidly the blood-brain barrier. Among these molecules the most promising are specific blockers of the p75NTR receptor. Additional drugs, that activate Trk receptors, were shown effective against synaptic loss and memory deficits. In the near future such approaches, coordinated with treatments with monoclonal antibodies and with developments in the microRNA field, are expected to improve the therapy of neurodegenerative diseases, and may be relevant also for other human disease conditions.
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Affiliation(s)
- Jacopo Meldolesi
- Department of Neuroscience, Vita-Salute San Raffaele University and Scientific Institute San Raffaele, via Olgettina 58, 20132 Milan, Italy.
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25
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Pharmacological Therapy for Apathy in Alzheimer’s Disease: A Systematic Review and Meta-Analysis. Can J Neurol Sci 2017; 44:267-275. [DOI: 10.1017/cjn.2016.426] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AbstractIntroduction:Apathy is highly prevalent in Alzheimer’s disease (AD), but whether pharmacotherapy is effective in managing apathy is unclear.Methods:To assess the efficacy of pharmacotherapy for apathy in AD we searched for randomized controlled trials (RCT) and aggregate data reporting on apathy in several search engines, reference lists of articles, and reviews. Demographic characteristics and relevant data were extracted to assess apathy.Results:Fifteen RCTs’ were examined, and 11 were used in aggregate meta-analytic statistics. Drugs included were cholinesterase inhibitors, memantine, and psycho-stimulants. We found no significant treatment effect in favour of any of the drugs, and the effect-size estimates under a random effect model were heterogeneous. Most RCTs had a high attrition rate and used the NPI apathy subscale to measure apathy.Conclusion:The lack of an effect could be explained by methodological limitations, publication bias, and heterogeneity.
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Kishi T, Matsunaga S, Iwata N. The effects of memantine on behavioral disturbances in patients with Alzheimer's disease: a meta-analysis. Neuropsychiatr Dis Treat 2017; 13:1909-1928. [PMID: 28790827 PMCID: PMC5530072 DOI: 10.2147/ndt.s142839] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Memantine is effective in the treatment of behavioral disturbances in patients with Alzheimer's disease. It has not yet been fully determined which behavioral disturbances respond best to memantine. METHODS We conducted a meta-analysis of memantine vs control (placebo or usual care) for the treatment of individual behavioral disturbances (delusion, hallucination, agitation/aggression, dysphoria, anxiety/phobia, euphoria, apathy, disinhibition, irritability/lability, aberrant motor activity/activity disturbances, nighttime disturbance/diurnal rhythm disturbances, and eating disturbances). Randomized controlled studies of memantine in patients with Alzheimer's disease were included in this study. To evaluate these outcomes, standardized mean difference (SMD), with 95% confidence intervals (95% CIs), based upon a random-effects model was evaluated in the meta-analysis. RESULTS A total of 11 studies (n=4,261; memantine vs placebo: N=4, n=1,500; memantine + cholinesterase inhibitors [M + ChEIs] vs ChEIs: N=7, n=2,761) were included in the meta-analysis. Compared to control, memantine showed significant improvement in agitation/aggression (SMD =-0.11; 95% CIs =-0.20, -0.03; P=0.01; I2=47%), delusion (SMD =-0.12; 95% CIs =-0.18, -0.06; P=0.0002; I2=0%), disinhibition (SMD =-0.08; 95% CIs =-0.15, -0.00; P=0.04; I2=0%), and nighttime disturbance/diurnal rhythm disturbances (SMD =-0.10; 95% CIs =-0.18, -0.02; P=0.02; I2=36%). Memantine was also marginally superior to control in hallucination (SMD =-0.06; 95% CIs =-0.12, 0.01; P=0.07; I2=0%) and irritability/lability (SMD =-0.09; 95% CIs =-0.19, 0.01; P=0.07; I2=42%). Memantine is similar to control in dysphoria, anxiety/phobia, euphoria, apathy, and eating disturbance. CONCLUSION The meta-analysis suggest that memantine has benefits for the treatment of most of the behavioral disturbances in patients with Alzheimer's disease. Memantine does not deteriorate negative symptoms as behavioral disturbances in patients with Alzheimer's disease.
