Alzheimer’s Disease: A Physician’s Guide to Practical Management PDF
Preview Alzheimer’s Disease: A Physician’s Guide to Practical Management
Alzheimer’s Disease C C N U R R E N T L I N I C A L E U R O L O G Y Daniel Tarsy, , S E MD ERIES DITOR Clinical Handbook of Insomnia, edited by Hrayr P. Attarian, 2004 Critical Care Neurology and Neurosurgery, edited by Jose I. Suarez, 2004 Alzheimer’s Disease:A Physician’s Guide to Practical Management, edited by Ralph W. Richter and Brigitte Zoeller Richter, 2004 Field of Vision: A Manual and Atlas of Perimetry, edited by Jason J. S. Barton and Michael Benatar, 2003 Surgical Treatment of Parkinson’s Disease and Other Movement Disorders, edited by Daniel Tarsy, Jerrold L. Vitek, and Andres M. Lozano, 2003 Myasthenia Gravis and Related Disorders, edited by Henry J. Kaminski, 2003 Seizures:Medical Causes and Management, edited by Norman Delanty, 2002 Clinical Evaluation and Management of Spasticity, edited by David A. Gelber and Douglas R. Jeffery, 2002 Early Diagnosis of Alzheimer's Disease, edited by Leonard F. M. Scinto and Kirk R. Daffner, 2000 Sexual and Reproductive Neurorehabilitation, edited by Mindy Aisen, 1997 Alzheimer’s Disease A Physician’s Guide to Practical Management Edited by Ralph W. Richter, MD, FACP Clinical Professor of Neurology and Psychiatry The University of Oklahoma College of Medicine Director, Alzheimer’s Disease Research Unit St. John Medical Center, Tulsa, OK Brigitte Zoeller Richter, DiplPharm Pharmacist, Publicist, Tulsa, OK SPRINGER SCIENCE+BUSINESS MEDIA, LLC © 2004 Springer Science+Business Media New York Originally published by Humana Press Inc. in 2004 Softcover reprint of the hardcover 1st edition 2004 www.humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have warranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences arising from the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experi- ence relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Further it is the responsi- bility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. Cover design: Patricia Cleary. Production Editor: J. Morgan. This publication is printed on acid-free paper. ∞ ANSI Z39.48-1984 (American National Standards Institute) Permanence of Paper for Printed Library Materials. Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients is granted by Springer Scienc e+Business Media, LLC. provided that the base fee of US $25.00 per copy is paid directly to the Copyright Clearance Center (CCC), 222 Rosewood Dr., Danvers MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to the Springer Science+Business Media, LLC. The fee code for users of the Transactional Reporting Service is 0-89603-891-2/04 $25.00. ISBN978-1-4757-4485-9 Library of Congress Cataloging-in-Publication Data Alzheimer’s disease : a physician’s guide to practical management / edited by Ralph W. Richter, Brigitte Zoeller Richter. p. ; cm. — (Current clinical neurology) Includes bibliographical references and index. ISBN 978-1-4757-4485-9 ISBN 978-1-59259-661-4 (eBook) DOI 10.1007/978-1-59259-661-4 1. Alzheimer’s disease. 2. Alzheimer’s disease—Treatment. [DNLM: 1. Alzheimer Disease. WT 155 A4756 2004] I. Richter, Ralph W. II. Zoeller Richter, Brigitte. III. Series. RC523.A3748 2004 616.8’31—dc21 2003006948 Preface Alzheimer’s disease (AD) is a devastating and dehumanizing illness affecting increasingly large numbers of elderly and even middle-aged persons in a worldwide epidemic. Alzheimer’s Disease: A Physician’s Guide to Practical Management was written by selected clinicians and scientists who represent some of the world’s leading centers of excellence in AD research. The editors are proud and grateful for their profound contributions. This book is particularly designed to assist physicians and other health-care professionals in the evaluation, assessment, and treatment of individuals with AD. At the same time, by illuminating the basic scientific background, we hope to provide state-of-the art information about the disease and possible future therapeutic strategies. The recent psychiatric treatment aspects of AD are also clearly presented. Because the early diagnosis of the dementia process is now considered of increasing importance, we focus particularly in several chapters on early changes and preclinical conditions, such as mild cognitive impairment and predementia AD. The pathway toward reaching the goal of prevention of the disease is arduous and requires patience and fortitude. Patients and their families are not well served by overenthusiastic releases from companies