Medical Care Corporation (MCC), the leading provider of high accuracy memory assessment technology, announced that physicians now have a fast and accurate memory assessment procedure, the MCI Screen, which enables them to accurately separate normal declines due to aging from more serious signs of memory loss associated with an underlying medical condition.
Medical Care Corporation's MCI Screen is a brief memory assessment that allows physicians to detect abnormal recall patterns caused by medical conditions such as Alzheimer's disease (AD), vascular disease, depression and other disorders. The easy-to-administer test is 97 percent accurate in detecting Mild Cognitive Impairment (MCI), a transition stage between normal cognition and severe impairment associated with dementia. According to a study from the Mayo Clinic, 60 percent of those with MCI are diagnosed with AD within the next six years so detecting MCI enables physicians to intervene quickly and manage AD at an earlier stage.
The U.S. Preventative Services Task Force recommends cognitive assessment whenever there is evidence or suspicion of memory loss. Since the MCI Screen is quick and noninvasive, it functions as an efficient traffic-control mechanism that escorts the "worried well" out of the healthcare system while retaining those with real memory loss for further evaluation. This process allows physicians to prioritize resources and focus on those patients whose memory concerns are well founded.
About Medical Care Corporation
The MCI Screen's precision is achieved by using advanced mathematical analysis that characterizes recall patterns within a large database of carefully studied patients. The test's computerized algorithm determines whether or not the patient's recall pattern matches those with a healthy profile. Research confirming the accuracy of the MCI Screen has been published in the Proceedings of the National Academy of Science and in the National Alzheimer's Association's Journal of Alzheimer's and Dementia.
Source: Medical Care Corporation
вторник, 14 июня 2011 г.
понедельник, 13 июня 2011 г.
MPs And Peers Must Unite To Prevent Social Care System 'Breaking At The Seams', UK
Baroness Sally Greengross called on the government to act with urgency to mend the crumbling social care system after being elected Chairman of the All-Party Parliamentary Group (APPG) on Dementia.
In her first act as Chairman, the crossbench peer spoke of the need for the government to push on with plans for a commission on social care. She proposed a meeting of APPGs concerned with older people, disability and carers issues to discuss the problem and create an influential voice on the matter.
Speaking after the APPG on Dementia's AGM on Wednesday (7 July), she said:
'The social care system we have in this country is breaking at the seams. Millions of people, including many thousands with dementia, are currently being forced to pay huge fees for often substandard care.'
'The Government has acknowledged this but we now need to see promises turned into action. By bringing together the APPGs, we can create a powerful voice to represent the views of millions of often unheard people and keep the pressure up. There is no quick fix solution but we must make sure the wheels keep turning until we reach our destination - quality care at a fair price.'
Ruth Sutherland, Acting Chief Executive of Alzheimer's Society, which acts as the secretariat for the APPG on Dementia, said:
'One in three people over 65 will die with dementia. People with dementia are some of the hardest hit by the current social care system. Many are forced to pay a 'dementia tax' of tens of thousands of pounds for essential care. These people cannot afford for the government to let this issue slip. They have a right to have the best quality of life possible and not have to bankrupt themselves trying to achieve it.'
'APPGs are an invaluable source of pressure on the government demonstrating how working together can create the best results. We will do everything we can to support Baroness Greengross and her fellow members in their fight for change.'
Baroness Greengross replaces Jeremy Wright MP as Chairman of the APPG. She holds top positions in a number of older people's organisations and committees including the APPG on Intergenerational Futures, the International Longevity Centre - UK think tank and Eurolink Age. MPs David Blunkett, Mike Freer, Tracey Crouch, Tim Farron and Mike Hancock were also elected as Vice Chairmen.
Source:
Alzheimer's Society
In her first act as Chairman, the crossbench peer spoke of the need for the government to push on with plans for a commission on social care. She proposed a meeting of APPGs concerned with older people, disability and carers issues to discuss the problem and create an influential voice on the matter.
Speaking after the APPG on Dementia's AGM on Wednesday (7 July), she said:
'The social care system we have in this country is breaking at the seams. Millions of people, including many thousands with dementia, are currently being forced to pay huge fees for often substandard care.'
