Tratamento da doença de Alzheimer: recomendações e sugestões do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia  <span class="so-article-trans-title" dir="auto"> Translated title: Treatment of Alzheimer’s Disease: recommendations and suggestions of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology </span>

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

As presentes recomendações e sugestões para o "Tratamento da Doença de Alzheimer" foram elaboradas por grupo de trabalho constituído por participantes da IV Reunião de Pesquisadores em Doença de Alzheimer e Desordens Relacionadas, patrocinada pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Compreendem tópicos sobre o tratamento farmacológico e não farmacológico do comprometimento cognitivo e declínio funcional, assim como dos sintomas de comportamento e psicológicos dessa doença demenciante. São utilizados diversos níveis de evidências e de recomendações e sugestões para os diversos fármacos propostos, assim como para o tratamento não farmacológico, baseado em ampla revisão bibliográfica, nacional e internacional.

Translated abstract

The present recommendations and suggestions on "Treatment of Alzheimer’s Disease" were elaborated by a work group constituted by participants of the IV Meeting of Researchers on Alzheimer’s Disease and Related Disorders, sponsored by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. They comprise topics on pharmacological and non-pharmacological treatment of cognitive impairment and functional decline, as well as of behavioral and psychological symptoms of this dementing disease. Several levels of evidence and of recommendations and suggestions are used for the various proposed drugs, as well as for non-pharmacological treatment, underpinned by a wide national and international bibliographical review.

Related collections

Most cited references 105

Record: found
Abstract: found
Article: not found

Nonsteroidal antiinflammatory drugs and the risk of Alzheimer's disease.

Bas In 't Veld, Annemieke Ruitenberg, Albert Hofman … (2001)

Previous studies have suggested that the use of nonsteroidal antiinflammatory drugs (NSAIDs) may help to prevent Alzheimer's disease. The results, however, are inconsistent. We studied the association between the use of NSAIDs and Alzheimer's disease and vascular dementia in a prospective, population-based cohort study of 6989 subjects 55 years of age or older who were free of dementia at base line, in 1991. To detect new cases of dementia, follow-up screening was performed in 1993 and 1994 and again in 1997 through 1999. The risk of Alzheimer's disease was estimated in relation to the use of NSAIDs as documented in pharmacy records. We defined four mutually exclusive categories of use: nonuse, short-term use (1 month or less of cumulative use), intermediate-term use (more than 1 but less than 24 months of cumulative use), and long-term use (24 months or more of cumulative use). Adjustments were made by Cox regression analysis for age, sex, education, smoking status, and the use or nonuse of salicylates, histamine Hz-receptor antagonists, antihypertensive agents, and hypoglycemic agents. During an average follow-up period of 6.8 years, dementia developed in 394 subjects, of whom 293 had Alzheimer's disease, 56 vascular dementia, and 45 other types of dementia. The relative risk of Alzheimer's disease was 0.95 (95 percent confidence interval, 0.70 to 1.29) in subjects with short-term use of NSAIDs, 0.83 (95 percent confidence interval, 0.62 to 1.11) in those with intermediate-term use, and 0.20 (95 percent confidence interval, 0.05 to 0.83) in those with long-term use. The risk did not vary according to age. The use of NSAIDs was not associated with a reduction in the risk of vascular dementia. The long-term use of NSAIDs may protect against Alzheimer's disease but not against vascular dementia.

0 comments Cited 236 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial.

Sylvia Wassertheil‐Smoller, Judith Ockene, Claudine Legault … (2003)

Postmenopausal women have a greater risk than men of developing Alzheimer disease, but studies of the effects of estrogen therapy on Alzheimer disease have been inconsistent. On July 8, 2002, the study drugs, estrogen plus progestin, in the Women's Health Initiative (WHI) trial were discontinued because of certain increased health risks in women receiving combined hormone therapy. To evaluate the effect of estrogen plus progestin on the incidence of dementia and mild cognitive impairment compared with placebo. The Women's Health Initiative Memory Study (WHIMS), a randomized, double-blind, placebo-controlled clinical trial, began enrolling participants from the Women's Health Initiative (WHI) estrogen plus progestin trial in May 1996. Of the 4894 eligible participants of the WHI study, 4532 (92.6%) postmenopausal women free of probable dementia, aged 65 years or older, and recruited from 39 of 40 WHI clinical centers were enrolled in the WHIMS. Participants received either 1 daily tablet of 0.625 mg of conjugated equine estrogen plus 2.5 mg of medroxyprogesterone acetate (n = 2229), or a matching placebo (n = 2303). Incidence of probable dementia (primary outcome) and mild cognitive impairment (secondary outcome) were identified through a structured clinical assessment. The mean (SD) time between the date of randomization into WHI and the last Modified Mini-Mental State Examination (3MSE) for all WHIMS participants was 4.05 (1.19) years. Overall, 61 women were diagnosed with probable dementia, 40 (66%) in the estrogen plus progestin group compared with 21 (34%) in the placebo group. The hazard ratio (HR) for probable dementia was 2.05 (95% confidence interval [CI], 1.21-3.48; 45 vs 22 per 10 000 person-years; P =.01). This increased risk would result in an additional 23 cases of dementia per 10 000 women per year. Alzheimer disease was the most common classification of dementia in both study groups. Treatment effects on mild cognitive impairment did not differ between groups (HR, 1.07; 95% CI, 0.74-1.55; 63 vs 59 cases per 10 000 person-years; P =.72). Estrogen plus progestin therapy increased the risk for probable dementia in postmenopausal women aged 65 years or older. In addition, estrogen plus progestin therapy did not prevent mild cognitive impairment in these women. These findings, coupled with previously reported WHI data, support the conclusion that the risks of estrogen plus progestin outweigh the benefits.

