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Shen M, Zhang L, Li C, Ma Y, Gao S, Ma Y. Meta-analysis with trial sequential analysis investigating the impact of adjunctive electroacupuncture therapy on vascular mild cognitive impairment. Transl Psychiatry 2024; 14:349. [PMID: 39214960 PMCID: PMC11364872 DOI: 10.1038/s41398-024-03052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND To systematically collect, evaluate, and synthesize evidence from randomized controlled trials (RCTs) supporting the use of electroacupuncture (EA) as an additional treatment option for Vascular mild cognitive impairment (VaMCI), a meta-analysis was carried out. METHODS Electronic searches of eight databases were used to locate RCTs that evaluated EA as a VaMCI adjuvant therapy. The Cochrane Risk of bias was used to assess the included trials' methodological quality. Review Manager 5.4 was used to analyze the data. Trial sequential analysis (TSA) was conducted with the trial sequential analysis program. RESULTS There were 15 RCTs with 1033 subjects in them. Compared to conventional therapy (CT) alone, the Montreal Cognitive Assessment (SMD 0.72, 95 percent CI [0.55, 0.88]), Mini-mental State Examination (SMD 0.73, 95 percent CI [0.60, 0.87]), and activities of daily living (SMD 0.83, 95 percent CI [0.54, 1.12]) were significantly improved while EA was used in conjunction with CT. The current studies exceeded the required information size, according to trial sequential analysis (TSA), demonstrating the reliability of EA adjuvant therapy VaMCI. CONCLUSIONS According to the pooled data, EA as an adjunct therapy for the treatment of VaMCI increases clinical efficacy. Although the TSA confirms a stable conclusion, it is encouraged to conduct studies of the highest quality standards.
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Affiliation(s)
- Min Shen
- Department of Acupuncture and Massage, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Linlin Zhang
- Key Laboratory of New Material Research, Institute of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chunjing Li
- Department of Acupuncture and Massage, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuning Ma
- Key Laboratory of New Material Research, Institute of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shuzhong Gao
- Department of Acupuncture and Massage, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yuxia Ma
- Department of Acupuncture and Massage, College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
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Gareri P, Cotroneo AM, Gelmini G, Mossello E, Massaia M. An algorithm for the early diagnosis and correct approach to dementia management: results of a multiprofessional team. Aging Clin Exp Res 2024; 36:102. [PMID: 38702570 PMCID: PMC11068660 DOI: 10.1007/s40520-024-02749-z] [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: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUNG The early identification of cognitive disorder is a primary scope, because it could reduce the rate of severe cognitive impairment and thus contribute to reduce healthcare costs in the next future. AIMS The present paper aimed to build a virtuous diagnostic path of cognitive impairment, highlighting all the professionalism that can serve this purpose. METHODS The Delphi method was used by the experts, who reviewed the information available during each meeting related to the following topics: early diagnosis of cognitive impairment, definition of Mild Cognitive Impairment, unmet needs in post-stroke patients, critical decision-making nodes in complex patients, risk factors, neuropsychological, imaging diagnosis, blood tests, the criteria for differential diagnosis and the possible treatments. RESULTS The discussion panels analyzed and discussed the available evidences on these topics and the related items. At each meeting, the activities aimed at the creation of a diagnostic-welfare flow chart derived from the proposal of the board and the suggestions of the respondents. Subsequently, the conclusions of each panel were written, and the study group reviewed them until a global consensus was reached. Once this process was completed, the preparation of the final document was carried out. CONCLUSIONS Eventually, we built an algorithm for the early diagnosis and treatment, the risk factors, with the possible differences among the different kinds of dementia.
