Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-30T02:32:58.084Z Has data issue: false hasContentIssue false
  • English
  • Français

The Use of Medications for Cognitive Enhancement

Published online by Cambridge University Press:  02 December 2014

William Pryse-Phillips ,
Shelley Sternberg ,
Paula Rochon ,
Gary Naglie ,
Howard Strong  and
John Feightner
William Pryse-Phillips
Affiliation:
Memorial University, St. John’s, Newfoundland, Canada
Shelley Sternberg
Affiliation:
Department of, Medicine, Section of Geriatrics, University of Chicago, USA
Paula Rochon
Affiliation:
Department of Medicine, University of Toronto, Ontario, Canada
Gary Naglie
Affiliation:
Department of Medicine, University of Toronto, Ontario, Canada
Howard Strong
Affiliation:
Department of Psychiatry, Memorial University, St. John’s, Newfoundland, Canada
John Feightner
Affiliation:
University of Western Ontario, London ON, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To provide Canadian physicians and allied health care professionals with the evidence they need to help them make treatment decisions in the management of patients with Alzheimer’s disease or other dementias.

Options:

The full range and quality of diagnostic and therapeutic modalities available to Canadian physicians for the management of dementia.

Outcomes:

Improvement in the treatment of dementias, leading to reduced suffering, increased functional capacity and decreased economic burden.

Evidence and values:

The creation of these evidence-based consensus statements involved literature reviews of the subject by the authors; comparison of alternative clinical pathways and description of the methods whereby published data were analyzed; definition of the level of evidence for data in each case; evaluation and revision in a conference setting (involving primary care physicians, neurologists, psychiatrists, geriatricians, psychologists, consumers and other interested parties); insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all authors.

Benefits, harms, and costs:

A rational plan for the therapy of dementias is likely to lead to substantial benefits in both human and economic terms.

Recommendations:

Treatment decisions should be made taking into account the severity or stage of the disease, the availability of caregivers, the presence of disease affecting other bodily systems and the ability of the subject to pay the cost of the medications. Donepezil is considered to have positive effects upon certain tests of neuropsychological function and may produce some improvement in Alzheimer’s disease of mild to moderate severity as measured by rating scales. Its ability to improve quality of life remains uncertain. No other drug treatments* (apart from symptomatic therapies) are at present approved for the treatment of Alzheimer’s disease.

Validation:

These recommendations were created by a writing committee, evaluated and revised at a consensus conference and further reviewed and revised by the writing committee prior to publication.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 28 , Supplement S1: Canadian Consensus Conference on Dementia , May 2001 , pp. S108 - S114
Copyright
Copyright © The Canadian Journal of Neurological 2001

