Krista L Lanctôt

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

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Publications (242)994.88 Total impact

  • Jordana O’Regan · Krista L. Lanctôt · Graham Mazereeuw · Nathan Herrmann ·

    The Journal of Clinical Psychiatry 11/2015; DOI:10.4088/JCP.14r09237 · 5.50 Impact Factor
  • Damien Gallagher · Alex Kiss · Krista Lanctot · Nathan Herrmann ·
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    ABSTRACT: Background: Depressive symptoms have been associated with increased risk of cognitive decline in later life. There are no interventions proven to reduce risk of cognitive decline in older adults with depression, and it is unclear how these effects are mediated. We aim to determine what mediates the relationship between depressive symptoms and cognitive decline in later life. Methods: Seven thousand six hundred and sixty six community dwelling older adults (age≥50) from the English Longitudinal study of Ageing (ELSA) underwent clinical assessment. Inflammation was assessed with C Reactive Protein and depressive symptoms were assessed with the 8-item version of the Center for Epidemiologic Studies (CESD) scale. Results: Five thousand, five hundred and ninety (73.5%) had a follow-up cognitive assessment after a median of 47 months. Depressive symptoms were independently associated with cognitive decline (B=0.09, p<0.001). Low physical activity, inflammation, metabolic syndrome and vascular risk factors were associated with elevated depressive symptoms. Low physical activity (z=2.16, p=0.03) and inflammation (z=2.3, p=0.02) mediated the relationship between depressive symptoms and cognitive decline while hypertension, diabetes and smoking also contributed. Limitations: This is an observational study with a limited duration of follow up. Not all variables related to cognitive decline were accounted for in this analysis. Conclusions: The relationship between depressive symptoms and cognitive decline in later life appears to be mediated by low physical activity, increased inflammation and vascular risk factors that may be amenable to modification.
    Journal of Affective Disorders 11/2015; 190:235-240. DOI:10.1016/j.jad.2015.09.046 · 3.38 Impact Factor
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    ABSTRACT: Objectives: Cholinesterase inhibitors (ChEIs) offer modest benefits in Alzheimer disease (AD), which must be balanced against risks. Relatively few data delineate the benefits and risks of long-term ChEI administration in institutionalized patients with advanced AD. This study investigated the effects of ChEI discontinuation in institutionalized patients with AD. Design: Institutionalized patients with moderate to severe AD (standardized Mini- Mental Status Examination ≤15) and treated with a ChEI for ≥2 years were randomized, double-blind, to ChEI continuation or placebo, with a 2-week tapering phase, for 8-weeks. Measurements: The primary outcome of this pilot study was change on the Clinician's Global Impression of Change (CGI-C) scale. Secondary outcomes included safety, efficacy, and tolerability. Baseline (BL) predictors of clinical deterioration were also determined. Results: Forty patients (mean ± standard deviation age = 89.3 ± 3.5 years, standardized Mini-Mental Status Examination = 8.1 ± 5.2, Neuropsychiatric Inventory-Nursing Home version total score = 21.1 ± 15.9, 80% male) were randomized to ChEI continuation (n = 21) or placebo (n = 19). There was no significant difference in clinical worsening in the ChEI continuation (28.6%) and placebo groups (36.8%) on CGI-C (odds ratio for worsening 1.58, 95% confidence interval .38-6.55, P = .53). The occurrence of adverse events was similar in both groups. There were no significant differences in any of the secondary outcome measures. In the placebo group, BL hallucinations predicted CGI-C worsening [F(1,17) = 6.4, P = .02], and there was a trend for BL delusions to predict CGI-C worsening [F(1,15) = 3.5, P = .08]. Conclusions: These results suggest that ChEI discontinuation is safe and well tolerated in the majority of institutionalized patients with moderate to severe AD. When discontinuing ChEI, the presence of hallucinations and delusions may predict clinical deterioration, suggesting the need for increased caution.
    Journal of the American Medical Directors Association 10/2015; DOI:10.1016/j.jamda.2015.08.019 · 4.94 Impact Factor
  • Haben Y Abraha · Krista L Lanctôt · Bosco Paes ·