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Affiliation(s)
- Pietro Gareri
- Department of Frailty, Head Physician CDCD Catanzaro Lido - ASP Catanzaro, Viale Crotone 214, 88100, Catanzaro, Italy.
| | | | | | - Enrico Mossello
- Department of Experimental and Clinical Medicine, University of Florence and SOD Geriatrics-UTIG, AOU Careggi, Florence, Italy
| | - Massimiliano Massaia
- Head Physician CDCD, Complex Unit of University Geriatrics - AO Health and Science City, Turin, Italy
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Gareri P, Cotroneo AM, Montella R, Gaglianone M, Putignano S. Citicoline: A Cholinergic Precursor with a Pivotal Role in Dementia and Alzheimer's Disease. J Alzheimers Dis 2024; 100:725-733. [PMID: 38905051 PMCID: PMC11307077 DOI: 10.3233/jad-240497] [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] [Accepted: 05/15/2024] [Indexed: 06/23/2024]
Abstract
Background Citicoline is a naturally occurring compound with pleiotropic effects on neuronal function and cognitive processes. Objective Based on previous studies, which shed light on the positive effects of citicoline 1 g when combined with acetylcholinesterase inhibitors (AChEIs) and/or memantine, we further investigated the benefits of citicoline in combination therapy in Alzheimer's disease and mixed dementia. Methods We integrated the datasets of CITIMEM and CITIDEMAGE, increasing the overall sample size to enhance statistical power. We analyzed data from these two investigator-initiated studies involving 295 patients. The primary outcome was the assessment over time of the effects of combined treatment versus memantine given alone or AChEI plus memantine on cognitive functions assessed by Mini-Mental State Examination (MMSE). The secondary outcomes were the influence of combined treatment on daily life functions, mood, and behavioral symptoms assessed by activities of daily life (ADL) and instrumental ADL, Geriatric Depression Scale, and Neuropsychiatric Inventory Scale. One-hundred-forty-three patients were treated with memantine and/or AChEI (control group), and 152 patients were treated with memantine and/or AChEI plus citicoline 1 g/day orally (Citicoline group). Results A significant difference in MMSE score was found in the average between the two groups of treatment at 6 and 12 months. Conclusions This study confirmed the effectiveness of combined citicoline treatment in patients with mixed dementia and Alzheimer's disease, with a significant effect on the increase of MMSE score over time. The treated group also showed a significant reduction in the Geriatric Depression Scale and a significant increase in the instrumental ADL scale.
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Affiliation(s)
- Pietro Gareri
- Unit of Frailty, Center of Cognitive Impairment and Dementia, Catanzaro Lido, ASP Catanzaro, Catanzaro Lido, Italy
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Xue Q, Yang Y, Li H, Li X, Zou L, Li T, Ma H, Qi H, Wang J, Yu T. Functions and mechanisms of protein lysine butyrylation (Kbu): Therapeutic implications in human diseases. Genes Dis 2023; 10:2479-2490. [PMID: 37554202 PMCID: PMC10404885 DOI: 10.1016/j.gendis.2022.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/27/2022] [Accepted: 10/20/2022] [Indexed: 11/30/2022] Open
Abstract
Post-translational modifications (PTM) are covalent modifications of proteins or peptides caused by proteolytic cleavage or the attachment of moieties to one or more amino acids. PTMs play essential roles in biological function and regulation and have been linked with several diseases. Modifications of protein acylation (Kac), a type of PTM, are known to induce epigenetic regulatory processes that promote various diseases. Thus, an increasing number of studies focusing on acylation modifications are being undertaken. Butyrylation (Kbu) is a new acylation process found in animals and plants. Kbu has been recently linked to the onset and progression of several diseases, such as cancer, cardiovascular diseases, diabetes, and vascular dementia. Moreover, the mode of action of certain drugs used in the treatment of lymphoma and colon cancer is based on the regulation of butyrylation levels, suggesting that butyrylation may play a therapeutic role in these diseases. In addition, butyrylation is also commonly involved in rice gene expression and thus plays an important role in the growth, development, and metabolism of rice. The tools and analytical methods that could be utilized for the prediction and detection of lysine butyrylation have also been investigated. This study reviews the potential role of histone Kbu, as well as the mechanisms underlying this process. It also summarizes various enzymes and analytical methods associated with Kbu, with the goal of providing new insights into the role of Kbu in gene regulation and diseases.