References

1. Canadian Medical Association. Guidelines for Canadian clinical practice guidelines. Ottawa: The Association; 1994.Google Scholar
2. Woolf, SH, Battista, RN, Anerson, GM, et al. Assessing the clinical effectiveness of preventive manoeuvres: analytical principles and systematic methods in reviewing evidence and developing clinical practice recommendations. J Clin Epidemiol 1994;43: 891–905.Google Scholar
3. Patterson, CJS, Gauthier, S, Bergman, H, et al. The recognition, assessment and management of dementing disorders: conclusions from the Canadian conference on dementia. Can Med Assoc J 1999; (Suppl 12):160.Google ScholarPubMed
4. Chatellier, G, Lacomblez, L. Tacrine (tetrahydroaminoacridine;THA) and lecithin in senile dementia of the Alzheimer type: a multicentre trial. Br Med J 1990;300(6723):495–499.Google Scholar
5. Molloy, DW, Guyatt, GH, Wilson, DB, et al. Effect of tetrahydroaminoacridine on cognition, function and behaviour in Alzheimer’s disease. Can Med Assoc J 1991;144:29–33.Google Scholar
6. Gracon, SI. Evaluation of tacrine hydrochloride (Cognex) in two parallel-dose studies. Acta Neurol Scanda 1996;165(Suppl): S114–S122.Google Scholar
7. Knapp, MJ, Knopman, DS, Solomon, PR, et al. A 30-week randomized controlled trial of high-dose tacrine in patients with Alzheimer’s disease. JAMA 1994;271:985–989.CrossRefGoogle ScholarPubMed
8. Raskind, MA, Sadowsky, CH, Sigmund, WR, et al. Effect of tacrine on language, praxis and noncognitive behavioural problems in Alzheimer’s disease. Arch Neurol 1997;54:836–840.Google Scholar
9. Knopman, DS, Schneider, L, Davis, K, et al. Long term tacrine (Cognex) treatment: effects on nursing home placement and mortality. Neurology 1996;47; 166–177.Google Scholar
10. Watkins, PB, Zimmerman, HJ, Knapp, MJ, et al. Hepatotoxic effects of tacrine administration in patients with Alzheimer’s disease. JAMA 1994;271:992–998.Google Scholar
11. Rogers, SL, Friedhoff, LT, Donepezil study group. The efficacy and safety of donepezil in patients with Alzheimer’s disease: results of a US multicenter randomized double-blind, placebo-controlledtrial. Dementia 1996;7:293–303.Google Scholar
12. Rogers, SL, Friedhoff, LT. Long term efficacy and safety of donepezil in the treatment of Alzheimer’s disease: an interim analysis of the results of a US multicenter open label study. Eur Neuropsychopharmacol 1997;8:67–75.CrossRefGoogle Scholar
13. Rogers, SL, Farlow, MR, Doody, RS, et al. A 24-week, double-blind placebo controlled trial of donepezil in patients with Alzheimer’s disease. Neurology 1998;50:136–145.CrossRefGoogle ScholarPubMed
14. Burns, A, Rossor, M, Hecker, J, et al. The effects of donepezil in Alzheimer’s disease-results from a multinational trial. Dement Geriatr Cog Disord 1999;10:237–244.Google Scholar
15. Rogers, SL, Doody, RS, Mohs, RC, et al. Donepezil improves cognition and global function in Alzheimer’s disease. Arch Intern Med 1998;158:1021–1031.Google Scholar
16. Greenberg, SM, Tennis, MK, Brown, LB, et al. Donepezil therapy in clinical practice. Arch Neurol 2000;57:94–99.CrossRefGoogle ScholarPubMed
17. Sano, M, Ernesto, C, Thomas, RG, et al. A controlled trial of selegiline, alpha tocopherol or both as treatment for Alzheimer’s disease: the AD cooperative study. New Eng J Med 1997;336:1216–1222.Google Scholar
18. Drachman, DA, Leber, P. Treatment of Alzheime ’s disease: Searching for a breakthrough, settling for less. New Eng J Med 1997;336(17):1245–1247.Google Scholar
19. Gnemmni, P, Rossi, F, Monteverde, A, et al. Selegiline in the treatment of mild to moderate Alzheimer-type dementia. Clin Therap 1990;12:315–322.Google Scholar
20. Campi, N, Todeschini, GP, Scarzella, L, et al. Selegiline vs L-acetylcarnitine in the treatment of Alzheimer-type dementia. Clin Therap 1990;12:306–314.Google Scholar
21. Tariot, PN, Cohen, RM, Welkowitz, JA, et al. Multiple-dose arecholine infusions in Alzheimer’s disease. Arch Gen Psychiatry 1988;45:901–905.Google Scholar
22. Lawlor, BA, Aisen, PS, Green, C, et al. Selegiline in the treatment of behavioural disturbances in Alzheimer’s disease. Int J Geriatric Psychiatr 1997;12:319–322.3.0.CO;2-Q>CrossRefGoogle Scholar
