Category Archives: Alzheimer’s

Dr. Gott: Seroquel not advised for elderly

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I know some of you read Dr. Gott. Here’s another MD’s opinion about Seroquel (quetiapine). Of course your MD’s opinion may be different!

http://www.montereyherald.com/health/ci_11525837

Ask Dr. Gott: Seroquel not advised for elderly
Peter Gott
Updated: 01/22/2009

Dear Dr. Gott: Please give your opinion on Seroquel being prescribed to a patient with dementia. I’ve heard it is a dangerous drug when given to the elderly, as it can cause death. Should this drug be given long term?

Dear Reader: Seroquel is a medication used to treat conditions such as bipolar disorder. It is not approved for behavioral problems related to dementia. Black-box warnings for elderly patients with a dementia-related psychosis indicate an increased risk of serious side effects, including pneumonia, heart attack, stroke and death.

The product is available in doses from 25 milligram to 300 milligram tablets or capsules by prescription only. When the drug is prescribed for the elderly, the recommended initial dose is 25 milligrams daily. Contraindications are noted for people with a history of hypertension, stroke, thyroid disorder, diabetes, high cholesterol, seizures or heart attack.

Side effects include fever, sweating, uncontrolled muscle movements, severe headaches, visual and gait disturbances, and more. Be sure to speak to the prescribing physician should any symptoms occur.

Seroquel XR extended-release tablets contain black-box warnings because of an increased mortality rate in elderly patients with dementia. XR is indicated for treatment of schizophrenia, a name given to a group of mental disorders in which a patient loses touch with reality and is unable to think or act in a rational manner. The condition is often treated with tranquilizers and specific drugs to lessen the degree of depression.

Extended-release tabs are not recommended for the elderly. Adverse reactions include dry mouth, dizziness, orthostatic hypotension, constipation, a feeling of sedation and more.

There are a number of interactions with this drug. Be sure to advise your physician of medications you are taking to ensure there will not be a negative response should he or she choose to prescribe Seroquel XR.

The long-term effectiveness (more than six weeks) has not been fully evaluated. All prescribing physicians should re-evaluate patients on a regular basis.

You are correct that the drug can be dangerous for elderly patients with dementia. I can only hope the prescribing physician fully researched all the options before prescribing it and that the dose is a reasonable one.

All patients regardless of age who are treated with antidepressants or antipsychotics for any condition should be monitored carefully for negative alterations in behavior, especially during the early stages of a new medication. Family and caregivers must be observant and should report those changes accordingly.

If you continue to have unanswered questions and have the legal right to be involved with the care of the individual in question, return to the prescribing physician with a list and request answers. If you are dissatisfied, seek a second opinion.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, N.Y. 10016.

Study of Antipsychotics in Alzheimer’s (UK)

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UK research was published in the journal Lancet Neurology today. This was a study comparing those with Alzheimer’s taking antipsychotics (including Risperdal) and those with AD not taking this type of medication. In the article below, the study’s lead author is quoted as saying: ”Would I want to take a drug that slightly reduced my aggression but doubled my risk of dying? I’m not sure I would.” Here’s the text of the short article:

(This AP story was published in many places, including the New York Times.)
http://www.nytimes.com/aponline/2009/01 … Drugs.html

January 8, 2009
Study: Alzheimer’s Drugs May Raise Death Risk in Elderly
By THE ASSOCIATED PRESS

LONDON (AP) — Anti-psychotic drugs commonly used to treat Alzheimer’s disease may double a patient’s chance of dying within a few years, suggests a new study that adds to concerns already known about such medications.

”For the vast majority of Alzheimer’s patients, taking these drugs is probably not a worthwhile risk,” said Clive Ballard, the paper’s lead author, of the Wolfson Centre for Age-Related Diseases at King’s College London.

”Would I want to take a drug that slightly reduced my aggression but doubled my risk of dying? I’m not sure I would,” Ballard said.

The research was published Friday in the medical journal, Lancet Neurology.

Alzheimer’s disease is the most common cause of dementia and causes symptoms including aggression, delusions and hallucinations. Previous studies have shown anti-psychotic drugs, which can help control the aggression and hallucinations for a few months raise the risk of death in older patients with dementia. There are other side effects, including respiratory problems and stroke.

Ballard and colleagues followed 165 patients aged 67 to 100 years with moderate to severe Alzheimer’s disease from 2001 to 2004 in Britain. Half continued taking their anti-psychotic drugs, which included Risperdal, Thorazine and Stelazine. The other half got placebos.

Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia.

After two years, 46 percent of Alzheimer’s patients taking the anti-psychotics were alive, versus 71 percent of those not on the drugs. After three years, only 30 percent of patients on the drugs were alive, versus 59 percent of those not taking drugs.

In the United Kingdom and the United States, guidelines advise doctors to use anti-psychotic drugs cautiously and temporarily. But in many nursing homes in Europe and North America, up to 60 percent of patients with dementia are routinely given the drugs for one to two years.

