Risk of Developing Alzheimer’s Disease in Persons with MCI Survival curve of persons characterized...
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Transcript of Risk of Developing Alzheimer’s Disease in Persons with MCI Survival curve of persons characterized...
Alzheimer’s Disease Prevention Initiative
No Disease,No Symptoms
Early BrainChanges,
No Symptoms
Mild MemoryLoss
Mild, Moderate and Severe Impairment
Disease ProgressionDisease Progression
Mild Cognitive
Impairment
Pre-symptomatic
ADNormal AD
PrimaryPrevention
SecondaryPrevention Treatment
Risk of Developing Alzheimer’s Disease in Persons with MCI
Survival curve of persons characterized as having a mild cognitive impairment for 6 years. Approximately 80% have converted to dementia during this time.
Peterson RC, et al., Arch Neurol. 58:1985-1992, 2001.
Normal, 75 years old
Alzheimer’s disease, 75 years old
Volume of Hippocampus and Rate of Shrinkage Predicts Crossover from MCI to AD
Percent Annual Decline in Hippocampal Volume
0
0.5
1
1.5
2
2.5
3
3.5
4
Control MCI AD
StableDecliner
Jack CR, et al, Neurology 55: 484-489, 2000De Leon MJ, 1999
PET Imaging of Amyloid Deposits in Alzheimer’s Disease vs Normal Controls
Source: Klunk, et al. Ann Neurol 2004: 55:306-319.
PET imaging with a novel tracer, Pittsburgh Compound-B (PIB), can provide quantitative information on amyloid deposits in living subjects.
Current Drug Treatments for AD
• Acetylcholinesterase inhibitors for mild to moderate AD− Tacrine (Cognex)− Denepezil (Aricept)− Rivastigmine (Exelon)− Galantamine (Reminyl)
• Neuroprotective agent for moderate to severe AD− Memantine (Namenda)
Funded AD Prevention and Selected Treatment Trials
Vitamins E, Aricept
Aspirin, Vitamin E
Estrogen
B-Carotene, Vit. E, C
Celecoxib, Naproxen
Ginkgo Biloba
Vitamin E, SeleniumSimvastatin
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Vitamin E, C, B6, B12, Folate, B-Carotene
April 2002
Complementary & Alternative Therapies for AD
• Ginkgo Evaluation of Memory (GEM) study
• Clinical trial of huperzine• Traditional Asian medicines• High intensity light therapy
REACH II Intervention
The REACH II intervention is a multi-component
intervention designed to address five areas
linked to caregiver risk profile:
• Safety• Social Support• CR Problem Behaviors• Emotional well-being• Self-care and Health Behaviors