|
  ![[help]](/images/buttons/help.gif) |
|
|
|
|
|
Biomedical Frontiers: SPRING/SUMMER 1997, Vol.4, No.3
Special Section: Alzheimer's Research
Formula Predicts Disease
Course
Another area of interest for Dr. Stern is determining why
some patients are better able to cope with Alzheimer's
disease pathology. This scan shows the differences between
cerebral blood flow in the brains of two groups of patients
with Alzheimer's disease that were matched for the severity
of their clinical symptoms. The brains of patients whose
occupations called for high interpersonal skills (working
with people vs. working with things) had more pathology
(seen by the more depleted flow in the parieto-temporal
cortex) than patients with low interpersonal skills
professions. Dr. Stern concluded that patients whose
occupations called for high interpersonal skills may
have more "cognitive reserve," allowing them to cope
better with Alzheimer's disease pathology. A similar
but separate relationship was noted between increased
educational attainment and cognitive reserve.
|
Dr. Stern, professor of clinical neuropsychology, and colleagues developed the formula to estimate the length of time before an Alzheimer's disease patient either requires nursing home care (or its equivalent) or dies. The formula is based on information a physician could obtain on a patient's initial visit, such as the presence or absence of extrapyramidal signs and psychotic symptoms, the age at onset of the disease, the patient's score on a standard mental status test, duration of the illness, gender, and age.
The formula does not give an exact prediction, but rather provides a time frame for an expected outcome. For instance, a typical prediction might read, "based upon the patients that we have followed, 25 percent of patients with a similar clinical profile require nursing home care within x months, 50 percent within x months, and 75 percent within x months."
To assist clinicians who wish to use this formula, Dr. Stern has
posted the formula on a web page. A clinician simply has to plug
in the appropriate numbers and the page will automatically do all
the necessary calculations. The URL for the predictor page is: cpmcnet.columbia.edu/dept/sergievsky/predictor.html
|
Vitamin E,
Selegiline for AD
Both selegiline (Eldepryl) and alpha-tocopherol (vitamin E) delay important functional signs and symptoms of Alzheimer's disease by about seven months, according to a study from CPMC and 23 Alzheimer's Disease Cooperative Study (ADCS) sites. The study was published in an April issue of the New England Journal of Medicine. The clinical trial followed 341 patients, who were divided into four groups: subjects receiving a placebo; subjects taking 10 milligrams of selegiline a day; subjects taking 2,000 IU of vitamin E per day; and subjects taking a combination of both drugs. The researchers assessed the patients every three months for two years, marking four milestones in disease progression: death, institutionalization, loss of the ability to perform basic daily activities, and progression to severe dementia. The researchers found a significant delay after treatment with either drug but no additive benefit from a combination of the two. Subjects on selegiline took 215 days longer than the placebo group to reach any of the four milestones. With vitamin E, the delay was about 230 days. "This is the first study designed to measure a delay in disease progression, and it raises our hopes and expectations for future treatments," says Dr. Mary Sano, project director and associate professor of clinical neuropsychology. |