”The drug regimen for any person with Alzheimer’s needs to be personalized,” said William Thies of the Alzheimer’s Association in the U.S. Thies was not connected to the study. ”At some points, some people will be better off with no medication.”

Simon Lovestone of the Institute of Psychiatry at King’s College in London said psychiatrists should try environmental or behavioral therapies instead of anti-psychotics.

Experts aren’t sure how the anti-psychotics increase patients’ risk of dying. But they think the drugs could be damaging to the brain and their sedative effects make patients less able to exercise and more susceptible to deadly infections.

The study was paid for by the U.K. Alzheimer’s Research Trust. Ballard reported receiving grants from various pharmaceutical companies which make drugs used to treat Alzheimer’s patients.

Tau aggregation, 12/08 research (Japan)

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Here’s the most interesting part of this new abstract on research into tau aggregation: “It is believed that aberrant modifications of tau, including phosphorylation, truncation, and conformational changes, induce filamentous aggregation. However, the mechanism underlying the conversion of tau protein from a soluble state to one of insoluble aggregates still remains elusive. ”

Current Alzheimer Research. 2008 Dec;5(6):591-8.

Tau oligomerization: a role for tau aggregation intermediates linked to neurodegeneration.

Sahara N, Maeda S, Takashima A.
Laboratory for Alzheimer’s Disease, RIKEN Brain Science Institute, Wako-shi, Saitama, Japan.

Intracellular accumulation of filamentous tau proteins is a defining feature of neurodegenerative diseases, including Alzheimer’s disease, progressive supranuclear palsy, corticobasal degeneration, Pick’s disease, and frontotemporal dementia with Parkinsonism linked to chromosome 17, all known collectively as tauopathies. Tau protein is a member of microtubule (MT)-associated proteins. Tau is a highly soluble and natively unfolded protein dominated by a random coil structure in solution. It is believed that aberrant modifications of tau, including phosphorylation, truncation, and conformational changes, induce filamentous aggregation. However, the mechanism underlying the conversion of tau protein from a soluble state to one of insoluble aggregates still remains elusive. The importance of tau aggregation intermediates (e.g. tau dimer, tau multimer, and granular tau oligomer) in disease pathogenesis was suggested by recent studies. Here, we review the latest developments in tracking the structural changes of tau protein and discuss the utility improving our understanding of tau aggregation pathway leading to human tauopathies.

PubMed ID#: 19075586 (see pubmed.gov for abstract only)

NPH Commonly Misdiagnosed as PD, Atypical Parkinsonism or AD

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Good Morning America (on ABC) had a segment this Thursday on NPH (normal pressure hydrocephalus). (Janet Edmunson alerted me to this segment.) Common symptoms in NPH are gait problems (shuffling), urinary incontinence, memory problems, and slowed thinking. Some of these symptoms can also be found in the four atypical parkinsonism disorders. I have occasionally read about people being diagnosed with PSP, CBD, MSA, or LBD initially, and then MDs figure out it is actually NPH. (I’ve probably read about more cases that go the other way: initial diagnosis of NPH, and a later diagnosis of an atypical parkinsonism disorder.) According to this GMA segment, NPH can be misdiagnosed as Alzheimer’s or Parkinson’s Disease. An MRI is critical in diagnosing NPH. This is one of the few dementia-causing conditions that is treatable.

Here’s a link to the video of the GMA segment:
http://abcnews.go.com/Video/playerIndex?id=6196343
(You’ll have to watch a short commercial beforehand. And the volume is set *very* high for both the ad and the segment; you can turn it down.)

At the bottom of this post is a transcript of the Good Morning America segment. Here’s a link to the transcript:
http://abcnews.go.com/GMA/OnCall/story? … 680&page=1

Finally, you can locate info on NPH here:
http://www.lifenph.com/
http://www.emedicine.com/neuro/topic277.htm

Is It Really Alzheimer’s?
NPH Commonly Is Misdiagnosed as Alzheimer’s Disease
By JUJU CHANG, THEA TRACHTENBERG and IMAEYEN IBANGA
Good Morning America (ABC News)

Nov. 6, 2008 —

When 74-year-old Phil Myers was barely able to walk and his memory seemed to be going quickly, his wife, Shirley Myers, was terrified. She watched as the man she loved and was married to for 54 years slipped away, with thoughts of the two children they’d raised clearly in her mind.

“At first I was scared,” Shirley Myers said. “He took care of his family. He was just a family man. That was it. And he did so much for me.”

Is It Alzheimer’s?
“The doctors kept saying, ‘Oh, he’s OK. He’s OK,’ but then things kept getting worse — like dragging his feet. And then he started kind of forgetting where he was at,” Shirley Myers said.

The first diagnosis doctors gave Phil Myers was devastating; they believed it was a form of Alzheimer’s.

“When they told me it was Alzheimer’s, I couldn’t believe it because he was only 70 years old and it just didn’t seem like it was his time yet,” Shirley Myers said.

So the two went to see neurologist Mark Luciano from the Cleveland Clinic. He suspected it wasn’t Alzheimer’s at all, but rather something called normal pressure hydrocephalus, or NPH.