or from scientists at a stage of research that can offer only experimental and animal data as grounds for optimism. Nevertheless, it is necessary to be informed about what might be coming up in the future. For this reason, comprehensive and timely information about potential future options for prevention and treatment of AD is included. A number of basic scientists discuss their areas of research in this volume. As a result, we have provided our readers with broad insight into such new therapeutic directions as stem cell therapy and other unique strategies. AD imposes a tremendously painful burden on caregivers as well as friends. The consequences of providing this care are associated with deep feelings of isolation, loneliness, and despair. This has led us to include treatment of these aspects in this volume. We also provide some guidance for caregivers and medical providers on how to overcome the breakdown of communication that the illness creates. It was our primary goal as editors to provide established scientific and clinical knowledge in comprehensible language and to touch upon more recent objects of research. As the reader may notice, we also cover aspects of the disease that have not yet been discussed in the available textbooks on AD. We certainly hope that Alzheimer’s Disease: A Physician’s Guide to Practical Management will serve as a rich source of information that can be utilized by physicians in their daily practice of diagnosing and treating patients with AD. We must particularly bear in mind that the disease still appears to be underdiagnosed and undertreated (1). Supporting physicians in their management of AD is a way of helping patients and families to live better with the disease and to cope with the problems it poses. As we all know, dealing with an AD patient can be an extremely sad and frustrating task. Perhaps this book, by providing practical guidance, can make the task a little easier and help to “keep our hearts open in hell,” as a caregiver once said (2). Ralph Walter Richter, MD, FACP Brigitte Zoeller Richter, DiplPharm 1. Reichman, W.E.: Current pharmacologic options for patients with Alzheimer’s disease. Ann Gen Hosp Psychiatry 2003; 2: 1. 2. Cited from: Thobaben, M.: Helping families understand and communicate with family members who suffer from dementia. Home Care Provid 1999; 4: 139–139,146. v Contents Preface........................................................................................................................................v Contributors.............................................................................................................................xi Part I Scientific Background of Alzheimer’s Disease 1 Genetics of Alzheimer’s Disease and Related Disorders.................................................. 3 John Hardy 2 Neuropathology of Alzheimer’s Disease...........................................................................21 Christian Schultz, Kelly Del Tredici, and Heiko Braak 3 Oxidative Stress in the Development of Alzheimer’s Disease and Other Dementias........................................................................................................33 Domenico Praticò 4 Metabolism and Alzheimer’s Disease................................................................................39 John P. Blass Part II Epidemiology 5 Alzheimer’s Disease: Epidemiological and Statistical Data................................................51 Brigitte Zoeller Richter and Ralph W. Richter 6 The Economic Burden of Alzheimer’s Disease and Dementia......................................57 Anders Wimo and Bengt Winblad 7 Potential and Established Risk Factors for Alzheimer’s Disease..................................65 Brigitte Zoeller Richter Part III Clinical Assessment 8 Medical Diagnosis and Workup of Alzheimer’s Disease...............................................75 Ralph W. Richter 9 Neuroimaging Techniques: CT, MRI, SPECT, PET..........................................................89 Norman L. Foster 10 Biological Markers in Alzheimer’s Disease.....................................................................103 Ramon Diaz-Arrastia and Fred Baskin 11 The Neuropsychology of Alzheimer’s Disease ..............................................................109 Kirsten I. Taylor and Andreas U. Monsch 12 Vascular Cognitive Impairment in Clinical Practice.....................................................121 Kenneth Rockwood and Timo Erkinjuntti 13 Lewy Body Disease..............................................................................................................127 