'The Government has acknowledged this but we now need to see promises turned into action. By bringing together the APPGs, we can create a powerful voice to represent the views of millions of often unheard people and keep the pressure up. There is no quick fix solution but we must make sure the wheels keep turning until we reach our destination - quality care at a fair price.'
Ruth Sutherland, Acting Chief Executive of Alzheimer's Society, which acts as the secretariat for the APPG on Dementia, said:
'One in three people over 65 will die with dementia. People with dementia are some of the hardest hit by the current social care system. Many are forced to pay a 'dementia tax' of tens of thousands of pounds for essential care. These people cannot afford for the government to let this issue slip. They have a right to have the best quality of life possible and not have to bankrupt themselves trying to achieve it.'
'APPGs are an invaluable source of pressure on the government demonstrating how working together can create the best results. We will do everything we can to support Baroness Greengross and her fellow members in their fight for change.'
Baroness Greengross replaces Jeremy Wright MP as Chairman of the APPG. She holds top positions in a number of older people's organisations and committees including the APPG on Intergenerational Futures, the International Longevity Centre - UK think tank and Eurolink Age. MPs David Blunkett, Mike Freer, Tracey Crouch, Tim Farron and Mike Hancock were also elected as Vice Chairmen.
Source:
Alzheimer's Society
воскресенье, 12 июня 2011 г.
Alzheimer's Disease May Be Predicted By New Brain Marker
Duke University Medical Center researchers have used imaging technology to identify a new marker that may help identify those at greatest risk for cognitive decline and the development of Alzheimer's disease.
The study focused on people with mild cognitive impairment (MCI), a condition that affects an estimated four to five million individuals in the United States. People with MCI are at increased risk for developing Alzheimer's disease in the future and approximately 30-50 percent of MCI subjects will develop Alzheimer's if followed over a three- to five-year period.
Duke researchers used functional magnetic resonance imaging, also known as fMRI, on people with MCI to track regions of the brain that become active or inactive when participating in tasks that involve memory. They then followed these individuals over time to document progression to Alzheimer's.
"A single baseline fMRI measure of deactivation could help predict which individuals will convert to Alzheimer's over the next several years," said the study's lead author, Jeffrey R. Petrella, M.D. "On the other hand, the fMRI scans of MCI subjects who did not convert looked more like those of healthy normal people, and could therefore be reassuring," said Petrella, who is director of the Alzheimer's Imaging Research Laboratory and associate professor of radiology at Duke.
The results of this study, published in PLoS ONE, focus on an area of the brain known as the posteromedial cortex, which has recently been implicated in personal memory.
"Our theory is that the posteromedial cortex may be our brain's 'cruise control' that normally deactivates when we are trying to remember things, so resources can be sent to other areas of the brain that encode memories. However, in people with mild cognitive impairment or Alzheimer's disease, the deactivation does not happen and the posteromedial cortex remains active," said Dr. Petrella.
The process of brain deactivation is similar to some other common bodily functions. For example, when a person is participating in a marathon, the gastrointestinal system temporarily turns off so blood can be redirected to areas which need it more, namely the muscles that are keeping the runner in motion.
In this study, researchers conducted fMRI scans on 75 people, including 34 with mild cognitive impairment, 13 with Alzheimer's disease and 28 with normal cognition. Study participants completed standard neuropsychological testing and were monitored with fMRI while performing a memory task matching names and faces. Patients were then followed for three and a half years to determine how their cognition changed over time.
"At present we treat all people with mild memory loss the same, even though some MCI subjects may convert in a year and others may take five years," said study co-author P. Murali Doraiswamy, M.D., chief of the division of biological psychiatry at Duke. "This is because there is no single test that can definitively predict who will develop late-onset Alzheimer's or not. The ability to probe brain circuits at a deeper level may help us diagnose risk with greater certainty."
The researchers found that approximately a third of the MCI subjects converted to Alzheimer's in three and half years after their initial scans. The conversion to Alzheimer's was determined by study doctors using routine clinical and memory tests. fMRI level of deactivation was found to significantly predict which MCI subjects converted to Alzheimer's.
While other studies have focused on the brain's ability to turn on certain regions, this research determined that losing the ability to turn off a region of the brain may be a more sensitive marker of future cognitive decline
"The Holy Grail in this field is to predict with 100 percent accuracy whether a 50-year old who forgets names will get dementia or not. We are not there yet but are inching closer and closer everyday. The combination of genetic, biochemical and imaging biomarkers will soon become the gold standard," said Doraiswamy.