0 comments Cited 166 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study.

Jon Lane, Howard Fillit, Claudine Legault … (2004)

The Women's Health Initiative Memory Study (WHIMS) previously found increased risk for dementia and no effect on mild cognitive impairment (MCI) in women treated with conjugated equine estrogens (CEE) plus medroxyprogesterone acetate (MPA). To determine the effects of CEE alone and CEE plus MPA on incidence of probable dementia and MCI in older women. Randomized, double-blind, placebo-controlled clinical trials of CEE (estrogen-alone trial) or CEE plus MPA (estrogen plus progestin trial) in community-dwelling women aged 65 to 79 years, conducted from June 1995 to July 8, 2002 (estrogen plus progestin; n = 4532), or to February 29, 2004 (estrogen-alone; n = 2947), in 39 of the 40 WHI clinical centers. In the estrogen-alone trial, 1 daily tablet containing either 0.625 mg/d of CEE vs matching placebo; in the estrogen plus progestin trial, 1 daily tablet containing CEE (0.625 mg/d) plus MPA (2.5 mg/d) vs matching placebos. Probable dementia and MCI. In the estrogen-alone trial, 47 participants were diagnosed with probable dementia, of whom 28 were assigned to CEE and 19 to placebo (hazard ratio [HR], 1.49; 95% confidence interval [CI], 0.83-2.66). Incidence rates for probable dementia in the estrogen-alone trial were statistically similar to those in the estrogen plus progestin trial (45 vs 22 per 10 000 person-years for CEE plus MPA vs placebo, respectively; P =.11). When data were pooled per the original WHIMS protocol, the overall HR for probable dementia was 1.76 (95% CI, 1.19-2.60; P =.005). After excluding participants with baseline Modified Mini-Mental State Examination scores at or below the screening cut point, the HR was 1.77 (95% CI, 0.74-4.23; P =.20) in the estrogen-alone trial and 2.19 (95% CI, 1.25-3.84; P =.006) in the pooled trials. In the estrogen-alone trial, 76 participants were diagnosed with MCI in the CEE group vs 58 in the placebo group (HR, 1.34; 95% CI, 0.95-1.89). In the combined trial data, the HR was similar (1.25; 95% CI, 0.97-1.60). In the estrogen-alone trial, 93 participants receiving CEE were diagnosed with either probable dementia or MCI vs 69 receiving placebo (HR, 1.38; 95% CI, 1.01-1.89; P =.04). Estrogen therapy alone did not reduce dementia or MCI incidence and increased the risk for both end points combined. Pooling data for estrogen alone and estrogen plus progestin resulted in increased risks for both end points. Use of hormone therapy to prevent dementia or cognitive decline in women 65 years of age or older is not recommended.

0 comments Cited 110 times – based on 0 reviews      Review now

All references

Author and article information

Journal

Journal ID (publisher-id): anp

Title: Arquivos de Neuro-Psiquiatria

Abbreviated Title: Arq. Neuro-Psiquiatr.

Publisher: Academia Brasileira de Neurologia - ABNEURO (São Paulo, SP, Brazil )

ISSN (Print): 0004-282X

ISSN (Electronic): 1678-4227

Publication date (Print and electronic): December 2005

Volume: 63

Issue: 4

Pages: 1104-1112

Affiliations

[02] orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina orgdiv2Grupo de Neurologia Cognitiva e do Comportamento

[06] orgnameFMUSP orgdiv1Instituto de Psiquiatria

[08] , Rio de Janeiro RJ orgnameUERJ orgdiv1Faculdade de Medicina orgdiv2Faculdade de Ciências Médicas Brasil

[03] São Paulo SP orgnameUniversidade Federal de São Paulo orgdiv1Departamento de Psicobiologia Brasil

[05] orgnameINDC/UFR orgdiv1Ambulatórios de Demência

[07] orgnameUFRJ orgdiv1Instituto de Psiquiatria orgdiv2Centro de Doença de Alzheimer

[04] orgnameUFRJ

[09] orgnameCHMS-RP orgdiv1Grupo de Neurologia do Comportamento

[01] RJ orgnameUniversidade Federal do Rio de Janeiro orgdiv1Instituto de Neurologia Deolindo Couto orgdiv2Setor de Neurologia Cognitiva e do Comportamento Brasil