Robert Barber, Jane Newby, and Ian G. McKeith 14 Frontotemporal Lobe Dementia........................................................................................137 Malgorzata Franczak, Diana Kerwin, and Piero Antuono Part IV The Transitional Stage 15 Mild Forgetfulness: Distinguishing Early AD from Normal Aging................................147 Scott A. Small 16 Mild Cognitive Impairment: What the Physician Should Know.....................................153 Brigitte Zoeller Richter vii viii Contents 17 Diagnosis of Predementia AD in a Clinical Setting.......................................................157 Pieter Jelle Visser 18 Loss of Olfactory Function in Patients With Alzheimer’s Disease.............................165 Claire Murphy and Paul E. Gilbert Part V Treatment Options 19 Treatment of Alzheimer’s Disease: Basic Considerations...............................................177 Brigitte Zoeller Richter and Ralph W. Richter 20 Donepezil in Treatment of AD ..........................................................................................179 Ging-Yuek Robin Hsiung and Howard Feldman 21 Rivastigmine for Treatment of AD ...................................................................................187 Martin R. Farlow 22 Galantamine in Treatment of AD......................................................................................193 M. Saleem Ismail and Pierre N. Tariot 23 Memantine in Treatment of AD ........................................................................................203 Hans Jörg Möbius 24 Alternative Treatment Options .........................................................................................211 Brigitte Zoeller Richter Part VI Late-Stage Therapy 25 Pain and Palliative Care in Late-Stage Dementia Patients...........................................217 Sophie Pautex, Dina Zekry, Gilbert Zulian, Gabriel Gold, and Jean-Pierre Michel 26 Cardiological Issues in Late-Stage Alzheimer’s Disease: A Clinician’s Approach .....................................................................................................225 José R. Medina Part VII Prevention Strategies 27 Neuroprotection and Neurodegenerative Disease........................................................235 Frank John Emery Vajda 28 Neurotrophic Factors for Prevention of Alzheimer’s Disease.....................................245 Mark H. Tuszynski 29 Statins in Prevention and Treatment of Alzheimer’s Disease.....................................253 David A. Drachman 30 Potential Role of Androgens and Androgen Receptors in Alzheimer’s Disease...................................................................................................259 Jacob Raber 31 Role of Nutrition in Prevention or Delay of Alzheimer’s Disease..............................273 Hannes B. Staehelin 32 Impact of Physical Activity on Prevention of Alzheimer’s Disease...........................281 Danielle Laurin, René Verreault, and Joan Lindsay Part VIII Future Developments 33 Stem Cell Therapy for Alzheimer’s Disease....................................................................289 Kiminobu Sugaya 34 Secretases as Potential Targets for Treatment of Alzheimer’s Disease......................301 Weiming Xia Contents ix 35 AMPA Potentiation as a Treatment Option for Alzheimer’s Disease........................309 Amy S. Chappell and Michael M. Witte 36 Glycosaminoglycans as Potential Future Treatment of Alzheimer’s Disease..........315 Umberto Cornelli 37 Implications of Research for Management of AD..........................................................329 Peter J. Whitehouse Part IX Treatment Outcome Measurement 38 Rating Scales and Outcome Variables Used in Clinical Trials....................................337 Lon S. Schneider Part X Neuropsychiatric Management 39 Gender Differences in Behavior of AD Patients.............................................................353 Brian R. Ott 40 Management of Emotional and Behavioral Symptoms in AD....................................363 Myron F. Weiner 41 Assessment and Treatment of Neuropsychiatric Symptoms in Alzheimer’s Disease...................................................................................................371 Andrew R. Gustavson and Jeffrey L. Cummings 42 Neuropsychiatric Symptoms in African American Dementia Patients.....................387 Raymelle Schoos, Carl I. Cohen, and Lorna Walcott-Brown 43 Resource Utilization by African American Dementia Patients...................................395 