Dr. Petrella added, "Although we tend of think of Alzheimer's as a disease causing shrinkage of discrete memory centers, at its earliest stages it really disrupts neural circuits. The diagnostic tests of the future will examine not just structure but also the interplay between the many nodes in the brain's memory circuits."
The study was supported by the National Institute on Aging.
Click here to view an animation illustrating the continuum from a healthy brain to one with Alzheimer's disease.
Click here to view the complete study manuscript on the PLoS ONE website.
Source: Melissa Sccwarting
Duke University Medical Center
The study focused on people with mild cognitive impairment (MCI), a condition that affects an estimated four to five million individuals in the United States. People with MCI are at increased risk for developing Alzheimer's disease in the future and approximately 30-50 percent of MCI subjects will develop Alzheimer's if followed over a three- to five-year period.
Duke researchers used functional magnetic resonance imaging, also known as fMRI, on people with MCI to track regions of the brain that become active or inactive when participating in tasks that involve memory. They then followed these individuals over time to document progression to Alzheimer's.
"A single baseline fMRI measure of deactivation could help predict which individuals will convert to Alzheimer's over the next several years," said the study's lead author, Jeffrey R. Petrella, M.D. "On the other hand, the fMRI scans of MCI subjects who did not convert looked more like those of healthy normal people, and could therefore be reassuring," said Petrella, who is director of the Alzheimer's Imaging Research Laboratory and associate professor of radiology at Duke.
The results of this study, published in PLoS ONE, focus on an area of the brain known as the posteromedial cortex, which has recently been implicated in personal memory.
"Our theory is that the posteromedial cortex may be our brain's 'cruise control' that normally deactivates when we are trying to remember things, so resources can be sent to other areas of the brain that encode memories. However, in people with mild cognitive impairment or Alzheimer's disease, the deactivation does not happen and the posteromedial cortex remains active," said Dr. Petrella.
The process of brain deactivation is similar to some other common bodily functions. For example, when a person is participating in a marathon, the gastrointestinal system temporarily turns off so blood can be redirected to areas which need it more, namely the muscles that are keeping the runner in motion.
In this study, researchers conducted fMRI scans on 75 people, including 34 with mild cognitive impairment, 13 with Alzheimer's disease and 28 with normal cognition. Study participants completed standard neuropsychological testing and were monitored with fMRI while performing a memory task matching names and faces. Patients were then followed for three and a half years to determine how their cognition changed over time.
"At present we treat all people with mild memory loss the same, even though some MCI subjects may convert in a year and others may take five years," said study co-author P. Murali Doraiswamy, M.D., chief of the division of biological psychiatry at Duke. "This is because there is no single test that can definitively predict who will develop late-onset Alzheimer's or not. The ability to probe brain circuits at a deeper level may help us diagnose risk with greater certainty."
The researchers found that approximately a third of the MCI subjects converted to Alzheimer's in three and half years after their initial scans. The conversion to Alzheimer's was determined by study doctors using routine clinical and memory tests. fMRI level of deactivation was found to significantly predict which MCI subjects converted to Alzheimer's.
While other studies have focused on the brain's ability to turn on certain regions, this research determined that losing the ability to turn off a region of the brain may be a more sensitive marker of future cognitive decline
"The Holy Grail in this field is to predict with 100 percent accuracy whether a 50-year old who forgets names will get dementia or not. We are not there yet but are inching closer and closer everyday. The combination of genetic, biochemical and imaging biomarkers will soon become the gold standard," said Doraiswamy.
Dr. Petrella added, "Although we tend of think of Alzheimer's as a disease causing shrinkage of discrete memory centers, at its earliest stages it really disrupts neural circuits. The diagnostic tests of the future will examine not just structure but also the interplay between the many nodes in the brain's memory circuits."
The study was supported by the National Institute on Aging.
Click here to view an animation illustrating the continuum from a healthy brain to one with Alzheimer's disease.
Click here to view the complete study manuscript on the PLoS ONE website.
Source: Melissa Sccwarting
Duke University Medical Center
суббота, 11 июня 2011 г.