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Affiliation(s)
- Qianqian Xue
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Yanyan Yang
- Department of Immunology, School of Basic Medicine, Qingdao University, Qingdao, Shandong 266021, China
| | - Hong Li
- Clinical Laboratory, Central Laboratory. The Affiliated Qingdao Hiser Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Xiaoxin Li
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Lu Zou
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Tianxiang Li
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Huibo Ma
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Hongzhao Qi
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Jianxun Wang
- Department of Immunology, School of Basic Medicine, Qingdao University, Qingdao, Shandong 266021, China
| | - Tao Yu
- Institute for Translational Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
- Department of Cardiac Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
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Gareri P, Veronese N, Cotroneo AM. An Overview of Combination Treatment with Citicoline in Dementia. Rev Recent Clin Trials 2021; 17:4-8. [PMID: 34939548 DOI: 10.2174/1574887117666211221170344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/01/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The present article reports an overview of the studies about combination treatment with citicoline of Alzheimer's (AD) and mixed dementia (MD). METHODS A Medline search was carried out by using the keywords Alzheimer's dementia, mixed dementia, older people, treatment with citicoline, memantine, and acetylcholinesterase inhibitors (AchEIs). RESULTS Six studies were found to match the combination treatment of citicoline with AcheIs and/or memantine. The CITIRIVAD and CITICHOLINAGE studies were the first to report the potential benefits of adding citicoline to acetylcholinesterase inhibitors (AchEIs). Then, we added citicoline to memantine in the CITIMEM study, and finally, we demonstrated benefits in terms of delay in cognitive worsening with the triple therapy (citicoline + AchEIs + memantine). Other authors also reinforced our hypothesis through two further studies. CONCLUSIONS Open, prospective studies are advised to confirm the utility of combination therapy with citicoline for the treatment of AD and MD.
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Affiliation(s)
- Pietro Gareri
- Center for Cognitive Disorders and Dementia - Catanzaro Lido, ASP Catanzaro; Catanzaro. Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo. Italy
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Barbier M, Schulte C, Kornadt A, Federspiel C, Steinmetz JP, Vögele C. Using social marketing for the promotion of cognitive health: a scoping review protocol. BMJ Open 2021; 11:e049947. [PMID: 34645664 PMCID: PMC8515474 DOI: 10.1136/bmjopen-2021-049947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The use of social marketing strategies to induce the promotion of cognitive health has received little attention in research. The objective of this scoping review is twofold: (i) to identify the social marketing strategies that have been used in recent years to initiate and maintain health-promoting behaviour; (ii) to advance research in this area to inform policy and practice on how to best make use of these strategies to promote cognitive health. METHODS AND ANALYSIS We will use the five-stage methodological framework of Arksey and O'Malley. Articles in English published since 2010 will be searched in electronic databases (the Cochrane Library, DoPHER, the International Bibliography of the Social Sciences, PsycInfo, PubMed, ScienceDirect, Scopus). Quantitative and qualitative study designs as well as reviews will be considered. We will include those articles that report the design, implementation, outcomes and evaluation of programmes and interventions concerning social marketing and/or health promotion and/or promotion of cognitive health. Grey literature will not be searched. Two independent reviewers will assess in detail the abstracts and full text of selected citations against the inclusion criteria. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart for Scoping Reviews will be used to illustrate the process of article selection. We will use a data extraction form, present the results through narrative synthesis and discuss them in relation to the scoping review research questions. ETHICS AND DISSEMINATION Ethics approval is not required for conducting this scoping review. The results of the review will be the first step to advance a conceptual framework, which contributes to the development of interventions targeting the promotion of cognitive health. The results will be published in a peer-reviewed scientific journal. They will also be disseminated to key stakeholders in the field of the promotion of cognitive health.