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Affiliation(s)
- Taro Kishi
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shinji Matsunaga
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Matsunaga S, Kishi T, Iwata N. Tsoi KK et al: Combination Therapy Showed Limited Superiority Over Monotherapy for Alzheimer Disease: A Meta-analysis of 14 Randomized Trials. J Am Med Dir Assoc 2016; 17:1061-1062. [DOI: 10.1016/j.jamda.2016.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
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28
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Response to the Letter to the Editor by Shinji Matsunaga “Combination Therapy Showed Limited Superiority Over Monotherapy for Alzheimer Disease: A Meta-analysis of 14 Randomized Trials”. J Am Med Dir Assoc 2016; 17:1063. [DOI: 10.1016/j.jamda.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022]
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29
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Kamiya K, Narita N, Iwaki S. Improved Prefrontal Activity and Chewing Performance as Function of Wearing Denture in Partially Edentulous Elderly Individuals: Functional Near-Infrared Spectroscopy Study. PLoS One 2016; 11:e0158070. [PMID: 27362255 PMCID: PMC4928845 DOI: 10.1371/journal.pone.0158070] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/09/2016] [Indexed: 01/29/2023] Open
Abstract
The purpose of this study was to elucidate the effects of wearing a denture on prefrontal activity during chewing performance. We specifically examined that activity in 12 elderly edentulous subjects [63.1±6.1 years old (mean ± SD)] and 12 young healthy controls (22.1±2.3 years old) using functional near-infrared spectroscopy (fNIRS) in order to evaluate the quality of prefrontal functionality during chewing performance under the conditions of wearing a denture and tooth loss, and then compared the findings with those of young healthy controls. fNIRS and electromyography were used simultaneously to detect prefrontal and masticatory muscle activities during chewing, while occlusal force and masticatory score were also examined by use of a food intake questionnaire. A significant increase in prefrontal activity was observed during chewing while wearing a denture, which was accompanied by increased masticatory muscle activity, occlusal force, and masticatory score, as compared with the tooth loss condition. Prefrontal activation during chewing while wearing a denture in the elderly subjects was not much different from that in the young controls. In contrast, tooth loss in the elderly group resulted in marked prefrontal deactivation, accompanied by decreased masticatory muscle activity, occlusal force, and masticatory score, as compared with the young controls. We concluded that intrinsic prefrontal activation during chewing with a denture may prevent prefrontal depression induced by tooth loss in elderly edentulous patients.
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Affiliation(s)
- Kazunobu Kamiya
- Department of Removable Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Noriyuki Narita
- Department of Removable Prosthodontics, Nihon University School of Dentistry at Matsudo, Chiba, Japan
| | - Sunao Iwaki
- Automotive Human Factors Research Center, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, Ibaraki, Japan
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30
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Tsoi KKF, Chan JYC, Leung NWY, Hirai HW, Wong SYS, Kwok TCY. Combination Therapy Showed Limited Superiority Over Monotherapy for Alzheimer Disease: A Meta-analysis of 14 Randomized Trials. J Am Med Dir Assoc 2016; 17:863.e1-8. [PMID: 27349622 DOI: 10.1016/j.jamda.2016.05.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/11/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acetylcholinesterase inhibitor (AChEI) and memantine are recognized drug treatments with limited clinical efficacy. Combination therapy for patients with Alzheimer disease (AD) was suggested, but the additional benefit of combination therapy is still controversial. AIM To evaluate the additional benefit of combination therapy over monotherapy with either AChEI or memantine. METHODS Prospective randomized controlled trials were searched from the OVID databases. The trials were eligible if study subjects were diagnosed with AD, and were randomized to compare combination therapy with monotherapy. Any clinical assessment measured using validated scales on cognitive function, activities of daily living, behavioral problems, and global changes were the primary outcomes, and any reported adverse events were the secondary outcomes. Quality of studies and risk of bias were evaluated. RESULTS Fourteen randomized trials were identified between 2004 and 2015 from the United States, Canada, Germany, Japan, China, and Korea. A total of 5019 patients with AD were randomly assigned to receive combination therapy of AChEI and memantine or monotherapy with AChEI or memantine. Combination therapy showed no significant benefit on cognitive function (mean difference [MD] of MMSE = 0.06, 95% CI -0.52 to 0.65), activities of daily living (MD of ADCS-ADL = -0.15, 95% CI -1.08 to 0.78), neuropsychiatric symptoms and behavioral problems (MD of NPI = -1.85, 95% CI -4.83 to 1.13), and global changes (MD of CIBIC-plus = 0.01, 95% CI -0.25 to 0.28). In subgroup analyses, combination therapy can improve cognitive function more than memantine alone; and it can significantly relieve neuropsychiatric symptoms and behavioral problems when concomitantly used with donepezil. No additional adverse event was reported in the combination therapy. CONCLUSION Combination therapy only showed the benefit on neuropsychiatric symptoms and behavioral problems in moderate-to-severe AD, but no other superiority in terms of cognitive function, activities of daily living, and global changes. Although reported adverse events were comparable, the additional cost for combination therapy may be unnecessary.