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    ABSTRACT: Premature infants are at substantial risk for a spectrum of morbidities that are gestational age dependent. Respiratory syncytial virus (RSV) infection is most common in the first two years of life with the highest burden in children aged <6 months. Preterm infants ≤35 weeks' gestation are handicapped by incomplete immunological and pulmonary maturation and immature premorbid lung function with the added risk of bronchopulmonary dysplasia. Superimposed RSV infection incites marked neutrophilic airway inflammation and innate immunological responses that further compromise normal airway modeling. This review addresses the epidemiology and burden of RSV disease, focusing on the preterm population. Risk factors that determine RSV-disease severity and hospitalization and the impact on healthcare resource utilization and potential long-term respiratory sequelae are discussed. The importance of disease prevention and the evidence-based rationale for prophylaxis with palivizumab is explored, while awaiting the development of a universal vaccine.
    Expert Review of Respiratory Medicine 10/2015; DOI:10.1586/17476348.2015.1098536
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    ABSTRACT: Reports of elevated inflammatory markers in mild cognitive impairment (MCI) suggest that inflammation may be a potential early marker of the neurodegenerative cascade associated with Alzheimer's disease (AD). The aim of this study was to quantitatively summarize the data on peripheral blood concentrations of inflammatory factors in patients with MCI compared to controls. Mean (±SD) blood concentrations of inflammatory factors for MCI and control subjects were extracted from original English language peer-reviewed studies for meta-analysis. Twenty-two studies measuring concentrations of cytokines, chemokines, acute phase reactant proteins, immunoglobulins, intercellular adhesion molecules, and fibrinogen were included. No significant differences in inflammatory factors studied were found between subjects with MCI and healthy controls. These findings do not support the involvement of inflammatory markers at the MCI stage of cognitive decline although significant heterogeneity was observed in some comparisons. It remains to be established whether inflammation may predict increased rate of conversion to dementia.
    Journal of Alzheimer's disease: JAD 09/2015; 47(3):669-679. DOI:10.3233/JAD-150042 · 4.15 Impact Factor
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    ABSTRACT: Background: Stroke incidence and outcomes vary between English and Non-English speaking populations. Language status may reflect differences in vascular risk, socioeconomic status, and healthcare access, all of which may modify stroke risk. Moreover, Depression, Obstructive sleep apnea (OSA) and Cognitive impairment (DOC comorbidities) are modifiers of outcome after stroke that may also be related to language status. Methods: A validated screening tool was administered to stroke/TIA patients to assess DOC comorbidities. Participants were categorized either 1) Primary English Speaking (PES), 2) English as a Second Language (ESL) but functionally fluent, or 3) Non-English Speaking (NES) requiring translation. 1335 participants were screened: 964 PES, 269 ESL and 102 NES. Chi-Squared and Logistic Regression analyses were performed. Results: Impairment was greatest in the NES cohort, lowest in the PES, and intermediate in the ESL cohort in cognitive (X2 = 71.89, p < 0.0001), OSA (X2 = 7.8, p = 0.02) and depression (X2 = 6.65, p = 0.04) screening scores. The same gradation of risk with was seen for hypertension (X2 = 15.54, p < 0.0001). Controlling for covariates in logistic regressions, we assessed whether language classification might predict differences in DOC comorbidities and vascular risk. Language classification was only associated with cognitive impairment (OR = 1.55, CI = 1.26–1.92, p < 0.0001). Excluding the NES cohort to reduce bias related to translation, we found that ESL patients still had greater risk of cognitive impairment (OR = 1.53, CI = 1.10–2.14, p = 0.01) compared to PES patients. Language status also predicted differences in vascular risk: ESL patients demonstrated greater risk of hypertension (OR = 1.36, CI = 1.01–1.84, p = 0.04) compared to PES patients. Conclusions: Language status is related to hypertension and likelihood of cognitive impairment in patients with stroke/TIA. This study highlights the importance of studying ESL and non-English speaking populations to better characterize how stroke risk factors and complications may vary across different populations.
    International Journal of Stroke 09/2015; 10(Suppl 4):21-106. DOI:10.1111/ijs.12633_2 · 3.83 Impact Factor
  • Ian Mitchell · Parco Chan · Abby Li · Hao Yi · Bosco Paes · Krista Lanctot ·

