Effects of a caregiver intervention on negative caregiver appraisals of behavior problems in patients with Alzheimer's disease: results of a randomized trial. Health Behavior Changes After Genetic Risk Assessment for Alzheimer Disease: The REVEAL Study Tolerability and safety of Souvenaid in patients with mild Alzheimer's disease: results of multi-center, 24-week, open-label extension study. Exercise training for depressed older adults with Alzheimer's disease Adjunctive treatment with high frequency repetitive transcranial magnetic stimulation for the behavioral and psychological symptoms of patients with Alzheimer's disease: a randomized, double-blind, sham-controlled study Medication development for agitation and aggression in Alzheimer disease: review and discussion of recent randomized clinical trial design. Medication adherence survey of drugs useful in prevention of dementia of Alzheimer's type among Indian patients.
Behavioral problems are among the most challenging aspects of caring for a person with Alzheimer 's disease . A sample of 406 spouses-caregivers of patients with Alzheimer 's disease was r and omized to an active multicomponent counseling and support intervention condition or to a usual care condition . Caregivers reported on the frequency of troublesome patient behaviors and their reactions to them at baseline and at regular follow-up interviews . R and om-effects regression models over the first 4 years after r and omization revealed that , although the intervention did not affect the frequency of patient behavioral problems , it did significantly reduce caregivers ' reaction ratings . Because caregiver appraisal s have been found to mediate the impact of caregiving stress on depression and to predict nursing home placement rates , they deserve greater attention as an important target of intervention services Risk information for Alzheimer disease ( AD ) may be communicated through susceptibility gene disclosure , even though this is not currently in clinical use . The REVEAL Study is the first r and omized clinical trial of risk assessment for AD with apolipoprotein E ( APOE ) genotype and numerical risk estimate disclosure . We examined whether APOE genotype and numerical risk disclosure to asymptomatic individuals at high risk for AD alters health behaviors . One hundred sixty-two participants were r and omized to either intervention ( APOE disclosure ) or control ( no genotype disclosure ) groups . Subjects in both groups received numerical lifetime risk estimates of future AD development based on sex and family history of AD . The intervention group received their APOE genotype . Subjects were informed that no proven preventive measures for AD existed and given an information sheet on preventative therapies under investigation . Participants who learned they were ϵ4 positive were significantly more likely than ϵ4 negative participants to report AD-specific health behavior change 1 year after disclosure ( adjusted odds ratio : 2.73 ; 95 % confidence interval : 1.14 , 6.54 ; P=0.02 ) . Post hoc analyses revealed similar significant associations between numerical lifetime risk estimates and self-report of AD-specific health behavior change . Despite lack of preventive measures for AD , knowledge of APOE genotype , numerical lifetime risk , or both , influences health behavior BACKGROUND The medical food Souvenaid , containing the specific nutrient combination Fortasyn Connect , is design ed to improve synapse formation and function in patients with Alzheimer 's disease ( AD ) . Two double-blind r and omized controlled trials ( RCT ) with Souvenaid of 12 and 24 week duration ( Souvenir I and Souvenir II ) showed that memory performance was improved in drug-naïve mild AD patients , whereas no effects on cognition were observed in a 24-week RCT ( S-Connect ) in mild to moderate AD patients using AD medication . Souvenaid was well-tolerated in all RCTs . OBJECTIVE In this 24-week open-label extension ( OLE ) study to the 24-week Souvenir II RCT , long-term safety and intake adherence of the medical food Souvenaid was evaluated . METHODS Patients with mild AD ( n = 201 ) received Souvenaid once-daily during the OLE . Main outcome parameters were safety and product intake adherence . The memory domain z-score from a revised neuropsychological test battery was continued as exploratory parameter . RESULTS Compared to the RCT , a similar ( low ) incidence and type of adverse events was observed , being mainly ( 68.3 % ) of mild intensity . Pooled data ( RCT and OLE ) showed that 48-week use of Souvenaid was well tolerated with high intake adherence ( 96.1 % ) . Furthermore , a significant increase in the exploratory memory outcome was observed in both the active-active and control-active groups during Souvenaid intervention . CONCLUSION Souvenaid use for up to 48-weeks was well tolerated with a favorable safety profile and high intake adherence . The findings in this OLE study warrant further investigation toward the long-term safety and efficacy of Souvenaid in a well-controlled , double-blind RCT The purpose of this study was to compare the effects of 16 weeks of a comprehensive exercise routine to supervised walking and social conversation on depression in nursing home residents with Alzheimer 's disease ( AD ) . Method : This study was a three-group , repeated- measures design with r and om assignment to treatment group . Forty-five nursing home residents with moderate to severe AD were r and omly assigned to a 16-week programme of comprehensive exercise , supervised walking or social conversation . Raters were blinded to treatment group assignment . Major outcome variables were depression measured by the Cornell Scale for Depression in Dementia , mood measured by the Dementia Mood Assessment Scale and the Alzheimer 's Mood Scale , and affect measured by the Observed Affect Scale . Depression was reduced in all three groups with some evidence of superior benefit from exercise .  Depression is a common problem with serious and costly consequences for nursing home residents with AD .  