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Affiliation(s)
- Kelvin K F Tsoi
- Jockey Club School of Public Health and Primary Care, Hong Kong; Stanley Ho Big Data Decision Analytics Research Centre, Hong Kong
| | - Joyce Y C Chan
- Jockey Club School of Public Health and Primary Care, Hong Kong
| | | | - Hoyee W Hirai
- Jockey Club School of Public Health and Primary Care, Hong Kong; Stanley Ho Big Data Decision Analytics Research Centre, Hong Kong
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
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31
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Uemura K, Shimada H, Doi T, Makizako H, Tsutsumimoto K, Park H, Suzuki T. Reduced prefrontal oxygenation in mild cognitive impairment during memory retrieval. Int J Geriatr Psychiatry 2016; 31:583-91. [PMID: 26387497 DOI: 10.1002/gps.4363] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Memory impairment is considered a hallmark of amnestic mild cognitive impairment (aMCI) and dementia. Emerging evidence suggests that the prefrontal lobe is required to maintain memory functions. The purpose of this study was to clarify whether older adults with aMCI have decreased prefrontal oxygenation during memory encoding and retrieval compared with age-matched healthy older adults, using multi-channel near-infrared spectroscopy. METHODS We examined 64 older adults with aMCI (mean 71.8 years) and 66 cognitively healthy control subjects comparable in age and gender (mean 71.7 years). The concentration of oxy-hemoglobin, which is a reliable biomarker of changes in regional cerebral blood flow, was measured in the prefrontal cortex during encoding and delayed retrieval of a list of 10 target words. Task performance was evaluated as average number of correct answers in the retrieval task. RESULTS Subjects with aMCI showed reduced activation in the bilateral dorsolateral cortex (approximately Brodmann area 9) and provided fewer correct answers in the retrieval period than control subjects. There were no significant differences during encoding. CONCLUSIONS Reduced activation in the dorsolateral cortex during retrieval may cause deficits in memory performance, which may be used as a marker of aMCI. Further studies are required to examine the predictive validity of this decreased activation pattern for the incidence of Alzheimer's disease.