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Affiliation(s)
- Mathilde Barbier
- Department of Behavioral and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Caroline Schulte
- Department of Computer Science, Therapeutic Sciences, University of Applied Sciences Trier Department of Computer Science, Trier, Germany
| | - Anna Kornadt
- Department of Behavioral and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | | | | | - Claus Vögele
- Department of Behavioral and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Castagna A, Fabbo A, Manzo C, Lacava R, Ruberto C, Ruotolo G. A Retrospective Study on the Benefits of Combined Citicoline, Memantine, and Acetylcholinesterase Inhibitor Treatments in Older Patients Affected with Alzheimer's Disease. J Alzheimers Dis 2021; 79:1509-1515. [PMID: 33459645 DOI: 10.3233/jad-201211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Background: Citicoline has been proven to have beneficial effects in patients with cognitive impairment. In previous studies, combined treatment with memantine and acetylcholinesterase inhibitors (AChEIs) maintained cognitive function in patients with Alzheimer's disease (AD) better than memantine or AChEIs alone. OBJECTIVE To evaluate the effectiveness and safety of a combination therapy of oral citicoline, memantine, and an AChEI in AD when compared with memantine and an AChEI without citicoline. METHODS This was a retrospective multi-centric case-control study, conducted in Italian Centers for Cognitive Impairment and Dementia. Overall, 170 patients were recruited (34.11%of men, mean age 76,81±4.93 years): 48.8%treated with memantine and donepezil; 48.2%with memantine and rivastigmine; 2.9%with memantine and galantamine. 89 patients (control-group) were treated with memantine and an AChEI, whereas 81 patients (case-group) were treated with oral citicoline 1000 mg/day added to memantine and an AChEI given orally. Cognitive functions, activities of daily living, instrumental activities of daily living, comorbidities, mood and behavioral disturbances were assessed at baseline, month 6, and month 12. RESULTS In the case group, MMSE score had a statistically significant increasing trend between T0 and T2 (14.88±2.95 versus 15.09±3.00; p = 0.040), whereas in the control group, MMSE score showed a statistically significant decrease trend (14.37±2.63 versus 14.03±2.92 p = 0.024). CONCLUSION In older patients with AD, a triple therapy with citicoline, memantine, and AChEI was more effective than memantine and AChEI without citicoline in maintaining the MMSE total score after 12 months.
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Affiliation(s)
- Alberto Castagna
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
| | - Andrea Fabbo
- Health Authority and Services of Modena (AUSL di Modena), Geriatric Service-Cognitive Disorders and Dementia Unit, Modena, Italy
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department, Center for Cognitive Disorders and Dementia, Pomigliano d'Arco (Naples), Italy
| | - Roberto Lacava
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
| | - Carmen Ruberto
- Azienda Sanitaria Provinciale Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
| | - Giovanni Ruotolo
- Azienda Ospedaliera Pugliese-Ciaccio, Geriatric Unit, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
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Svob Strac D, Konjevod M, Sagud M, Nikolac Perkovic M, Nedic Erjavec G, Vuic B, Simic G, Vukic V, Mimica N, Pivac N. Personalizing the Care and Treatment of Alzheimer's Disease: An Overview. Pharmgenomics Pers Med 2021; 14:631-653. [PMID: 34093032 PMCID: PMC8169052 DOI: 10.2147/pgpm.s284615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive, complex, and multifactorial neurodegenerative disorder, still without effective and stable therapeutic strategies. Currently, available medications for AD are based on symptomatic therapy, which include acetylcholinesterase (AChE) inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonist. Additionally, medications such as antipsychotic drugs, antidepressants, sedative, and hypnotic agents, and mood stabilizers are used for the management of behavioral and psychological symptoms of dementia (BPSD). Clinical research has been extensively investigated treatments focusing on the hallmark pathology of AD, including the amyloid deposition, tau hyperphosphorylation, neuroinflammation, and vascular changes; however, so far without success, as all new potential drugs failed to show significant clinical benefit. The underlying heterogeneous etiology and diverse symptoms of AD suggest that a precision medicine strategy is required, which would take into account the complex genetic, epigenetic, and environmental landscape of each AD patient. The article provides a comprehensive overview of the literature on AD, the current and potential therapy of both cognitive symptoms as well as BPSD, with a special focus on gut microbiota and epigenetic modifications as new emerging drug targets. Their specific patterns could represent the basis for novel individually tailored approaches aimed to optimize precision medicine strategies for AD prevention and treatment. However, the successful application of precision medicine to AD demands a further extensive research of underlying pathological processes, as well as clinical and biological complexity of this multifactorial neurodegenerative disorder.