    European Respiratory Journal 09/2015; 46(suppl 59):PA3626. DOI:10.1183/13993003.congress-2015.PA3626 · 7.64 Impact Factor
  • Parco Chan · Abby Li · Bosco Paes · Haben Abraha · Ian Mitchell · Krista L. Lanctôt ·

    The Pediatric Infectious Disease Journal 09/2015; DOI:10.1097/INF.0000000000000922 · 2.72 Impact Factor
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    ABSTRACT: Background: Major depressive disorder (MDD) may be associated with oxidative damage to lipids, which can potentially affect mood-regulating pathways. This meta-analysis summarizes current knowledge regarding lipid peroxidation markers in clinical samples of MDD and the effects of antidepressant pharmacotherapy on those markers. Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Collaboration were searched for original, peer-reviewed articles measuring markers of lipid peroxidation in patients with MDD and nondepressed healthy controls up to April 2015. Standardized mean differences (SMDs) were generated from random effects models summarizing mean (± standard deviations) concentrations of selected markers. Results: Lipid peroxidation was greater in MDD than in controls (studies =17, N=857 MDD/782 control, SMD =0.83 [0.56-1.09], z=6.11, P<0.01, I (2)=84.0%) and was correlated with greater depressive symptom severity (B=0.05, df=8, P<0.01). Antidepressant treatment was associated with a reduction in lipid peroxidation in MDD patients (studies=5, N=222, SMD=0.71 [0.40-0.97], P<0.01; I (2)=42.5%). Limitations: Lipid peroxidation markers were sampled from peripheral blood, included studies comparing MDD to controls were all cross-sectional, and only five antidepressant treatment studies were eligible for inclusion. Conclusion: Increased lipid peroxidation was associated with MDD and may be normalized by antidepressants. Continued investigation of lipid peroxidation in MDD is warranted.
    Neuropsychiatric Disease and Treatment 09/2015; 11:2479. DOI:10.2147/NDT.S89922 · 1.74 Impact Factor
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    ABSTRACT: Introduction Depression is a frequent complication of coronary artery disease (CAD) with an unknown etiology. Platelet activating factor (PAF) lipids, which are associated with CAD, have recently been linked with novel proposed etiopathological mechanisms for depression such as inflammation, oxidative/nitrosative stress, and vascular endothelial dysfunction. Methods and results This hypothesis-generating study investigated the relationships between various PAF species and depressive symptoms in 26 CAD patients (age: 60.6±9.2 years, 69% male, mean Hamilton Depression Rating Scale [HAM-D] score: 11.8±5.2, HAM-D range: 3–20). Plasma PAF analyses were performed using high performance liquid chromatography electrospray ionization mass spectrometry in precursor ion scan. Significant associations between depressive symptom severity (HAM-D score) and a greater plasma abundance of the PAFs phosphocholine (PC) PC(O-12:0/2:0) (r=0.49, P=0.01), PC(O-14:1/2:0) (r=0.43, P=0.03), PC(O-17:3/2:0) (r=0.44, P=0.04), and PC(O-18:3/2:0) (r=0.50, P=0.01) were observed. Associations between those PAFs and HAM-D score persisted after adjusting for age and sex. Conclusion These preliminary findings support the exploration of the PAF lipidome for depressive symptom biomarkers in CAD patients. Patients were recruited as part of the following clinical trial: NCT00981383.
    Neuropsychiatric Disease and Treatment 09/2015; 11:2309. DOI:10.2147/NDT.S87111 · 1.74 Impact Factor
  • Candice Bjornson · Parco Chan · Abby Li · Bosco Paes · Krista Lanctot · Ian Mitchell ·