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Affiliation(s)
- Kazuki Uemura
- Institute of Innovation for Future Society, Nagoya University, Nagoya, Japan
| | - Hiroyuki Shimada
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takehiko Doi
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan.,Research Fellow of the Japan Society for the Promotion of Science, Tokyo, Japan
| | - Hyuma Makizako
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kota Tsutsumimoto
- Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hyuntae Park
- National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Medicinal Biotechnology, Dong-A University, Busan, Korea
| | - Takao Suzuki
- National Center for Geriatrics and Gerontology, Obu, Japan
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32
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Kudoh C, Arita R, Honda M, Kishi T, Komatsu Y, Asou H, Mimura M. Effect of ninjin'yoeito, a Kampo (traditional Japanese) medicine, on cognitive impairment and depression in patients with Alzheimer's disease: 2 years of observation. Psychogeriatrics 2016; 16:85-92. [PMID: 25918972 DOI: 10.1111/psyg.12125] [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] [Received: 07/18/2014] [Revised: 01/13/2015] [Accepted: 02/22/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Only a few approved drugs are capable of alleviating the cognitive and behavioural symptoms of people living with Alzheimer's disease (AD). In recent years, however, the number of studies examining the clinical effects of herbal medicines on cognitive function in patients with AD has increased considerably. This study evaluated the long-term effects of a traditional Japanese medicine (Kampo medicine) known as ninjin'yoeito (NYT) on cognitive impairment and mood status in patients with AD over a 2-year period. METHODS Twenty-three patients with mild-to-moderate probable AD according to the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria were included. Each participant had exhibited an insufficient response to treatment with donepezil alone before the start of the trial. Eleven patients received treatment with donepezil alone, and the remaining patients received a combined treatment of donepezil and NYT for 2 years. Patients were assessed by the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale-cognitive component-Japanese version for cognitive function, and the Neuropsychiatric Inventory was used to evaluate the patients' mood status at baseline and every 6 months for 2 years. RESULTS The Mini-Mental State Examination results showed no significant differences between the two groups. Significant improvements were observed on the Alzheimer's Disease Assessment Scale-cognitive component-Japanese version and the Neuropsychiatric Inventory depression scores of patients who received the combined therapy with donepezil and NYT (Alzheimer's Disease Assessment Scale-cognitive component-Japanese version, 12 months: P < 0.01, 18 months: P = 0.04, 24 months: P < 0.01; Neuropsychiatric Inventory depression, 6 months: P < 0.05, 24 months: P < 0.05). CONCLUSIONS A 2-year follow-up of patients receiving donepezil and NYT treatment showed an improved cognitive outcome and alleviation of AD-related depression.
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Affiliation(s)
- Chiaki Kudoh
- KUDOH Clinic for Neurosurgery and Neurology, Tokyo, Japan.,Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryutaro Arita
- Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Honda
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Tokyo, Japan
| | - Taichi Kishi
- Department of Educational Planning and Development, Toho University School of Medicine, Tokyo, Japan
| | - Yasuhiro Komatsu
- Laboratory of Biochemical Pharmacology for Phytomedicine, Kirasato University, Kitasato Institute for Life Science, Tokyo, Japan
| | - Hiroaki Asou
- Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Center for Kampo Medicine, Keio University School of Medicine, Tokyo, Japan
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Magierski R, Sobow T. Benefits and risks of add-on therapies for Alzheimer's disease. Neurodegener Dis Manag 2015; 5:445-62. [DOI: 10.2217/nmt.15.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Despite three decades of intensive research, the efforts of scientific society and industry and the expenditures, numerous attempts to develop effective treatments for Alzheimer's disease have failed. Currently, approved and widely used medications to treat cognitive deficits in Alzheimer's disease are symptomatic only and show at best modest efficacy. In this context, the need to develop a successful, disease-modifying treatment is loudly expressed. One way to achieve this goal is the use of add-on therapies or various combinations of existing ‘conventional’ drugs. Results of several clinical studies and post hoc analyses of combination therapy with all cholinesterase inhibitors and memantine are published. Moreover, there is a need for studies on long-term efficacy of combination therapy in Alzheimer's.
