Type 2 diabetes mellitus is associated with Mild Cognitive Impairment (often presenting as short-term memory loss that is either subjective or confirmed by rigorous memory tests) as well as dementia (moderate to severe short-term memory loss that causes a lack of independence). Furthermore, insulin resistance, the hall mark of adult onset or type 2 diabetes, increases the risk of developing Alzheimer’s disease. Results from the Honolulu aging study provide an example of the association of the balance of glucose and insulin with risk of dementia. Study participants who had either very high or very low levels of serum insulin were more likely than those in between to become demented over the course of 5 years. Other studies, but not all, have shown this link between insulin resistance, impaired glucose metabolism, diabetes and dementia. You have probably read the headlines generated [...]
Archive for October, 2011
There are currently five drugs approved for the treatment of Alzheimer’s disease: tacrine (not used because of toxicity to the liver), donepezil (Aricept), Rivastigmine (Exelon), galantamine (Razadyne), and memantine (Namenda). The first three are called cholinesterase inhibitors and have been around since the mid 1990s. All three medications are effective for mild to severe Alzheimer’s disease. There does not appear to be a difference in efficacy among the three medications. All of these treatments produce statistically significant effects but the effects are usually small. There are many clinical trials attempting to find more effective treatments. The trials are mostly developed around four strategies: reduce amyloids (reduce plaques), modify tau (reduce tangles), treat with antioxidants, improve ion regulation, reduce inflammation, and improve cholesterol regulation. Treatments to reverse or lessen the amount of amyloids (anti-amyloid aggregation) have been the main stay of [...]
Dr. Beckwith will conduct a three hour workshop (fee $100 per person/$150 per couple – limited seating) in Naples October 17 (call 591-6226 to register).
Placebos have powerful effects on the mind and the body. They can produce improvements, cause side effects, and reverse the actions of medications. Indeed, placebos are so powerful that medications are approved by the FDA only if they are proven better than placebos in clinical trials. For example, Namenda was not approved for treatment of mild to moderate Alzheimer’s disease because it did not do better than placebo. But treatment versus placebo effects is complicated as is demonstrated by teasing out whether antidepressants work better than placebos in treating depression. Irving Kirsch (2008) completed a technical review (called a metaanalysis) of antidepressants and placebos as they are compared to no treatment. Among his findings were that some get better by treatment with active medications. Some get better with placebos (as many as 30% of study participants by some estimates). The [...]