New Ethical Guidelines Needed For Dementia Research
How do we handle the ethical dilemmas of research on adults who can't give their informed consent? In a recent article in the journal Bioethics, ethicist Stefan Eriksson proposes a new approach to the dilemma of including dementia patients and others with limited decision making capabilities in research.
There is a need for research on persons with impaired decision making, for example dementia patients. Without their participation we stand to loose knowledge necessary for future treatments that can benefit these groups. There are ethical guidelines to guard their interests, but they are somewhat ill-guided, says Stefan Eriksson, associate professor of research ethics at the Centre for Research Ethics & Bioethics (CRB).
We are sometimes led to believe that these guidelines conclusively state that research on these groups is permitted only in exceptional cases, but they don't, he says.
According to Stefan Eriksson, today's guidelines are often arbitrary. On one hand, research that benefits some groups, for example one's own age group, is allowed. On the other hand, research that benefits other groups, for example one's own children or community is not allowed. The previous will or interests expressed by person has little or no weight in these situations.
Another problem that Stefan Eriksson highlights is that some ethical standards simply make no sense for these groups. For example, the idea of a 'minimal risk standard' builds on the idea that there is something ordinary or routine about the risks we take in our daily lives. Such risks should then be acceptable in research as well. This kind of reasoning doesn't work for someone with for example Alzheimer's. The same is true for 'very slight impact' and 'routine examination', notions that doesn't translate well to a person with dementia who might very well react in a very different way than a person without dementia.
The guidelines that researchers act according to allows for vulnerable persons to be exploited, says Stefan Eriksson.
Instead of trying to translate the norm to those who fall outside it, we need to address the real issues at stake and re-write the guidelines that apply today Stefan Eriksson says. We need to rid them of notions of exceptionality, minimal risk and group beneficence. We also need to monitor this kind of research more closely and provide legal obligations to compensate for any injuries suffered. He concludes:
But we also need to consider other issues, such as how surrogate decision-makes can be of use to these persons and how to find ways to estimate a dementia patient's capacity for autonomy. We need to continue the debate and do more research on the ethics of research on persons with limited decision-making capacity.
Source: Uppsala Universitet
There is a need for research on persons with impaired decision making, for example dementia patients. Without their participation we stand to loose knowledge necessary for future treatments that can benefit these groups. There are ethical guidelines to guard their interests, but they are somewhat ill-guided, says Stefan Eriksson, associate professor of research ethics at the Centre for Research Ethics & Bioethics (CRB).
We are sometimes led to believe that these guidelines conclusively state that research on these groups is permitted only in exceptional cases, but they don't, he says.
According to Stefan Eriksson, today's guidelines are often arbitrary. On one hand, research that benefits some groups, for example one's own age group, is allowed. On the other hand, research that benefits other groups, for example one's own children or community is not allowed. The previous will or interests expressed by person has little or no weight in these situations.
Another problem that Stefan Eriksson highlights is that some ethical standards simply make no sense for these groups. For example, the idea of a 'minimal risk standard' builds on the idea that there is something ordinary or routine about the risks we take in our daily lives. Such risks should then be acceptable in research as well. This kind of reasoning doesn't work for someone with for example Alzheimer's. The same is true for 'very slight impact' and 'routine examination', notions that doesn't translate well to a person with dementia who might very well react in a very different way than a person without dementia.
The guidelines that researchers act according to allows for vulnerable persons to be exploited, says Stefan Eriksson.
Instead of trying to translate the norm to those who fall outside it, we need to address the real issues at stake and re-write the guidelines that apply today Stefan Eriksson says. We need to rid them of notions of exceptionality, minimal risk and group beneficence. We also need to monitor this kind of research more closely and provide legal obligations to compensate for any injuries suffered. He concludes:
But we also need to consider other issues, such as how surrogate decision-makes can be of use to these persons and how to find ways to estimate a dementia patient's capacity for autonomy. We need to continue the debate and do more research on the ethics of research on persons with limited decision-making capacity.
Source: Uppsala Universitet
пятница, 10 июня 2011 г.
Update On NICE Guidance On The Use Of Drugs To Treat Alzheimer's Disease, UK
The National Institute for Health and Clinical Excellence (NICE) has today published the next draft of its guidance on the use of donepezil, rivastigmine, galantamine and memantine for the treatment of Alzheimer's disease.