Exercise as a behavioural approach to treatment of depression in nursing home residents with severe AD evidence d a clear benefit to participants in this study . More research is needed to clarify the relative benefits of different types of exercise in conjunction with or without pharmacological intervention Background Behavioral and psychological symptoms of dementia ( BPSD ) occur in 70 - 90 % of patients at different stages of Alzheimer ’s Disease ( AD ) , but the available methods for managing these problems are of limited effectiveness . Aim Assess the effects of high-frequency repetitive transcranial magnetic stimulation ( rTMS ) , applied over the left dorsolateral prefrontal cortex ( DLPFC ) , on BPSD and cognitive function in persons with AD . Methods Fifty-four patients with AD and accompanying BPSD were r and omly divided into an intervention group ( n=27 ) and a control group ( n=27 ) . In addition to st and ard antipsychotic treatment , the intervention group was treated with 20Hz rTMS five days a week for four weeks , while the control group was treated with sham rTMS.The  Behavioral Pathology in Alzheimer 's Disease Rating Scale ( BEHAVE-AD ) , the Alzheimer 's Disease Assessment Scale-Cognitive ( ADAS-Cog ) , and the Treatment Emergent Symptom Scale ( TESS ) were administered by raters who were blind to the group assignment of patients before and after four weeks of treatment . Results Twenty-six subjects from each group completed the study . After four weeks of antipsychotic treatment with adjunctive real or sham rTMS treatment , the mean ( sd ) total BEHAVE-AD scores and mean total ADAS-Cog scores of both groups significantly decreased from baseline . After adjusting for baseline values , the intervention group had significantly lower scores ( i.e. , greater improvement ) than the control group on the BEHAVE-AD total score , on five of the seven BEHAVE-AD factor scores ( activity disturbances , diurnal rhythm , aggressiveness , affective disturbances , anxieties and phobias ) , on the ADAS-Cog total score , and on all four ADAS-Cog factor scores ( memory , language , constructional praxis , and attention ) . The proportion of individuals whose behavioral symptoms met a predetermined level of improvement ( i.e. , a drop in BEHAVE-AD total score of > 30 % from baseline ) in the intervention group was greater than that in the control group ( 73.1 % vs.42.3 % , X2=5.04 , p=0.025 ) . Conclusion Compared to treatment of AD with low-dose antipsychotic medications alone , the combination of low-dose antipsychotic medication with adjunctive treatment with high frequency rTMS can significantly improve both cognitive functioning and the behavioral and psychological symptoms that often accompany AD ABSTRACT Background : The management of disruptive neuropsychiatric symptom ( NPS ) such as agitation and aggression ( A/A ) is a major priority in caring for people with Alzheimer 's disease ( AD ) . Few effective pharmacological or non-pharmacological options are available . Results of r and omized clinical trials ( RCTs ) of drugs for A/A have been disappointing . This may result from the absence of biological efficacy for medications tested in treating A/A. It may also be related to method ological issues such as the choice of outcomes . The aim of this review was to highlight key method ological issues pertaining to RCTs of current and emerging medications for the treatment of A/A in AD . Methods : We search ed PubMed / Medline , Cochrane Central Register of Controlled Trials , and Clinical Trials.gov for RCTs comparing medications with either placebo or other drugs in the treatment of A/A in AD , between January 2008 and December 2013 . Results : We identified a total of 18 RCTs ; of these , 11 were completed and 7 ongoing . Of the ongoing RCTs , only one is in Phase III . Seven of 10 completed RCTs with reported results did not report greater benefit from drug than placebo . Each of the completed RCTs used a different definition of " clinical ly significant A/A. " There was considerable heterogeneity in study design . The primary endpoints were largely proxy-based but a variety of scales were used . The definition of caregiver and scales used to assess caregiver outcomes were similarly heterogeneous . Placebo response was notable in all trials . Conclusions : This review highlights a great heterogeneity in RCTs design of drugs for A/A in AD and some key method ological issues such as definition of A/A , choice of outcome measures and caregiver participation that could be addressed by an expert consensus to optimize future trials design BACKGROUND Good medication adherence is the cornerstone of therapeutic success . Alzheimer 's disease ( AD ) is the most common type of dementia and most patients are old and on multiple drugs , and good compliance therefore is even more important in this population . Dementia of Alzheimer 's type ( DAT ) at present is yet to find a cure . Anticholinesterases and N-methyl-D-aspartate blockers are specific anti-AD therapies available . Hypertension , diabetes , and dyslipidemia can contribute to cognitive worsening . Keeping hypertension , diabetes , and dyslipidemia in control can therefore possibly prevent further cognitive decline . METHODS Patients with subjective memory complaints ( n = 75 ) were chosen r and omly . Upon thorough neurological diagnostic work up for dementia , those with mild cognitive impairment/ question able dementia ( Clinical Dementia Rating = 0.5 ) or those with AD were recruited in this study ( n = 67 ) . Those with hypertension , diabetes , and deranged lipid profile were further interviewed if they were able to take medicines regularly or not . An attempt was made to know causes of non-compliance . RESULTS Forty-one percent of patients were not taking the drugs that have potential to prevent cardiovascular complications or ability to slow down cognitive decline in AD on regular basis . The lack of awareness , ignorance , medicines being " too expensive , " and the pressure of taking medicines regularly were cited as the reasons for non-compliance . Being illiterate and having low education contributed majorly to poor compliance in this study . CONCLUSION Compliance to drugs that have potential or real ability to slow down cognitive decline is low in elderly people with DAT
Results : Intentional factors affecting adherence include patient , caregiver and prescriber beliefs about therapies and the disease itself .
Conclusion : Due to the high level of caregiver involvement in the care of patients with AD , strategies that address caregiver concerns may improve adherence
Background / Aims : Treatment adherence is a major problem in numerous medical conditions , and is a particular challenge in patients with Alzheimer 's disease ( AD ) .