Guidelines for the use of tacrine in Alzheimer's disease: clinical application and effectiveness. Johns Hopkins Dementia Research Clinic

The efficacy of tacrine for treatment of Alzheimer's has been demonstrated in several clinical trials but has not been assessed in cases complicated by medical and psychiatric comorbidities. Additionally, the benefit-risk ratio of tacrine is small, so it is best administered with carefully developed guidelines that specify this ratio for patients and families. On the basis of guidelines developed for the Johns Hopkins Dementia Research Clinic, tacrine treatment was offered to 162 patients with probable Alzheimer's. Only 35 accepted, and only 22 continued on tacrine beyond 3 months. The latter group declined by 1.36 points over 1 year on the Mini-Mental State Examination, significantly less than expected. The authors conclude that, if used in the context of clinical guidelines, tacrine is an effective treatment for Alzheimer's.

Factors affecting influenza vaccination among attendees at a senior center

Influenza is an important cause of morbidity and mortality in the elderly. We questioned attendees at a Baltimore County senior center that offered influenza vaccination about the factors that influenced their decision to receive vaccination. Of the 43 responders, 37 (86%) stated they already had received vaccination in 1994 or were planning to be vaccinated. Vaccinated seniors were more likely than nonvaccinated seniors to believe that they were susceptible to influenza and they were more likely to have had influenza vaccination recommended to them by their physician. Vaccinated seniors also were more knowledgeable about the influenza vaccine. Physician recommendation appears to be an important factor in the decision by seniors to receive influenza vaccination.

Mania in Alzheimer's disease

A chart review of 134 patients with Alzheimer's disease (AD) showed a 2.2% prevalence of mania, lower than previously cited. Of 3 patients with mania, 2 had a history of mania before the onset of AD. Prevalence rates and the role of Alzheimer's disease in the development of mania are discussed.