The Appraisal Committee is recommending that donepezil, galantamine and rivastigmine should be considered as options in the treatment of people with Alzheimer's disease of moderate severity only (that is, those with a mini mental state examination [MMSE] score of between 10 and 20 points). Memantine is not recommended as a treatment option for people with moderately-severe to severe Alzheimer's disease except as part of clinical studies.
The draft recommendations are subject to an appeal period which closes on 15 June: the consultation document has been published earlier than anticipated, for information, following a leak of the document to national newspapers. During this period registered stakeholder organisations including those representing healthcare professionals, patients and carers can decide if they wish to appeal against the draft guidance. If no appeals are received, the guidance will be issued to the NHS. If appeals are received these will be considered by the Institute. NICE is expecting to issue final guidance to the NHS in July 2006.
The guidance which NICE issued on the use of donepezil, galantamine and rivastigmine for Alzheimer's disease in 2001 is still in force and will continue to apply until NICE issues updated guidance. When published, the guidance will apply to newly diagnosed patients only. Patients currently using these drugs should continue to do so, on the basis on which they were initiated.
NICE is currently also consulting on a clinical guideline on the management of dementia which addresses the wider issue of care of patients with dementia (including Alzheimer's disease). This guideline is expected to be published in December 2006. More details can be found at nice.uk/page.aspx?o=guidelines.inprogress.dementia.
nice.uk
The Appraisal Committee is recommending that donepezil, galantamine and rivastigmine should be considered as options in the treatment of people with Alzheimer's disease of moderate severity only (that is, those with a mini mental state examination [MMSE] score of between 10 and 20 points). Memantine is not recommended as a treatment option for people with moderately-severe to severe Alzheimer's disease except as part of clinical studies.
The draft recommendations are subject to an appeal period which closes on 15 June: the consultation document has been published earlier than anticipated, for information, following a leak of the document to national newspapers. During this period registered stakeholder organisations including those representing healthcare professionals, patients and carers can decide if they wish to appeal against the draft guidance. If no appeals are received, the guidance will be issued to the NHS. If appeals are received these will be considered by the Institute. NICE is expecting to issue final guidance to the NHS in July 2006.
The guidance which NICE issued on the use of donepezil, galantamine and rivastigmine for Alzheimer's disease in 2001 is still in force and will continue to apply until NICE issues updated guidance. When published, the guidance will apply to newly diagnosed patients only. Patients currently using these drugs should continue to do so, on the basis on which they were initiated.
NICE is currently also consulting on a clinical guideline on the management of dementia which addresses the wider issue of care of patients with dementia (including Alzheimer's disease). This guideline is expected to be published in December 2006. More details can be found at nice.uk/page.aspx?o=guidelines.inprogress.dementia.
nice.uk
четверг, 9 июня 2011 г.
Alzheimer's Disease Research Seeks Volunteers For Dietary Study
The Indiana University Center for Alzheimer's disease and Related Disorders seeks volunteers for a clinical study on the effects of a fatty acid on patients with Alzheimer's.
The fatty acid, docosahexaenoic acid or DHA, which is found in small amounts in the diet, is essential for normal brain and eye development. Center researchers want to evaluate whether chronic use of DHA changes the progression of Alzheimer's. This research will help physicians learn more about the usefulness of DHA for future prevention and treatment of the disease.
Volunteers, who must have been diagnosed with Alzheimer's disease, will participate in the study for 18 months and will be seen approximately six times during the course of the study at the IU Medical Center. Study medication, procedures, exams and compensation for time and travel are provided.
For more information, call 317-278-8307.
Center for Alzheimer Disease and Related Disorders
The fatty acid, docosahexaenoic acid or DHA, which is found in small amounts in the diet, is essential for normal brain and eye development. Center researchers want to evaluate whether chronic use of DHA changes the progression of Alzheimer's. This research will help physicians learn more about the usefulness of DHA for future prevention and treatment of the disease.
Volunteers, who must have been diagnosed with Alzheimer's disease, will participate in the study for 18 months and will be seen approximately six times during the course of the study at the IU Medical Center. Study medication, procedures, exams and compensation for time and travel are provided.