What Is NPH?
According to “Good Morning America” medical editor Dr. Tim Johnson, NPH can begin at age 55 and no one knows why.

The condition occurs when cerebral spinal fluid accumulates in the brain. The extra fluid pushes the brain against the nerves that affect memory, walking and balance, and bladder control.

“Hydrocephalis just means water inside the brain. It’s when water builds up and starts pressing on the brain itself,” Luciano said.

“The symptoms come on very gradually and they can be very subtle,” he said. “A gait problem, a problem with your bladder control, a problem with your memory, those are all very common symptoms in our elderly population.”

Other symptoms include problems with thinking, a slowing down of the thought process. Since the symptoms are so common, the condition is often misdiagnosed.

That happens in part because the warning signs come on very gradually and they can be very subtle, Johnson said. Also, in the elderly population, loss of memory, walking slowly, bladder control problems are all very common problems, so it looks like many other diseases, such as Parkinson’s, Alzheimer’s or dementia, he added.

“It is one of the only treatable forms of dementia or memory loss. It can be not only treated, but in many cases reversed to a great extent just by removing the fluid,” Luciano said.

An MRI of the brain will show the enlarged ventricles and is a way for doctors to properly diagnose the condition, Johnson said.

Treatment of NPH
Treatment for NPH is a relatively simple operation.

“When they told us it was — it would be treatable, it was like a miracle,” Shirley Myers said. “We all felt like it’s a miracle.”

A shunt is implanted in the brain and leads the excess fluid away from the brain and into the abdomen.

“Quite honestly, we weren’t sure that fluid removal was going to help him,” Luciano said.

Four months ago, Phil Myers had the operation to implant the shunt, four years after his symptoms first appeared.

Now the man, who once had tremendous trouble walking, travels with much more ease.

“It was quite, quite nice to be able to do the things you want to do,” he said.

Phil Myers remains in recovery and Luciano said it can take up to a full year to see all the effects of the procedure.

“The improvement that we see now, we hope, that he has for many years,” Luciano said.

“He still has a ways to go on some issues, but his walking is terrific. And that’s what the doctor was looking for I think. And his balance has improved,” Shirley Myers said.

Click here to get more information about NPH: http://www.lifenph.com/

“Alzheimer’s vaccine stopped plaque, not dementia”

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Interesting news today out of London about an AD vaccine that removed beta-amyloid protein in the brain of 7 patients but did nothing for their dementia.

http://www.salon.com/wires/ap/scitech/2 … index.html

Alzheimer’s vaccine stopped plaque, not dementia
By MARIA CHENG
Associated Press Writer

Jul 17th, 2008 | LONDON — Some doctors have long suspected that if the plaque that builds up in the brains of patients with Alzheimer’s disease could be removed, they could be saved. But a new vaccine that did just that suggests the theory is wrong.

British researchers gave 64 patients with moderate Alzheimer’s disease an experimental vaccine designed to eliminate plaque from their brains. Some patients were followed for up to six years.

Autopsies on seven patients who died of Alzheimer’s during the study showed that nearly all of the sticky beta-amyloid protein thought to be dangerous had been removed. But all patients still had severe dementia.

“It may be that these toxic plaques trigger the neurodegeneration, but don’t have an ongoing role,” said Clive Holmes of the University of Southampton, lead author, in a press statement. The study was published Friday in the medical journal, The Lancet.

The study was paid for by the Alzheimer’s Research Trust, a British charity.

Alzheimer’s disease is the most common cause of dementia and affects about 25 million people worldwide.

Other experts said that the study’s findings pointed to a major gap in our understanding of the disease. Doctors have never been sure whether the brain plaques are the cause of Alzheimer’s disease or just a side effect.

“We still don’t have enough understanding of what we should target,” said Dr. Bengt Winblad, director of the Alzheimer’s Centre at Sweden’s Karolinska Institute. Winblad was not connected to the study.

Aside from the plaque build-up, scientists also think that tangles of another brain protein called tau play a major role in Alzheimer’s. Because those tangles form later than the plaque, some experts think they should be the focus instead.

“It may be harder to get a response from targeting plaque because that forms years before people actually have Alzheimer’s,” said Dr. Simon Lovestone, professor of Old Age Psychiatry at King’s College in London. “By the time you do something, it may be too late.”

Winblad said there was a better connection between brain tangles and Alzheimer’s symptoms, but that no studies so far had looked at whether removing tangles might improve or even reverse Alzheimer’s disease in patients.

Still, experts say that attacking toxic plaque in the brain shouldn’t be abandoned just yet, since the formation of such plaques might be what sparks Alzheimer’s disease in the first place.

“Removal of the initial motor for the disease might slow progression,” wrote Peter H. St. George-Hyslop and John C. Morris of the University of Cambridge and the University of Toronto in an accompanying commentary in the Lancet.

Salon provides breaking news articles from the Associated Press as a service to its readers, but does not edit the AP articles it publishes.

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