RESUMEN
AIM: Yokukansan (YKS), a traditional herbal medicine, has been used to treat behavioral and psychological symptoms of dementia (BPSD). The present study is the first double-blind, randomized, placebo-controlled trial to determine the efficacy and safety of YKS for the treatment of BPSD in Alzheimer's disease (AD). METHODS: A total of 22 sites consisting of clinics, hospitals and nursing homes participated. A total of 145 patients with AD were randomized. Active YKS (7.5 g/day) and placebo were supplied to 75 and 70 participants, respectively. The primary outcome measure was the 4-week change in total score of the Neuropsychiatric Inventory Brief Questionnaire Form (NPI-Q), an instrument that evaluates BPSD. Secondary outcome measures included 12-week changes in NPI-Q scores, changes in NPI-Q subcategory scores and total scores of the Mini-Mental-State Examination. RESULTS: Four-week changes in NPI-Q total scores did not differ significantly between the treatment and placebo groups. There were also no significant differences between groups in 12-week changes in total NPI-Q scores, NPI-Q subcategory scores or total Mini-Mental-State Examination scores. However, a subgroup with fewer than 20 points on the Mini-Mental-State Examination at baseline showed a greater decrease in "agitation/aggression" score in the YKS group than in the placebo group (P = 0.007). No serious adverse effects were observed during the study. CONCLUSIONS: Our data did not reach statistical significance regarding the efficacy of YKS against BPSD; however, YKS improves some symptoms including "agitation/aggression" and "hallucinations" with low frequencies of adverse events. Geriatr Gerontol Int 2017; 17: 211-218.
Asunto(s)
Enfermedad de Alzheimer/psicología , Síntomas Conductuales/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Trastornos Mentales/tratamiento farmacológico , Fitoterapia , Anciano , Anciano de 80 o más Años , Síntomas Conductuales/etiología , Método Doble Ciego , Femenino , Humanos , Masculino , Trastornos Mentales/etiología , Pruebas NeuropsicológicasRESUMEN
Adiponectin (APN) is protective in animal models of neurodegenerative diseases, but the role of APN in human brain has not been established. Using an enzyme-linked immunosorbent assay, we found that APN was significantly decreased in cerebrospinal fluid (CSF) of patients with Alzheimer's disease (AD), compared to those in patients with mild cognitive impairment (MCI) and in normal controls (NC), despite elevation of APN in serum of patients with MCI and AD compared to that in NC. The discrepancy of CSF APN from serum APN in AD may suggest some critical actions of APN in the pathogenesis of AD. Indeed, it was histologically observed that APN was co-localized with tau in neurofibrillary tangles and immunoblot analysis showed that the functional trimers of APN were significantly decreased in AD compared to those in NC. Collectively, a loss of function of APN may be involved in the pathogenesis of AD.
Asunto(s)
Adiponectina/líquido cefalorraquídeo , Enfermedad de Alzheimer/etiología , Adiponectina/análisis , Adiponectina/sangre , Adiponectina/deficiencia , Anciano , Enfermedad de Alzheimer/líquido cefalorraquídeo , Enfermedad de Alzheimer/patología , Biomarcadores/sangre , Biomarcadores/líquido cefalorraquídeo , Encéfalo/patología , Química Encefálica , Estudios de Casos y Controles , Disfunción Cognitiva/sangre , Disfunción Cognitiva/líquido cefalorraquídeo , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , MasculinoRESUMEN
AIM: Although diabetes mellitus (DM) is considered to be one of the most consistent risks for developing dementia, it is not known if the pathology in dementia patients with DM is similar to or distinct from typical pathological features of Alzheimer's disease (AD). To discover the mechanism of developing dementia in AD patients with DM in a living state, we studied the distribution of amyloid ß (Αß) protein of diabetic AD patients. METHODS: To evaluate the accumulation of Aß, we examined 14 normal controls, four diabetic patients with AD and 11 non-diabetic patients with AD by positron emission tomography (PET) using BF-227, a currently developed Aß tracer. RESULTS: The analysis of PET images among the three groups showed an abundant aggregated Aß accumulation in the cerebral cortex of both AD patients with and without DM. The extent and distributions of BF-227 accumulation in diabetic AD patients were not significantly different from these of non-diabetic AD patients. CONCLUSION: These results suggest that the degree and extent of Aß deposition is not significantly different between AD with DM and AD alone.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico por imagen , Enfermedad de Alzheimer/metabolismo , Péptidos beta-Amiloides/metabolismo , Complicaciones de la Diabetes/diagnóstico por imagen , Complicaciones de la Diabetes/metabolismo , Tomografía de Emisión de Positrones , Anciano , Benzoxazoles , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , TiazolesAsunto(s)
Enfermedad de Alzheimer/complicaciones , Inhibidores de la Colinesterasa/administración & dosificación , Trastornos de Deglución/tratamiento farmacológico , Trastornos de Deglución/etiología , Fenilcarbamatos/administración & dosificación , Anciano de 80 o más Años , Femenino , Humanos , Rivastigmina , Índice de Severidad de la Enfermedad , Parche TransdérmicoAsunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Cognición/efectos de los fármacos , Demencia/prevención & control , Hipertensión/tratamiento farmacológico , Inhibidores de la Enzima Convertidora de Angiotensina/farmacocinética , Barrera Hematoencefálica/fisiología , Demencia/epidemiología , Demencia/etiología , Femenino , Humanos , Hipertensión/complicaciones , Hipertensión/metabolismo , Incidencia , Masculino , Factores de RiesgoAsunto(s)
Anciano/psicología , Cuidadores/psicología , Homicidio , Anciano de 80 o más Años , Femenino , Humanos , Vida Independiente , Japón , MasculinoRESUMEN
BACKGROUND: The down-regulation of the cough reflex in patients with aspiration pneumonia can involve both cortical facilitatory pathways for cough and medullary reflex pathways. In order to study the possible involvement of the supramedullary system in the down-regulation of cough reflex, we evaluated the urge-to-cough in patients with aspiration pneumonia. METHODS: Cough reflex sensitivity and the urge-to-cough to inhaled citric acid were evaluated in patients with at least a history of aspiration pneumonia and age-matched healthy elderly people. The cough reflex sensitivities were defined as the lowest concentration of citric acid that elicited two or more coughs (C2) and five or more coughs (C5). The urge-to-cough scores at the concentration of C2 and C5, and at the concentration of two times dilution of C2 (C2/2) and C5 (C5/2) were estimated for each subject. RESULTS: Both C2 and C5 in the control subjects were significantly greater than those for patients with aspiration pneumonia. There were no significant differences in the urge-to-cough at C2 and C5 between control subjects and patients with aspiration pneumonia. However, the urge-to-cough scores at both C2/2 and C5/2 in patients with aspiration pneumonia were significantly lower than those in control subjects. The number of coughs at C5/2 was significantly greater in the control subjects than those in the patients with aspiration pneumonia whereas the number of coughs at C2/2 did not show a significant difference between the control subjects and the patients with aspiration pneumonia. CONCLUSION: The study suggests the involvement of supramedullary dysfunction in the etiology of aspiration pneumonia in the elderly. Therefore, restoration of the cough motivation system could be a new strategy to prevent aspiration pneumonia in the elderly.