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Affiliation(s)
- Radoslaw Magierski
- Department of Old Age Psychiatry & Psychotic Disorders, Medical University of Lodz, 92–216 Lodz, Czechoslowacka Street 8/10, Poland
| | - Tomasz Sobow
- Department of Medical Psychology, Medical University of Lodz, 91–425 Lodz, Sterlinga Street 5, Poland
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Nagasawa S, Yajima D, Torimitsu S, Chiba F, Iwase H. Postmortem memantine concentration in a non-intoxication case, and the possibility of postmortem redistribution: A case report. Forensic Sci Int 2015; 257:e12-e15. [PMID: 26344557 DOI: 10.1016/j.forsciint.2015.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/14/2015] [Accepted: 08/23/2015] [Indexed: 10/23/2022]
Abstract
In this case study, we measured the concentration of memantine in the heart blood, peripheral blood, urine, liver, thigh muscle, and subcutaneous fat of a 64-year-old woman who was prescribed memantine for early-onset Alzheimer's disease. She died in hospital after an altercation with her husband. Cause of death was clearly not drug intoxication or overdose, so we investigated the postmortem redistribution (PMR) of memantine in the various tissues and blood ratios of the postmortem samples. Memantine concentrations detected were 1.31 μg/mL in the peripheral blood, 3.95 μg/mL in central blood, 2.09 μg/mL in the urine, 25.54 μg/g in the liver, 1.16 μg/g in the thigh muscle and 2.13 μg/g in the subcutaneous fat. In all samples, the concentrations were higher than the accepted therapeutic range (which is approximately 0.09-0.15 μg/mL). The central blood to peripheral blood (C/P) memantine ratio was 3.01 while the liver to peripheral blood (L/P) ratio was 19.5. It is documented that a C/P ratio exceeding 2 and L/P ratio exceeding 20 highlight a propensity for significant PMR. Although this is a single case study, our data suggest that memantine exhibits PMR. Additionally, a lowered pH was found in peripheral blood (pH 6.2) and central blood (pH 6.1). This postmortem reduction in blood pH may also promote the PMR of memantine. Because there is very little available postmortem toxicological data on memantine, our case study will serve as a foundation to assist in future forensic investigations.
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Affiliation(s)
- Sayaka Nagasawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Gao L, Chen X, Tang Y, Zhao J, Li Q, Fan X, Xu H, Yin ZQ. Neuroprotective effect of memantine on the retinal ganglion cells of APPswe/PS1ΔE9 mice and its immunomodulatory mechanisms. Exp Eye Res 2015; 135:47-58. [PMID: 25912193 DOI: 10.1016/j.exer.2015.04.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/20/2015] [Accepted: 04/21/2015] [Indexed: 01/16/2023]
Abstract
Besides the cognitive impairment and degeneration in the brain, vision dysfunction and retina damage are always prevalent in patients with Alzheimer's disease (AD). The uncompetitive antagonist of the N-methyl-d-aspartate receptor, memantine (MEM), has been proven to improve the cognition of patients with AD. However, limited information exists regarding the mechanism of neurodegeneration and the possible neuroprotective mechanisms of MEM on the retinas of patients with AD. In the present study, by using APPswe/PS1ΔE9 double transgenic (dtg) mice, we found that MEM rescued the loss of retinal ganglion cells (RGCs), as well as improved visual impairments, including improving the P50 component in pattern electroretinograms and the latency delay of the P2 component in flash visual evoked potentials of APPswe/PS1ΔE9 dtg mice. The activated microglia in the retinas of APPswe/PS1ΔE9 dtg mice were also inhibited by MEM. Additionally, the level of glutamine synthetase expressed by Müller cells within the RGC layer was upregulated in APPswe/PS1ΔE9 dtg mice, which was inhibited by MEM. Simultaneously, MEM also reduced the apoptosis of choline acetyl transferase-immunoreactive cholinergic amacrine cells within the RGC layer of AD mice. Moreover, the phosphorylation level of extracellular regulated protein kinases 1 and 2 was increased in APPswe/PS1ΔE9 dtg mice, which was blocked by MEM treatment. These findings suggest that MEM protects RGCs in the retinas of APPswe/PS1ΔE9 dtg mice by modulating the immune response of microglia and the adapted response of Müller cells, making MEM a potential ophthalmic treatment alternative in patients with AD.
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Affiliation(s)
- Lixiong Gao
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China; Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing 400038, China.
| | - Xi Chen
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China; School of Medicine, Nankai University, Tianjin 300071, China; Department of Ophthalmology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Yongping Tang
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.
| | - Jinghui Zhao
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing 400038, China.
| | - Qiyou Li
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.
| | - Xiaotang Fan
- Department of Developmental Neuropsychology, School of Psychology, Third Military Medical University, Chongqing 400038, China.
| | - Haiwei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.
| | - Zheng Qin Yin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China; Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.