For more information, call 317-278-8307.
Center for Alzheimer Disease and Related Disorders
среда, 8 июня 2011 г.
Gingko Biloba Not Effective Against Alzheimer's
A randomized clinical trial involving over 3,000 elderly people in the US found that the popular herbal supplement Gingko biloba fared no better
than placebo at preventing dementia or Alzheimer's disease.
The research was the work of the Ginkgo Evaluation of Memory (GEM) Study Investigators who are based at centers throughout the US, including the
University of Pittsburgh, Pennsylvania, where lead author Dr Steven T DeKosky, was working at the time of the investigation. The findings are
published in the 19 November issue of the Journal of the American Medical Association, JAMA.
Ginkgo biloba is taken by many people because of claims that it benefits memory and cognition and in some parts of the world it is prescribed for
such. But there have been no substantial clinical trials to evaluate the effectiveness of the supplement in the primary prevention of dementia, wrote the
authors.
More than 5 million people in the United States are currently affected by dementia and Alzheimer's in particular. This chronic disease is a leading
cause of age-associated disability requiring long term care, according to DeKosky and colleagues.
The randomized, placebo-controlled clinical trial included 3,069 community-dwelling volunteers aged 75 and over and took place at five US medical
research centers between 2000 and 2008. About half the volunteers were given a twice daily dose of 120mg extract of Ginkgo biloba and the other
half took a placebo.
None of the participants showed signs more advanced than mild cognitive impairment at the start (2,587 had normal cognition while 482 had mild
cognitive impairment). They were followed for a median period of 6.1 years during which time they underwent 6-monthly assessments for
dementia.
The results showed that:
During the period of the study, 523 participants were diagnosed with dementia: 16.1 per cent (246) in the placebo group and 17.9 per cent (277)
in the Ginkgo biloba group.
92 per cent of all the dementia cases were classed as possible or probable Alzheimer's Disease (AD), or AD with evidence of the tell-tale signs of
AD in the brain (vascular disease that shows as changes in the blood vessels).
The overall prevalence rate of dementia did not differ significantly between the two groups: 3.3 dementia cases per 100 persons per year of
exposure for the Gingko biloba group and 2.9 per 100 for the placebo group.
There was a similar lack of significance for Alzheimer's prevalence: 3.0 persons per 100 per year of exposure in the Gingko biloba group and 2.6
per 100 in the placebo group.
Ginkgo biloba appeared to have no impact on the rate of progression to dementia in the participants who had mild cognitive impairment.
There were no significant differences between the groups in the rate of side effects.
The authors concluded that:
"Based on the results of this trial, Ginkgo biloba cannot be recommended for the purpose of preventing dementia."
They also said that these findings confirm the idea that randomized trials play a crucial part in the evaluation of new traditional pharmaceutical and
complementary therapies alike and show that it is important to include older people in randomized trials of treatments that claim to be effective at
preventing or delaying dementia.
In an accompanying editorial, Dr Lon S Schneider from the University of Southern California, Los Angeles, wrote that two decades of research using
standardized extracts of Ginkgo biloba have yielded no definitive answer about its effectiveness. Preclinical scientific reports sing its praises but have
failed to identify the active compounds and the claims have not been proved in clinical research.
"The clinical research, in turn, has not adequately defined potential cognitive indications, potentially effective dosing ranges, pharmacodynamic
markers, or convincing evidence for efficacy for any one cognitive condition," wrote Schneider.
"The GEM study adds to the substantial body of evidence that Ginkgo biloba extract as it is generally used does not prevent dementia in individuals
with or without cognitive impairment and is not effective for Alzheimer disease," he added.
"Ginkgo biloba for Prevention of Dementia: A Randomized Controlled Trial."
Steven T. DeKosky; Jeff D. Williamson; Annette L. Fitzpatrick; Richard A. Kronmal; Diane G. Ives; Judith A. Saxton; Oscar L. Lopez; Gregory Burke;
Michelle C. Carlson; Linda P. Fried; Lewis H. Kuller; John A. Robbins; Russell P. Tracy; Nancy F. Woolard; Leslie Dunn; Beth E. Snitz; Richard L.
Nahin; Curt D. Furberg; for the Ginkgo Evaluation of Memory (GEM) Study Investigators.