23. Finali, G, Piccirilli, M, Oliani, C, et al. L-deprenyl therapy improves verbal memory in amnesic Alzheimer patients. Clin Neuro Pharmacol 1991;14:523–536.Google ScholarPubMed
24. Finali, G, Piccirilli, M, Oliani, C. Alzheimer-type dementia and verbal memory performances: influence of selegiline therapy. J Neurol Sci 1992;13:141–148.Google Scholar
25. Burke, WJ, Roccaforte, WH, Wengel, SP, et al. L-deprenyl in the treatment of mild dementia of the Alzheimer type: results of a 15-month trial. J Am Geriatr Soc 1993;41:1219–1225.CrossRefGoogle ScholarPubMed
26. Mangoni, A, Grassi, MP, Frattola, M, et al. Effects of a MAO-B inhibitor in the treatment of Alzheimer’s disease. Eur Neurol 1991;31(2):100–107.Google Scholar
27. Freedman, M, Rewilak, D, Xerri, T, et al. L-deprenyl in Alzheimer’s disease: cognitive and behavioural effects. Neurology 1998; 50(3):660–668.Google Scholar
28. Filip, V, Kolibas E for the Czech and Slovak Senile Dementia of Alzheimer Type Study Group. Selegiline in the treatment of Alzheimer’s disease: a long-term randomized placebo-controlled trial. J Psychiatry Neurosci 1999;24(3):234–243.Google Scholar
29. Kanowski, S, Herrmann, WM, Stephan, K. Proof of efficacy of the ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi-infarct dementia. Pharmacopsychiatry 1996;29(1):47–56.CrossRefGoogle ScholarPubMed
30. Le Bars, PL. A placebo-controlled, double-blind randomised trial of an extract of ginkgo biloba for dementia. JAMA 1997;278:1327–1332.Google Scholar
31. Marcusson, J, Rother, M, Kittner, BA. A 12-month, randomized, placebo-controlled trial of propentofylline (HWA285) in patients with dementia according to DSM-III. Dement Geriatr Cogn Disord 1997;8:320–328.Google Scholar
32. Thompson, TL. Lack of efficacy of hydergine in patients with Alzheimer’s disease. New Eng J Med 1990;323:445–448.Google Scholar
33. Van Reekum, R, et al. Cognition-enhancing drugs in dementia: A guide to the near future. Can J Psychiatr 1997;42(Suppl.1):35S–50S.Google Scholar
34. Schneider, LS, Olin, JT. Overview of clinical trials of hydergine in dementia. Arch Neurol 1994;51:787–798.Google Scholar
35. Thal, LJ, Carta, A, Clarke, WR, et al. A 1-year, multicenter, placebo-controlled study of acetyl-l-carnitine in patients with Alzheimer’s disease. Neurology 1996;47:705–711.Google Scholar
36. Spagnoli, A, Lucca, U, Menasce, G, et al. Long-term acetyl-L-carnitine treatment in Alzheimer’s disease. Neurology 1991;41:1726–1732.Google Scholar
37. Rai, G, Wriight, G, Scott, L, et al. Double-blind, placebo-controlled study of acetyl L-carnitine in patients with Alzheimer’s dementia. Curr Med Res Opinion 1990;11:638–647.Google Scholar
38. Heyman, A, Schmechel, D, Wilkinson, W, et al. Failure of long-term,high dose lecithin to retard progression of early-onset Alzheimer’s disease. J Neural Transmission (Suppl.) 1987;24(2):279–286.Google Scholar
39. Foster, NL, Petersen, RC, Gracon, SI, et al. An enriched-population,double-blind, placebo-controlled crossover study of tacrine and lecithin in Alzheimer’s disease. Dementia 1996;7:260–266.Google Scholar
40. Tariot, PN, Cohen, RM, Welkowitz, JA, et al. Multiple-dose arecholine infusions in Alzheimer’s disease. Arch Gen Psychiatry 1988;45:901–905.Google Scholar
41. Tollefson, GD. Long term effects of the calcium channel blocker nimodipine (Bay-e-9736) in the management of primary degenerative dementia. Biol Psychiatry 1990;27:1133–1142.Google Scholar
42. Antuono, PG. Effectiveness and safety of velnacrine for the treatment of Alzheimer’s disease: a double-blind, placebo-controlled study. Arch Int Med 1995;155:1766–1972.CrossRefGoogle ScholarPubMed
43. Thal, LJ, Schwartz, G, Sano, M, et al. A multicenter double-blind study of controlled-release physostigmine for the treatment of symptoms secondary to Alzheimer’s disease. Neurology 1996;47:1389–1395.Google Scholar
44. Sano, M, Bel, K, Marder, K. Safety and efficacy of oral physostigmine in the treatment of Alzheimer’s disease. Clin Neuro Pharmacol 1993;16:61–69.Google Scholar
45. Stern, RG, Sano, M, Mayeux, R. Long-term administration of oral physo-stigmine in Alzheimer’s disease. Neurology 1988;38:1837–1841.Google Scholar
46. Canal, N, Imbimbo, BP. Relationship between pharmacodynamic study and cognitive effects of eptastigmine in patients with Alzheimer’s disease. Clin Pharmacol Ther 1996;60:218–228.Google Scholar
