Acetylcholinesterase inhibitor in combination with cognitive training in older adults.
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.
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ABSTRACT: Traditional descriptions of the cortical cholinergic input system focused on the diffuse organization of cholinergic projections and the hypothesis that slowly changing levels of extracellular acetylcholine (ACh) mediate different arousal states. The ability of ACh to reach the extrasynaptic space (volume neurotransmission), as opposed to remaining confined to the synaptic cleft (wired neurotransmission), has been considered an integral component of this conceptualization. Recent studies demonstrated that phasic release of ACh, at the scale of seconds, mediates precisely defined cognitive operations. This characteristic of cholinergic neurotransmission is proposed to be of primary importance for understanding cholinergic function and developing treatments for cognitive disorders that result from abnormal cholinergic neurotransmission.Nature Reviews Neuroscience 06/2009; 10(5):383-90. DOI:10.1038/nrn2635 · 31.38 Impact Factor
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ABSTRACT: Converging lines of research indicate that complex mental activity is associated with reduced dementia risk. Thus, intense interest exists in whether different forms of cognitive exercise can help protect against cognitive decline and dementia. However, there is considerable confusion in terminology that is hindering progress in the field. We therefore introduce a concrete definition of cognitive training (CT) and make this the focus of our article. Clinical research that has evaluated CT in normal aging, mild cognitive impairment, and dementia is then critically reviewed. Despite many methodological shortcomings, the overall findings indicate that multidomain CT has the potential to improve cognitive function in healthy older adults and slow decline in affected individuals. Finally, practical issues, including the strengths and weaknesses of commercial products, are explored, and recommendations for further research and clinical implementation are made.Current Psychiatry Reports 02/2010; 12(1):20-7. DOI:10.1007/s11920-009-0085-y · 3.05 Impact Factor
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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