JAMA, Vol. 300 No. 19, pp 2253-2262, November 19, 2008.
Click here for Article.
Sources: JAMA.
Written by: , PhD
than placebo at preventing dementia or Alzheimer's disease.
The research was the work of the Ginkgo Evaluation of Memory (GEM) Study Investigators who are based at centers throughout the US, including the
University of Pittsburgh, Pennsylvania, where lead author Dr Steven T DeKosky, was working at the time of the investigation. The findings are
published in the 19 November issue of the Journal of the American Medical Association, JAMA.
Ginkgo biloba is taken by many people because of claims that it benefits memory and cognition and in some parts of the world it is prescribed for
such. But there have been no substantial clinical trials to evaluate the effectiveness of the supplement in the primary prevention of dementia, wrote the
authors.
More than 5 million people in the United States are currently affected by dementia and Alzheimer's in particular. This chronic disease is a leading
cause of age-associated disability requiring long term care, according to DeKosky and colleagues.
The randomized, placebo-controlled clinical trial included 3,069 community-dwelling volunteers aged 75 and over and took place at five US medical
research centers between 2000 and 2008. About half the volunteers were given a twice daily dose of 120mg extract of Ginkgo biloba and the other
half took a placebo.
None of the participants showed signs more advanced than mild cognitive impairment at the start (2,587 had normal cognition while 482 had mild
cognitive impairment). They were followed for a median period of 6.1 years during which time they underwent 6-monthly assessments for
dementia.
The results showed that:
During the period of the study, 523 participants were diagnosed with dementia: 16.1 per cent (246) in the placebo group and 17.9 per cent (277)
in the Ginkgo biloba group.
92 per cent of all the dementia cases were classed as possible or probable Alzheimer's Disease (AD), or AD with evidence of the tell-tale signs of
AD in the brain (vascular disease that shows as changes in the blood vessels).
The overall prevalence rate of dementia did not differ significantly between the two groups: 3.3 dementia cases per 100 persons per year of
exposure for the Gingko biloba group and 2.9 per 100 for the placebo group.
There was a similar lack of significance for Alzheimer's prevalence: 3.0 persons per 100 per year of exposure in the Gingko biloba group and 2.6
per 100 in the placebo group.
Ginkgo biloba appeared to have no impact on the rate of progression to dementia in the participants who had mild cognitive impairment.
There were no significant differences between the groups in the rate of side effects.
The authors concluded that:
"Based on the results of this trial, Ginkgo biloba cannot be recommended for the purpose of preventing dementia."
They also said that these findings confirm the idea that randomized trials play a crucial part in the evaluation of new traditional pharmaceutical and
complementary therapies alike and show that it is important to include older people in randomized trials of treatments that claim to be effective at
preventing or delaying dementia.
In an accompanying editorial, Dr Lon S Schneider from the University of Southern California, Los Angeles, wrote that two decades of research using
standardized extracts of Ginkgo biloba have yielded no definitive answer about its effectiveness. Preclinical scientific reports sing its praises but have
failed to identify the active compounds and the claims have not been proved in clinical research.
"The clinical research, in turn, has not adequately defined potential cognitive indications, potentially effective dosing ranges, pharmacodynamic
markers, or convincing evidence for efficacy for any one cognitive condition," wrote Schneider.
"The GEM study adds to the substantial body of evidence that Ginkgo biloba extract as it is generally used does not prevent dementia in individuals
with or without cognitive impairment and is not effective for Alzheimer disease," he added.
"Ginkgo biloba for Prevention of Dementia: A Randomized Controlled Trial."
Steven T. DeKosky; Jeff D. Williamson; Annette L. Fitzpatrick; Richard A. Kronmal; Diane G. Ives; Judith A. Saxton; Oscar L. Lopez; Gregory Burke;
Michelle C. Carlson; Linda P. Fried; Lewis H. Kuller; John A. Robbins; Russell P. Tracy; Nancy F. Woolard; Leslie Dunn; Beth E. Snitz; Richard L.
Nahin; Curt D. Furberg; for the Ginkgo Evaluation of Memory (GEM) Study Investigators.
JAMA, Vol. 300 No. 19, pp 2253-2262, November 19, 2008.
Click here for Article.
Sources: JAMA.
Written by: , PhD
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