    European Respiratory Journal 09/2015; 46(suppl 59):PA3625. DOI:10.1183/13993003.congress-2015.PA3625 · 7.64 Impact Factor
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    ABSTRACT: Alzheimer's disease (AD) is frequently associated with neuropsychiatric symptoms (NPS) such as agitation and aggression, especially in the moderate to severe stages of the illness. The limited efficacy and high-risk profiles of current pharmacotherapies for the management of agitation and aggression in AD have driven the search for safer pharmacological alternatives. Over the past few years, there has been a growing interest in the therapeutic potential of medications that target the endocannabinoid system (ECS). The behavioural effects of ECS medications, as well as their ability to modulate neuroinflammation and oxidative stress, make targeting this system potentially relevant in AD. This article summarizes the literature to date supporting this rationale and evaluates clinical studies investigating cannabinoids for agitation and aggression in AD. Letters, case studies, and controlled trials from four electronic databases were included. While findings from six studies showed significant benefits from synthetic cannabinoids-dronabinol or nabilone-on agitation and aggression, definitive conclusions were limited by small sample sizes, short trial duration, and lack of placebo control in some of these studies. Given the relevance and findings to date, methodologically rigorous prospective clinical trials are recommended to determine the safety and efficacy of cannabinoids for the treatment of agitation and aggression in dementia and AD.
    CNS Drugs 08/2015; 29(8). DOI:10.1007/s40263-015-0270-y · 5.11 Impact Factor
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    Jinghan Jenny Chen · Parco Chan · Bosco Paes · Ian Mitchell · Abby Li · Krista L. Lanctôt ·
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    ABSTRACT: Objectives: To evaluate the safety and tolerability of palivizumab for RSV prophylaxis in high-risk children in everyday practice. Methods: High-risk children prophylaxed against RSV infection were recruited into a prospective, observational, Canadian RSV Evaluation Study of Palivizumab (CARESS) registry with active, serious adverse event (SAE) monitoring from 2008 to 2013. SAE reports were systematically collected and assessed for severity and relationship to palivizumab. Data were analyzed by Chi-square or Fisher Exact Tests to examine group differences in proportions. Results: 13025 infants received 57392 injections. Hospitalizations for respiratory-related illness (RIH) were reported in 915 patients, and SAEs other than RIH were reported in 52 patients. Of these, 6 (0.05%) patients had a total of 14 hypersensitivity reactions that were deemed possibly or probably related to palivizumab (incidence: 2.8 per 10,000 patient-months). The SAEs of 42 patients were assessed as not related to palivizumab. SAEs in the remaining 4 patients were not classifiable as their records were incomplete. There were no significant demographic predictors of SAE occurrence. Conclusions: Under active surveillance, a small proportion of infants in the CARESS registry experienced SAEs that had a potential relationship with palivizumab and these appeared to be unpredictable in terms of onset. Palivizumab appears to be a safe and well-tolerated antibody for RSV prophylaxis in high-risk children in routine practice.
    PLoS ONE 08/2015; 10(8):e0134711. DOI:10.1371/journal.pone.0134711 · 3.23 Impact Factor
  • W Swardfager · P Yang · N Herrmann · K L Lanctôt · B R Shah · A Kiss · P I Oh ·
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    ABSTRACT: To quantify the impact of depressive symptoms on completion of exercise-based rehabilitation for Type 2 diabetes management. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale in a prospective cohort of consecutive patients with Type 2 diabetes entering a 6-month hybrid (home- and clinic-based) exercise rehabilitation programme. Attendance at exercise sessions was monitored and programme completion/non-completion was ascertained. Of the programme participants (n=624, mean age 55.6±10.5 years, 47% male), 26.8% endorsed significant depressive symptoms (depression score ≥16) and 68.1% completed the intervention, attending 54.6±30.0% of supervised exercise sessions. Baseline depressive symptoms (depression scale score ≥16) increased the risk of non-completion [hazard ratio 1.49 (95% CI 1.10-2.03); P = 0.010], and predicted fewer sessions attended (β=-2.1, P= 0.002) in adjusted models. A depression score threshold of ≥10 (48.4% of participants) predicted non-completion [hazard ratio 1.60 (95% CI 1.19-2.17); P= 0.002) with optimum accuracy. Non-completions resulting from lack of interest (18.9 vs. 11.0%; P= 0.026) and medical complications (14.6 vs. 6.6%; P= 0.006) were more common among participants with depression scores ≥10. Greater hazard ratios for depression scores ≥10 were observed in subgroups not currently using insulin [hazard ratio 1.70 (95% CI 1.24-2.33); P= 0.001), or an antidepressant [hazard ratio 1.83 (95% CI 1.32-2.54); P<0.001]. Depressive symptoms were highly prevalent among participants with Type 2 diabetes entering exercise-based rehabilitation, and even mild depressive symptoms posed a significant barrier to completion. Depression screening may help target additional supports to facilitate completion of exercise interventions for people with Type 2 diabetes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 07/2015; DOI:10.1111/dme.12872 · 3.12 Impact Factor
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    ABSTRACT: Every year, approximately 62 000 people with stroke and transient ischemic attack are treated in Canadian hospitals, and the evidence suggests one-third or more will experience vascular-cognitive impairment, and/or intractable fatigue, either alone or in combination. The 2015 update of the Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue Module guideline is a comprehensive summary of current evidence-based recommendations for clinicians in a range of settings, who provide care to patients following stroke. The three consequences of stroke that are the focus of the this guideline (poststroke depression, vascular cognitive impairment, and fatigue) have high incidence rates and significant impact on the lives of people who have had a stroke, impede recovery, and result in worse long-term outcomes. Significant practice variations and gaps in the research evidence have been reported for initial screening and in-depth assessment of stroke patients for these conditions. Also of concern, an increased number of family members and informal caregivers may also experience depressive symptoms in the poststroke recovery phase which further impact patient recovery. These factors emphasize the need for a system of care that ensures screening occurs as a standard and consistent component of clinical practice across settings as stroke patients transition from acute care to active rehabilitation and reintegration into their community. Additionally, building system capacity to ensure access to appropriate specialists for treatment and ongoing management of stroke survivors with these conditions is another great challenge. © 2015 World Stroke Organization.
    International Journal of Stroke 06/2015; 10(7). DOI:10.1111/ijs.12557 · 3.83 Impact Factor
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    ABSTRACT: Exercise is a promising strategy to prevent dementia, but no clinically supervised exercise program is widely available to people with mild cognitive impairment (MCI). The objective was to survey health professionals to assess the feasibility of using cardiac rehabilitation exercise programs for MCI populations. We distributed surveys to: 1) health professionals working in cardiac rehabilitation exercise programs (36/72 responded); and 2) physicians who treat MCI (22/32 responded). Questions addressed clinician and clinic characteristics and feasibility of referring and accommodating people with MCI. Most cardiac rehabilitation exercise programs currently treat people with MCI (61.1%). Nearly all were willing and able to accept people with MCI and comorbid vascular risk (91.7%), though only a minority could accept MCI without vascular risk (16.7%). Although most physicians recommend exercise to people with MCI (63.6%), few referred patients with MCI to programs or people to guide exercise (27.3%). However, all physicians (100%) would refer patients with MCI to a cardiac rehabilitation exercise program. Our study supports cardiac rehabilitation exercise programs as a feasible model of exercise for patients with MCI with vascular risk. Patients with and without vascular risk could likely be accommodated if program mandates were expanded.
    06/2015; 18(2):65-72. DOI:10.5770/cgj.18.166
  • P. Chan · J. Chen · B. Paes · I. Mitchell · A. Li · K. Lanctôt ·

