Should one use medications in combination with cognitive training? If so, which ones?
ABSTRACT In this article, we review current research regarding diagnosis of cognitive impairment in nondemented adults and discuss why medications and cognitive training together may be more beneficial than either alone. We also review potential cognitive enhancers and future research challenges. There are major reasons for such research: (a) Large numbers of older adults without dementia but with cognitive problems are not treatable with current cognitive training techniques; (b) some medications offer a rationale (i.e., cognitive enhancement) and some evidence that they might be a useful adjunct; and (c) there are unanswered questions about which population to target, which medications to use, how to administer them, and issues regarding tolerance and use of appropriate (active) placebo controls. As the number of cognitively impaired older adults grows, it is likely that there will be pressure to treat more broadly with both medications and cognitive training.
- The Lancet 01/1977; 2(8000):1403. · 39.06 Impact Factor
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ABSTRACT: Reductions in 2 neurotransmitter synthesizing enzymes in brain, glutamic acid decarboxylase (GAD) and choline acetyltransferase (CAT), have been found in dementias of different origins, including senile dementia (Alzheimer type). Significant reductions in cerebral GAD have also been found in depression (unipolar). The GAD reductions did not generally appear to be localised in any specific region of the brain examined. However, the reduction of CAT in the hippocampus, relative to reductions in other areas examined, was substantially greater in the brains with Alzheimer-type changes. GAD and CAT activities in normal brains were examined for the effects of some variable factors inherent in necropsy biochemical measurements. These factors included: (i) age; (ii) agonal status; (iii) time of death, and (iv) delay in tissue sampling; and GAD was found to be significantly influenced by (ii), (iii) and (iv) and CAT by (i), (iii) and (iv). None of these factors accounted for the total alterations in the enzyme activities of the mentally abnormal brains. The results indicate that reductions in cerebral GAD require to be interpreted with caution in view of the sensitivity of this enzyme to premortem status but that reductions in cerebral CAT may be a more reliable index of pathological change in senile (Alzheimer-type) dementia.Journal of the Neurological Sciences 12/1977; 34(2):247-65. · 2.24 Impact Factor
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ABSTRACT: Current smoking has been suggested as predicting poor response to cholinesterase inhibitor treatment. This observational study compares response in subjects with NINCDS-ADRDA 'probable' Alzheimer's disease who are current smokers and subjects who are non-smokers. Smoking status was not associated with response. Smokers were significantly more likely to improve Digit Symbol Substitution Test (DSST) scores following treatment. In non-smokers, improvement from baseline DSST scores was associated with good response but this was not the case in smokers. The change in the DSST is in keeping with smokers having increased numbers of nicotinic receptors. In smokers, the lack of association between improvement in DSST scores and good response may be representative of inhibitory properties of cigarette smoke that are unrelated to nicotine.Dementia and Geriatric Cognitive Disorders 02/2005; 19(1):11-4. · 2.79 Impact Factor