ABSTRACT
There are various anticholinesterase inhibitors (AChEIs) for the symptomatic treatment of mild to moderate Alzheimer's disease (AD). All AChEIs have shown greater efficacy than placebo in randomized, double-blind, parallel-group clinical trials. No differential studies have yet been made of the efficacy between all AChEIs. The study aims to determine the differential efficacy of the AChEIs with respect to a historical sample of patients with AD that were not treated with AChEIs. An open-label, prospective, observational study with a retrospective control group was undertaken to examine the evolution of the cognitive function over a 6-month period. The patients were assessed with the Mini-Mental State Examination (MMSE) at study entry and at 6 months. A general linear model was applied for repeated measurements with the MMSE score as the dependent variable, treatment type as an independent variable and the severity of the deterioration, age and the MMSE baseline score as covariables. Of the sample of 147 patients, 40 initiated treatment with donepezil, 32 with galantamine, 30 with rivastigmine and 45 were part of a historical sample of the memory clinic patients between 1991 and 1996 that had not been treated with AChEIs. The average age was 73.7 years (SD = 6.9; range = 52-86), 67.3% were women, 78.2% of the cases were mild and the MMSE baseline score was 18.1 points (range = 11-27). No significant intergroup differences were observed in these variables. The average doses of donepezil, galantamine and rivastigmine were 5.87 mg/day (SD = 1.92), 14.81 mg/day (SD = 6.25) and 6.41 mg/day (SD = 1.82), respectively. At 6 months, the difference in the MMSE score with respect to the untreated group was 1.6 points for donepezil (95% CI 0.79-2.37; p < 0.001), 0.99 points for galantamine (95% CI 0.14-1.85; p = 0.01) and 0.90 points for rivastigmine (95% CI 0.05-1.74; p = 0.03). No significant differences were observed in the efficacy among the groups treated with AChEIs (p > 0.05). Treatment with AChEIs significantly delays the global cognitive impairment associated with AD for at least 6 months. Our study found no significant differences in efficacy between donepezil, galantamine and rivastigmine. Further studies in the context of daily clinical practice will determine the clinical significance of the changes observed. An important variability of the response to the treatment was observed in treated patients.
Subject(s)
Alzheimer Disease/drug therapy , Cholinesterase Inhibitors/therapeutic use , Galantamine/therapeutic use , Indans/therapeutic use , Phenylcarbamates/therapeutic use , Piperidines/therapeutic use , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Cholinesterase Inhibitors/administration & dosage , Donepezil , Drug Administration Schedule , Female , Galantamine/administration & dosage , Humans , Indans/administration & dosage , Male , Middle Aged , Neuropsychological Tests , Phenylcarbamates/administration & dosage , Piperidines/administration & dosage , Prospective Studies , Retrospective Studies , Rivastigmine , Severity of Illness Index , Time FactorsABSTRACT
Los cambios fisiológicos que se producen en el sistema cardiovascular durante el embarazo son los que justifican que se produzca un estado proarritmógeno característico, siendo la taquicardia paroxística supraventricular (TSV) una de las arritmias más frecuentes durante el embarazo. Presentamos una embarazada de 15 semanas con TSV, que fue tratada con adenosina, revirtiendo a ritmo sinusal. Revisamos los tratamientos de la TSV en la gestante. Debemos hacer hincapié en la falta de estudios serios que valoren el empleo de uno u otro fármaco. Los artículos hacen referencia a casos aislados o series cortas en los que cuentan la experiencia obtenida en el uso de estos fármacos. Se ha venido empleando el propanolol, el verapamilo y la adenosina, siendo esta última la que se considera actualmente de elección frente a la taquicardia paroxística supraventricular en la embarazada. Ello se debe a las características farmacodinámicas de las que goza este fármaco, que hace que sea seguro tanto para la madre como para el feto (AU)
Subject(s)
Adult , Pregnancy , Female , Humans , Tachycardia, Supraventricular/drug therapy , Tachycardia, Paroxysmal/drug therapy , Adenosine/pharmacology , Fetal Monitoring , Pregnancy Trimester, Second , Propranolol/pharmacology , Emergency Treatment , Pregnancy Complications, Cardiovascular/drug therapyABSTRACT
La incidencia de los episodios de bloqueo auriculoventricular completo o bloqueo auriculoventricular de tercer grado es baja en la población general, aumentando en la anciana. Esto se debe a la degeneración senil que sufre el corazón de estos pacientes y a que la aparición del bloqueo está íntimamente ligada a la existencia de patología cardíaca subyacente, mucho más frecuente en ancianos. El bloqueo auriculoventricular de tercer grado es temporal en muchas ocasiones: no todos los pacientes que lo sufren serán candidatos a tratamiento con marcapasos definitivo. La clínica que puede provocar este bloqueo está en relación con la frecuencia ventricular. La menor actividad física de los ancianos condiciona un menor gasto cardíaco, por lo que ocasionalmente el bloqueo será bien tolerado pudiendo provocar únicamente sintomatología leve con el esfuerzo o ser completamente asintomático. Esto se corresponde con los 4 casos que presentamos en este trabajo (AU)
Subject(s)
Aged , Male , Humans , Heart Block/etiology , Pacemaker, Artificial , Heart Block/surgery , Heart Block/complications , Cardiac Output/physiology , Exercise , Heart Rate/physiology , Heart Failure/etiologySubject(s)
Addison Disease/drug therapy , Circadian Rhythm , Hydrocortisone/administration & dosage , Addison Disease/complications , Adrenocorticotropic Hormone/blood , Dexamethasone/administration & dosage , Dexamethasone/pharmacokinetics , Dexamethasone/therapeutic use , Drug Administration Schedule , Fatigue/etiology , Headache/etiology , Humans , Hydrocortisone/metabolism , Hydrocortisone/therapeutic use , Nausea/etiologyABSTRACT
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