47. Delwaide, PJ, Gyselynck-Mambourg, AM, Hurlet, A, et al. Double-blind randomized controlled study of phosphatidylserine in senile demented patients. Acta Neurol Scand 1986;73:136–140.Google Scholar
48. Fleischhacker, WW, Buchgeher, A, Schubert, H. Memantine in the treatment of senile dementia of the Alzheimer type. Prog Neuro-psychopharmacol Biol Psychiatry 1986;10:87–89.Google Scholar
49. Davidson, M, Zemishlany, Z, Mohs, RC, et al. 4-Aminopyridine in the treatment of Alzheimer’s disease. Biol Psychiatry 1988;23:485–490.CrossRefGoogle ScholarPubMed
50. Tariot, PN, Sunderland, T, Weingartner, H, et al. Naloxone and Alzheimer’s disease: cognitive and behavioural effects of a range of doses. Arch Gen Psychiatry 1986;43:727–732.Google Scholar
51. Rockwood, K, Beattie, BL, Eastwood, MR, et al. A randomized controlled trial of linopirdine in the treatment of Alzheimer’s disease. Can Med Assoc J 1987;24:140–145.Google Scholar
52. Senin, U, Abate, G, Fieschi, C, et al. Aniracetam (Ro 13-5057) in the treatment of senile dementia of Alzheimer type (SDAT): results of a placebo-controlled multicentre clinical study. Eur Neuropsychopharmacol 1991;1:511–517.Google Scholar
53. Dysken, MW, Mendels, J, Lewitt, P, et al. Milacemide: a placebo-controlled study in senile dementia of the Alzheimer type. J Am Geriatr Soc 1992;40:503–506.CrossRefGoogle ScholarPubMed
54. Hermann, WM, Stephan, K, Gaede, K, et al. A multicenter,randomized double-blind study on the efficacy and safety of nice rgoline in patients with multi-infarct dementia. Dement Geriatr Cogn Disord 1997;8:9–17.Google Scholar
55. Bergamasco, B, Scarzella, L, La Commare, P. Idebenone, a new drug in the treatment of cognitive impairment in patients with dementia of the Alzheimer type. Funct Neurol 1994;9:161–168.Google Scholar
56. Xu, SS, Gao, ZX, Weng, Z, et al. Efficacy of tablet huperzine-A on memory, cognition, and behaviour in Alzheimer’s disease. Acta Pharmacol Sinica 1995;16:391–395.Google Scholar
57. Passeri, M, Cucinotta, D, Abate, G, et al. Oral 5’-methyltetrahydrofolic acid in senile organic mental disorders with depression: results of a double-blind multicentre study. Aging 1938;5:63–71.Google Scholar
58. McLachlan, DR, Smith, WL, Kruck, T P. Desferrioxamine and Alzheimer’s disease: Video home behaviour assessment of clinical course and measures of brain aluminum. Ther Drug Monit 1993;15:602–607.Google Scholar
59. Kanowski, S, Fischhof, PK, Grobe-Einsler, R, et al. Efficacy of xantinolnicotinate in patients with dementia. Pharmacopsychiatry 1990;23:118–124.Google Scholar
60. Sramek, JJ, Viereck, C, Huff, FJ, et al. A “bridging” (safety/tolerance) study of bespirdine hydrochloride in patients with Alzheimer’s disease. Life Sci 1995;57:1241–1248.Google Scholar
61. Fakouki, TK, Jhee, SS, Shramik, JJ, et al. Evaluation of cysloserine in the treatment of Alzheimer’s disease. J Geriatr Psychiatry Neurol 1995;8:226–230.CrossRefGoogle Scholar
62. Schellenbert, R, Todorova, A, Wedekind, W, et al. Pathophysiology and psycho-pharmacology of dementia – a new study design. 2. Cyclandelate treatment – placebo-controlled, double-blind clinical trial. Neuropsychobiology 1997;35(3):132–142.Google Scholar
63. Mellor, AM, Sunderland, T, Cohen, RM, et al. Acute effects of high-dose thyrotropin releasing hormone infusions in Alzheimer’s disease. Psychopharmacology 1989;98:403–407.CrossRefGoogle Scholar
64. Rosen, WG, Mohs, WC, Davis, KL. A new rating scale for Alzheimer’s disease. Am J Psychiatry 1984;141:1356–1364.Google Scholar
65. Stern, RG, Mohs, RC, Davidson, M, et al. A longitudinal study of Alzheimer’s disease: measurement, rate and predictors of cognitive deterioration. Am J Psychiatry 1994;151:390–396.Google Scholar
66. Knopman, DS, Knapp, MJ, Gracon, SI, et al. The Clinician Interview-Based Impression (CIBI): a clinicians global change rating scale in Alzheimer’s disease. Neurology 1994;44:2315–2321.Google Scholar
67. Schneider, LS, Olin, JT, Doody, RS, et al. Validity and reliability of the Alzheimer’s disease Cooperative study – Clinical Global Impression of Change. Alzheimer Dis Assoc Disord 1997;11(Suppl 2):S22–S32.Google Scholar