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Affiliation(s)
- Dubravka Svob Strac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marcela Konjevod
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Marina Sagud
- Department of Psychiatry, Clinical Hospital Centre Zagreb, Zagreb, Croatia
- University of Zagreb Medical School, Zagreb, Croatia
| | - Matea Nikolac Perkovic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Gordana Nedic Erjavec
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Barbara Vuic
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Goran Simic
- Department of Neuroscience, Croatian Institute for Brain Research, Zagreb, Croatia
| | - Vana Vukic
- Department of Neuroscience, Croatian Institute for Brain Research, Zagreb, Croatia
| | | | - Nela Pivac
- Laboratory for Molecular Neuropsychiatry, Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
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Castagna A, Manzo C, Fabbo A, Lacava R, Ruberto C, Ruotolo G. The CITIMERIVA Study: CITIcoline plus MEmantina plus RIVAstigmine in Older Patients Affected with Alzheimer's Disease. Clin Drug Investig 2021; 41:177-182. [PMID: 33484469 DOI: 10.1007/s40261-020-00996-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Combined therapy of memantine or acetylcholinesterase inhibitors, with cholinergic precursors such as citicoline, can be effective in Alzheimer's disease. Indeed, they are able to increase the intrasynaptic levels of acetylcholine more than the single drug. Our aim was to evaluate the efficacy and safety of oral citicoline plus memantine plus rivastigmine in patients with Alzheimer's disease. METHODS This was a multi-centric, retrospective case-control study conducted in Italian Centers for Cognitive Impairment and Dementia on consecutive patients aged 65 years or older affected with Alzheimer's disease. Overall, 104 patients were recruited (27% male, mean age 76.04 ± 4.92 years); 41 (39.42%) treated with citicolin 1000 mg/day given orally + memantine + rivastigmine (Cases) and 63 (60.58%) treated with memantine + rivastigmine (Controls). At baseline (T0), month 6 (T1) and month 12 (T2), cognitive functions were assessed by the Mini Mental State Examination (MMSE), functional dependence by basal Activities (ADL) and Instrumental Activities of Daily Living (IADL), comorbidity by the Cumulative Illness Rating Scale (CIRS), mood by the Geriatric Depression Scale (GDS), and behavioural disturbances by the Neuropsychiatric Inventory (NPI). Adverse events were reported during the study. RESULTS The difference in MMSE score was not significant when comparing the two groups at T0, T1 or T2. However, in the case group, the MMSE total score showed a statistically significant difference at T0 versus T1 (13.63 ± 2.46 vs. 14.17 ± 2.24; p = 0.008), and at T0 versus T2 (13.63 ± 2.46 vs. 14.32 ± 2.53; p = 0.002). In the control group, no statistical differences were found at baseline (T0), T1 and T2. ADL, IADL, GDS and NPI total score did not improve during the study in either the case or the control group. CONCLUSIONS In our study we observed absence of a statistically significant difference between case and control groups for the MMSE total scores. However, in the case group in the MMSE total scores, there was a statistically significant increase between the baseline and the end of the study.
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Affiliation(s)
- Alberto Castagna
- Azienda Sanitaria Provinciale di Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, viale Crotone, 88100, Catanzaro, Italy.