    Value in Health 05/2015; 18(3):A228-A229. DOI:10.1016/j.jval.2015.03.1329 · 3.28 Impact Factor
  • A. Li · B. Paes · I. Mitchell · K. Lanctôt ·

    Value in Health 05/2015; 18(3):A232-A233. DOI:10.1016/j.jval.2015.03.1353 · 3.28 Impact Factor
  • H.Y. Abraha · Abby Li · Bosco Paes · Ian Mitchell · Krista Lanctot ·

    Value in Health 05/2015; 18(3):A231. DOI:10.1016/j.jval.2015.03.1343 · 3.28 Impact Factor
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    ABSTRACT: Current treatments for Alzheimer's disease (AD) provide modest symptomatic relief but do not slow the progression of the disease. Latrepirdine may modulate several targets involved in AD pathology, including lipid peroxidation, mitochondrial permeability, voltage-gated calcium ion channels as well as neurotransmitter receptor activity, and thus potentially represents both a symptomatic and disease-modifying intervention. Several randomized, placebo-controlled trials have sought to evaluate the effect of latrepirdine on cognition, function and behaviour in patients with AD. To evaluate the efficacy and safety of latrepirdine for the treatment of AD. We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 4 June 2014 using the terms: latrepirdine OR dimebon OR dimebolin OR 2,3,4,5-tetrahydro-2,8-dimethyl-5- (2-(6-methyl-3-pyridyl)ethyl)-1H-pyrido(4,3-b)indole. We included all randomized, double-blind, placebo-controlled trials where latrepirdine was administered to patients with mild, moderate or severe AD. We assessed the quality of studies and two authors extracted data. We calculated mean difference (MD), risk ratio (RR) and 95% confidence interval (CI) on an intention-to-treat (ITT) basis for all relevant outcome measures. Seven trials involving a total of 1697 participants were found and six were included in the quantitative analyses. No data were available from the seventh trial. Three trials involving 1243 patients were included in analyses of efficacy outcomes, and four trials involving 1034 patients were included in analyses of safety and tolerability outcomes. We judged five trials to be at high risk of bias due to selective outcome reporting and three to be at high risk of attrition bias. There was low quality evidence favouring latrepirdine on the Clinician's Interview - Based Impression of Change Plus Caregiver Input after 26 weeks (CIBIC-Plus) (MD -0.60, 95% CI -0.89 to -0.31, 1 study, P < 0.001). Due to imprecision in the results, it was not possible to determine whether latrepirdine had any effect on cognition measured with the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-Cog) (MD -1.49, 95% CI -3.47 to 0.49, 3 studies, P = 0.14) or the Mini-Mental State Examination (MMSE) (MD 0.59, 95% CI -0.94 to 2.11, 3 studies, P = 0.45), or on function measured with the Alzheimer's Disease Co-operative Study - Activities of Daily Living scale (ADCS-ADL) (MD 1.00, 95% CI -1.15 to 3.15, 3 studies, P = 0.36) at study endpoint (26 or 52 weeks). We considered the evidence provided on these outcomes to be of overall low quality. However, there was some high quality evidence showing a very small benefit of latrepirdine on the Neuropsychiatric Inventory (NPI) (MD -1.77, 95% CI -3.09 to -0.45, 3 studies, P = 0.009) at study endpoint (26 or 52 weeks). Additionally, moderate quality evidence suggested that latrepirdine and placebo were comparable in adverse events (RR 1.03, 95% CI 0.93 to 1.14, P = 0.51), serious adverse events (RR 0.86, 95% CI 0.55 to 1.35, P = 0.52), dropouts (RR 0.91, 95% CI 0.65 to 1.27, P = 0.57) and dropouts due to adverse events (RR 0.98, 95% CI 0.57 to 1.67, P = 0.93). Our meta-analysis is limited by the small number of studies, imprecision, inconsistencies between studies and likelihood of bias. Nevertheless, the evidence to date suggests that while not associated with an increased risk of adverse events compared with placebo, there is no effect of latrepirdine on cognition and function in mild-to-moderate AD patients, though there appears to be a modest benefit for behaviour. Further studies should investigate the potential benefit of latrepirdine on neuropsychiatric symptoms in AD.
    Cochrane database of systematic reviews (Online) 04/2015; 4:CD009524. DOI:10.1002/14651858.CD009524.pub2 · 6.03 Impact Factor

Publication Stats

6k Citations
994.88 Total Impact Points


  • 1996-2015
    • Sunnybrook Health Sciences Centre
      • Department of Psychiatry
      Toronto, Ontario, Canada
  • 1990-2015
    • University of Toronto
      • • Department of Psychiatry
      • • Department of Pharmacology and Toxicology
      • • Faculty of Medicine
      • • Sunnybrook Health Sciences Centre
      Toronto, Ontario, Canada
  • 2010
    • The University of Western Ontario
      • Department of Medicine
      London, Ontario, Canada
  • 1989
    • Instituto de Investigación Clínica de Occidente
      Zapopan, Jalisco, Mexico