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Chou PH, Koike S, Nishimura Y, Satomura Y, Kinoshita A, Takizawa R, Kasai K. Similar age-related decline in cortical activity over frontotemporal regions in schizophrenia: a multichannel near-infrared spectroscopy study. Schizophr Bull 2015; 41:268-79. [PMID: 24948388 PMCID: PMC4266293 DOI: 10.1093/schbul/sbu086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Although recent studies have demonstrated that patients with schizophrenia and healthy controls did not differ in the speed of age-related decline in cortical thickness and performances on cognitive tests, hemodynamic changes assessed by functional neuroimaging remain unclear. This study investigated age effects on regional brain cortical activity to determine whether there is similar age-related decline in cortical activity as those observed in cortical thickness and cognitive test performance. METHOD A total of 109 patients with schizophrenia (age range: 16-59 y) and 106 healthy controls (age range: 16-59 y) underwent near-infrared spectroscopy (NIRS) while performing a verbal fluency test (VFT). Group comparison of cortical activity was examined using 2-tailed t tests, adopting the false discovery rate method. The relationship between age and cortical activity was investigated using correlational and multiple regression analyses, adjusting for potential confounding variables. A 2-way ANOVA was conducted to investigate differences in the age effects between diagnostic groups. RESULTS The patient group exhibited significantly decreased cortical activity in several regions of the frontotemporal cortices. However, slopes of age-dependent decreases in cortical activity were similar between patients and healthy individuals at the bilateral frontotemporal regions. CONCLUSIONS Our study showed no significant between-group differences in the age-related decline in cortical activity, as measured by NIRS, over the frontotemporal regions during a VFT. The results of our study may indicate a decrease in cortical activity in a relatively limited period around illness onset rather than continuously progressing over the course of the illness.
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Affiliation(s)
- Po-Han Chou
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan;,Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Shinsuke Koike
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan;,Division for Counseling and Support, Office for Mental Health Support, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yukika Nishimura
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yoshihiro Satomura
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akihide Kinoshita
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ryu Takizawa
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan;,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan;
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Das D, Phillips C, Hsieh W, Sumanth K, Dang V, Salehi A. Neurotransmitter-based strategies for the treatment of cognitive dysfunction in Down syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2014; 54:140-8. [PMID: 24842803 DOI: 10.1016/j.pnpbp.2014.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 01/10/2023]
Abstract
Down syndrome (DS) is a multisystem disorder affecting the cardiovascular, respiratory, gastrointestinal, neurological, hematopoietic, and musculoskeletal systems and is characterized by significant cognitive disability and a possible common pathogenic mechanism with Alzheimer's disease. During the last decade, numerous studies have supported the notion that the triplication of specific genes on human chromosome 21 plays a significant role in cognitive dysfunction in DS. Here we reviewed studies in trisomic mouse models and humans, including children and adults with DS. In order to identify groups of genes that contribute to cognitive disability in DS, multiple mouse models of DS with segmental trisomy have been generated. Over-expression of these particular genes in DS can lead to dysfunction of several neurotransmitter systems. Therapeutic strategies for DS have either focused on normalizing the expression of triplicated genes with important roles in DS or restoring the function of these systems. Indeed, our extensive review of studies on the pathogenesis of DS suggests that one plausible strategy for the treatment of cognitive dysfunction is to target the cholinergic, serotonergic, GABA-ergic, glutamatergic, and norepinephrinergic system. However, a fundamental strategy for treatment of cognitive dysfunction in DS would include reducing to normal levels the expression of specific triplicated genes in affected systems before the onset of neurodegeneration.
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Affiliation(s)
- Devsmita Das
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Cristy Phillips
- Department of Physical Therapy, P.O. Box 910, Arkansas State University, State University, AR, USA
| | - Wayne Hsieh
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA
| | - Krithika Sumanth
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA
| | - Van Dang
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Ahmad Salehi
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA, USA; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA.
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