By Kenneth Rockwood
Given the elevated consciousness through clinicians, researchers and the pharmaceutical to the administration and therapy of dementia not just within the aged but in addition in more and more more youthful populations, the calls for for potent evidence-based pharmaceutical keep watch over of dementia and quantitative overview of results have elevated. on the grounds that a few first steps within the early 1960's to the arguable landmark paper of Summers and co-workers, to the newest trials, it's transparent either that a lot growth has been made, and that a lot continues to be performed. This e-book is written to take inventory of what's now usefully recognized, and to take a position on instructions for the future.
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Extra resources for Trial designs and outcomes in dementia therapeutic research
Example text
A number of therapeutic strategies based upon this knowledge have been explored, including attempts to increase acetylcholine synthesis, the use of postsynaptic receptor agonists, drugs augmenting the release of acetylcholine, and the reduction of acetylcholine degradation at a synaptic level with the cholinesterase inhibitors. The latter is the only strategy that has stood the test of time, and is now available in the form of licensed treatments. Four cholinesterase inhibitors have been licensed, tacrine, donepezil, galantamine and rivastigmine.
There are a number of glutamate receptors, among which the NMDA-receptor is thought to play an important role in the long-term potentiation processes involved in learning and memory function. Memantine is considered to reduce over-stimulation of the NMDA-receptor in its resting state, caused by an abnormally high concentration of glutamate. This allows some normalisation of the latter’s physiological signalling function, and may also reduce excitotoxicity, which may in turn be neuroprotective by preventing the neuronal calcium overload that has been implicated in neurodegenerative processes.
53 However, these post hoc studies are often affected by a bias in subject recruitment and selectivity in choice of outcomes measures. For example, these analyses often do not include the likely possibility that, even if achieved, a delay in nursing home placement would in fact extend life and therefore thereby increase overall healthcare costs. Ultimately, I believe we should decide what dementia drugs are worth, based on quality-of-life assessment. Does taking any current dementia drug improve the quality-of-life of the patient or the caregiver?