Alzheimer's disease and mild cognitive impairment deteriorate fine movement control.

Sensory-motor dysfunctions are often associated with Alzheimer's disease (AD) or mild cognitive impairment (MCI). This study suggests that deterioration in fine motor control and coordination characterizes sensory-motor deficiencies of AD and MCI. Nine patients with a clinical diagnosis of probable AD, 9 amnestic MCI subjects and 10 cognitively normal controls performed four types of handwriting movement on a digitizer. Movement time and smoothness were analyzed between the groups and across the movement patterns. Kinematic profiles were also compared among the groups. AD and MCI patients demonstrated slower, less smooth, less coordinated, and less consistent handwriting movements than their healthy counterparts. The theoretical relevance and practical implications of fine motor tasks, such as these movements involved in handwriting, are discussed relative to the deteriorated sensory-motor system of AD and MCI patients.

Meta-analysis of six-month memantine trials in Alzheimer's disease.

BACKGROUND: Clinical trials have suggested benefits of memantine for all stages of Alzheimer's disease (AD). A meta-analysis of memantine trials in outpatients with probable AD was conducted. METHODS: Six randomized, placebo-controlled trials fulfilled inclusion criteria. Cognitive, global, functional, behavioral, and safety measures were evaluated by using fixed or random effects models. Sensitivity analysis was performed to determine potential effects of disease severity and concomitant cholinesterase inhibitor use. RESULTS: Overall, memantine showed statistically significant, homogenous benefits on global and functional outcomes and statistically significant but heterogeneous benefit on cognition. In pooled moderate to severe AD studies, effects were significant and homogeneous on global, functional, and behavioral measures; in pooled mild to moderate studies, significant and homogeneous effects were found on global rating and cognition. Safety profiles suggested excellent safety and tolerability, with no differences between the severity groups. CONCLUSIONS: Memantine consistently benefited patients in all stages of AD and was well-tolerated.

Recommendations for best practices in the treatment of Alzheimer's disease in managed care.

BACKGROUND: Alzheimer's disease and related dementias (ADRDs) are increasingly recognized as important causes of impaired cognition, function, and quality of life, as well as excess medical care utilization and costs in the elderly Medicare managed care population. Evidence-based clinical practice guidelines for ADRDs were published in 2001. More recent studies have resulted in the approval of new agents and demonstrated an expanded role for antidementia therapy in various types of dementia, settings of care, stages of disease, and the use of combination therapy. However, these clinical guidelines have not been updated in the past few years. OBJECTIVE: The goal of this article was to provide practical recommendations developed by a panel of experts that address issues of early diagnosis, treatment, and care management of ADRDs. The panel also addressed the societal and managed care implications. METHODS: A panel of leading experts was convened to develop consensus recommendations for the treatment and management of dementia based on currently available evidence and the panel's informed expert opinion. The panel comprised 12 leading experts, including clinical investigators and practitioners in geriatric medicine, neurology, psychiatry, and psychology; managed care medical and pharmacy directors; a health systems medical director; and a health policy expert. In addition, articles were collected based on PubMed searches (2000-2005) that were relevant to the key issues identified. Search terms included Alzheimer's disease, dementia, clinical practice guidelines, clinical trials, screening and assessment, and managed care. RESULTS: ADRDs represent a significant clinical and economic burden to individuals and society, including Medicare managed care organizations (MCOs). Appropriate utilization of antidementia therapy and care management is vitally important to achieving quality of life and care for dementia patients and their caregivers, and for managing the excess costs of Alzheimer's disease. The recommendations address relevant, practical, and timely concerns that are faced on a daily basis by practitioners and by Medicare MCO medical management programs in the care of dementia patients. These consensus recommendations attempt to describe a reasonable current standard for the provision of quality care for patients with dementia. The panel recommendations support the use of screening for cognitive impairment and the use of antidementia therapy for ADRDs in different stages of disease and types of dementia in all clinical settings. The panel members evaluated the use of the 3 marketed cholinesterase inhibitors-donepezil, galantamine, and rivastigmine-as well as the N-methyl-D-aspartate antagonist memantine. Recommendations for using these medications are made with an appreciation of the difficulties in translating the results from investigational clinical trials into clinical practice. CONCLUSIONS: The recommendations of the expert panel represent a clear consensus that nihilism in the diagnosis, treatment, and management of ADRDs is unwarranted, impairs quality of care, and is ultimately not costeffective.

A method for estimating duration of illness in Alzheimer's disease.

BACKGROUND: We developed a set of questions for generating an estimate regarding the date of first symptoms to the nearest half-year. Physicians then revised this estimate in conjunction with medical record review and patient/informant interviews, and by testing the estimate by recall of life events. One experienced examiner rated 36 patients, and each was independently rated by a second, less experienced rater. The physician ratings were compared to each other and to an unstructured caregiver estimate of duration using Lin concordance coefficients. There was excellent agreement between independent physician raters (rho = 0.95, p < 0.001). Caregiver estimates of duration were usually shorter because of failure to relate the first symptoms to the onset of disease.