Beatrice Pollock 44 Apathy in Alzheimer’s Disease: Relationship to Executive Function.............................399 Susan McPherson 45 Are Alzheimer’s Patients Aware of Their Deficits?.......................................................407 Ben Seltzer Part XI Family and Care Issues 46 Diagnostic Family Conference in AD: Issues and Recommendations............................................................................................415 Paul Michael Ramirez, David Castro-Blanco, and Michelle Kehn 47 Care, Caregiver Issues, and Communication With the Demented Patient...............421 Ralph W. Richter and Brigitte Zoeller Richter 48 Dental Care of AD Patients................................................................................................427 Christina A. Gitto, Michael J. Moroni, Geza T. Terezhalmy, and Satinderpal K. Sandu 49 Long-Term Medical Care Issues........................................................................................441 Vonda K. Gravely and Jacobo Mintzer 50 Loneliness and Depression in Caregivers .......................................................................449 Rose A. Beeson 51 Frequently Asked Questions About Alzheimer’s Disease...........................................455 Brigitte Zoeller Richter Appendix:Resources.............................................................................................................461 Index.......................................................................................................................................465 Contributors PIERO ANTUONO,MD• Professor of Neurology and Pharmacology, The Medical College of Wisconsin, Milwaukee, WI ROBERT BARBER, MD,MRCPsych• Centre for Health of the Elderly, Newcastle General Hospital, Newcastle upon Tyne, United Kingdom FRED BASKIN,PhD• Associate Professor, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX ROSE A. BEESON,DNSc, RN• Assistant Professor, William F. Connell School of Nursing, Boston College, Cushing Hall, Chestnut Hill, MA JOHN P. BLASS,MD,PhD• Director, Dementia Research Service, Burke Medical Research Institute; Professor of Neurology and Medicine, Weill Medical College of Cornell University, White Plains, NY HEIKO BRAAK,MD• Professor, Institute for Clinical Neuroanatomy, Johann-Wolfgang-Goethe- University, Frankfurt/Main, Germany DAVID CASTRO-BLANCO,PhD• Associate Professor, Doctoral Program in Clinical Psychology, Department of Psychology, Long Island University, Brooklyn Campus, New York, NY AMY S. CHAPPELL,MD• Lilly Corporate Center, Indianapolis, IN CARL I. COHEN,MD• Professor and Director, Division of Geriatric Psychiatry, Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY UMBERTO CORNELLI,MD,PhD,DrScHc• Adjunct Professor of Pharmacology, Loyola University Stritch School of Medicine Chicago, Milan, Italy JEFFREY L. CUMMINGS,MD• Professor of Neurology and Psychiatry, Reed Neurological Research Center, Department of Neurology, UCLA School of Medicine, Los Angeles KELLY DEL TREDICI,PhD• Institute for Clinical Neuroanatomy, Johann-Wolfgang-Goethe- University, Frankfurt/Main, Germany RAMON DIAZ-ARRASTIA• Associate Professor, Department of Neurology, University of Texas Southwestern Medical School, Dallas, TX DAVID A. DRACHMAN,MD• Professor of Neurology, Department of Neurology, University of Massachusetts Medical School, Worcester, MA TIMO ERKINJUNTTI,MD,PhD•Department of Neurology, University of Helsinki, Helsinki, Finland MARTIN R. FARLOW,MD• Professor and Vice Chairman for Research in Neurology, Department of Neurology, Indiana University School of Medicine, IUPUI; Director, Clinical Care of Alzheimer Disease Care Center; Co-Director Alzheimer's Disease Clinic; Affiliated Scientist, Indiana University Center for Aging Research, Indianapolis, IN HOWARD FELDMAN,MD,FRCP(C)• Professor and Head, Division of Neurology, University of British Columbia Hospital, Vancouver, BC, Canada NORMAN L. FOSTER,MD• Professor, Department of Neurology, Senior Research Scientist, Institute of Gerontology, University of Michigan, Ann Arbor, MI MALGORZATA FRANCZAK,MD• Assistant Professor of Neurology, The Medical College of Wisconsin, Milwaukee, Wisconsin PAUL E. GILBERT,PhD• Department of Head and Neck Surgery, University of California San Diego, School of Medicine; Lifespan Human Senses Laboratory, San Diego, CA CHRISTINA A. GITTO,DDS• Department of Dentistry and Maxillofacial Prosthetics, The Cleveland Clinic Foundation, Cleveland, OH GABRIEL GOLD,MD• Hôpital de Gériatrie, Thônex-Genève, Switzerland xi
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