Article

Acetylcholinesterase inhibitor in combination with cognitive training in older adults.

Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences (Impact Factor: 2.85). 10/2008; 63(5):P288-94. DOI: 10.1093/geronb/63.5.P288
Source: PubMed

ABSTRACT To determine if donepezil, an acetylcholinesterase (AChE) inhibitor, improved the assimilation of cognitive training by older adults with memory complaints, we gave 168 nondemented, community-dwelling volunteers with memory complaints either 5 mg of donepezil (Aricept) or placebo daily for 6 weeks in a randomized, double-blind, placebo-controlled trial. The dosage rose to 10 mg daily for another 6 weeks before a 2-week course of cognitive training and was maintained for the remainder of a year. Cognitive training improved performance; donepezil was well tolerated. However, there were no significant benefits of donepezil compared with placebo. An additional dose-ranging study with a starting dose of 5 mg a day suggests that the high dose was not the reason. Physiological tolerance may occur with chronic donepezil treatment and may increase AChE levels; this may be why short-term studies have shown the benefit of AChE inhibitor use in nondemented participants whereas chronic use has failed to enhance cognition.

0 Bookmarks
 · 
103 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Increasingly, cognitive training appears an asset in improving attention and working memory for older adults. We conducted a study involving a 'holistic' training program for several cohorts of older adults (N = 112), targeting community residents with a spectrum of memory complaints ranging from Age Associated Memory Impairment to mild dementia. Method: We developed a 7-session, manualized program targeting concentration, as well as mindfulness, exercise, stress reduction, socialization, diet, and values/identity techniques. We applied this model to 11 cohorts and conducted pre- and post-testing on memory (List Learning, Story Memory, Coding, Digit Span, Recall, and Recognition) and function (Functional Assessment Questionnaire). We also divided the Memory Group by Risk Status - Low, Medium, and High. Results: Results showed that the Memory Clinic Group as a whole improved on this training on most scales. When broken down by risk status, the Low and Medium Risk Groups were statistically superior to the High Risk Group on cognitive measures. Conclusion: There were differences also on adjustment, this time favoring only the Low Risk Groups. Holistic memory training seems to be impactful for older adults.
    Aging and Mental Health 07/2013; 18(2). DOI:10.1080/13607863.2013.819832 · 1.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Over the past decade, HIV has been transformed from a terminal to chronic disease. Physical and occupational therapists are seeing increasing numbers of patients/clients who are aging with HIV. Nearly half of the adults with HIV experience mild to severe cognitive deficits, which can interfere with everyday functioning such as driving and medication adherence. Such cognitive deficits become more severe with increasing age. Given that nearly half of those with HIV will be 50 or older by 2015, physical and occupational therapists must explore strategies to improve or maintain cognitive functioning and/or mitigate for cognitive loss in this clinical population. In this review article, promising strategies to support healthy cognitive aging in HIV, such as psychostimulants and treatment of mental health issues, are discussed. Following this, some ineffective strategies such as acetylcholinesterase inhibitors are described. Finally, novel but unsupported strategies such as transcranial stimulation are examined. Implications for treatment and research are provided.
    Physical & Occupational Therapy in Geriatrics 08/2012; DOI:10.3109/02703181.2012.709588
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Highly active antiretroviral therapy has given the chance to those living with HIV to keep on living, allowing them the opportunity to age and perhaps age successfully. Yet, there are severe challenges to successful aging with HIV, one of which is cognitive deficits. Nearly half of those with HIV experience cognitive deficits that can interfere with everyday functioning, medical decision making, and quality of life. Given that cognitive deficits develop with more frequency and intensity with increasing age, concerns mount that as people age with HIV, they may experience more severe cognitive deficits. These concerns become especially germane given that by 2015, 50% of those with HIV will be 50 and older, and this older cohort of adults is expected to grow. As such, this paper focuses on the etiologies of such cognitive deficits within the context of cognitive reserve and neuroplasticity. From this, evidence-based and hypothetical prevention (i.e., cognitive prescriptions), rehabilitation (i.e., speed of processing training), and mitigation (i.e., spaced retrieval method) strategies are reviewed. Implications for nursing practice and research are posited.
    01/2013; 2013:297173. DOI:10.1155/2013/297173