| | - Ciro Manzo
- Azienda Sanitaria Locale Napoli 3 sud, Internal and Geriatric Medicine Department, Center for Cognitive Disorders and Dementia, Health District no.51, Pomigliano d'Arco, Naples, Italy
| | - Andrea Fabbo
- Azienda Unica Sanitaria Locale di Modena, Geriatric Service, Cognitive Disorders and Dementia Unit, Modena, Italy
| | - Roberto Lacava
- Azienda Sanitaria Provinciale di Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, viale Crotone, 88100, Catanzaro, Italy
| | - Carmen Ruberto
- Azienda Sanitaria Provinciale di Catanzaro, Primary Care Departiment, Center for Cognitive Disorders and Dementia, viale Crotone, 88100, Catanzaro, Italy
| | - Giovanni Ruotolo
- Azienda Ospedaliera Pugliese-Ciaccio di Catanzaro, Geriatric Unit, Center for Cognitive Disorders and Dementia, Catanzaro, Italy
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Gareri P, Cotroneo AM, Orsitto G, Putignano S. The Importance of Citicoline in Combined Treatment in Dementia: What did the Citimem Study Teach us? Rev Recent Clin Trials 2020; 16:126-130. [PMID: 33243132 DOI: 10.2174/1574887115999201126205538] [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: 05/06/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Citicoline is a drug used both in degenerative and in vascular cognitive decline; memantine is a drug used for the treatment of mild to moderate Alzheimer's disease (AD). Our hypothesis is that their combined use could have enhanced action in patients having AD and mixed dementia (MD). We report the main tips from a recent study on the use of these drugs, the CITIMEM study. METHODS The study was retrospective and was performed on 126 patients aged 65 years old or older affected with AD or MD (mean age 80.7 ± 5.2 years old) who had been visited between 2015 and 2017 in four different centers for dementia all over Italy. Neuropsychological and functional tests were administered at baseline (T0), after 6 (T1), and 12 months (T2). The effects of combined treatment versus memantine alone on cognitive functions assessed by Mini-Mental State Examination (MMSE) and the possible onset of side effects or adverse events, as well as the influence on daily life functions and behavioral symptoms, were investigated. RESULTS Patients undergoing combined treatment showed a significant increase in MMSE vs. memantine alone, both at T1 (p=0.003) and T2 (p =0.000). CONCLUSION The CITIMEM study confirms our hypothesis that the combined administration of memantine plus citicoline is safe and more effective than memantine alone on cognition in patients suffering from AD or MD.
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Affiliation(s)
- Pietro Gareri
- Center for Cognitive Disorders and Dementia, Catanzaro Lido, ASP Catanzaro, Catanzaro, Italy
| | - Antonino Maria Cotroneo
- Department of Elderly Health Care, Birago di Vische Hospital and Botticelli Territorial Geriatrics - ASL TO 2, Turin, Italy
| | - Giuseppe Orsitto
- U.O.C. Internal Medicine Ward, P.O. Bari Sud "Di Venere", Bari - Azienda Sanitaria Locale di Bari, Italy
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The Art of Safe and Judicious Deprescribing in an Elderly Patient: A Case Report. Geriatrics (Basel) 2020; 5:geriatrics5030057. [PMID: 32967254 PMCID: PMC7554853 DOI: 10.3390/geriatrics5030057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
Prescription for inappropriate drugs can be dangerous to the elderly due to the increased risk of adverse drug reactions and drug-interactions. In this manuscript, we report the complexity of polypharmacy and the possible harmful consequences in an old person. An 81-year-old man with a clinical history of diabetes, blood hypertension, non-valvular atrial fibrillation, chronic obstructive pulmonary disease, osteoarthritis, anxiety, and depression, was admitted to our attention for cognitive disorders and dementia. Brain magnetic resonance imaging showed parenchymal atrophy with lacunar state involving thalami and internal capsules. Neuropsychological tests revealed cognitive impairment and a depressed mood. History revealed that he was taking 11 different drug severy day with a potential risk of 55 drug-drug interactions. Therefore, risperidone, chlorpromazine, N-demethyl-diazepam, and L-DOPA/carbidopa were gradually discontinued and citicoline (1g/day), cholecalciferol (50,000 IU once a week), and escitalopram (5 mg/day) were started. Furthermore, he started a program of home rehabilitation. During the follow-up, three months later, we recorded an improvement in both mood and cognitive tests, as well as in walking ability. The present case report shows the need for a wise prescription and deprescribing in older people.
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