By: Ed Susman

VANCOUVER, BRITISH COLUMBIA, CANADA – Elderly patients with diabetes who have peripheral arterial disease have a 72% greater risk of developing dementia than individuals who do not have the complication linked to heart disease, researchers at the 2012 Alzheimer’s Association International Conference.

“We found that these patients with peripheral arterial disease are at increased risk of dementia, independent of sociodemographics, complications of diabetes, and vascular comorbidities,” said Lieza Exalto, MD, Utrecht Medical Center, Utrecht, the Netherlands.

Probing the Kaiser Permanente Northern California Diabetes Registry, Dr. Exalto and colleagues compared 28,119 patients who did not have peripheral arterial disease with 1,842 patients who exhibited the vascular complication. The prospective cohort was entered in the registry between 1996 and 2008. Hospital coding was used to determine cases of peripheral arterial disease and dementia.

“We know that peripheral artery disease in the general population is a risk factor for dementia, but the data are unclear about whether that relationship holds true for individuals with diabetes,” Dr. Exalto said at her poster presentation.

The researchers found that 17% of the patients without peripheral arterial disease developed dementia compared with 20% of those individuals with peripheral arterial disease (P <.001).

“The association between dementia risk and peripheral arterial disease in diabetes may reflect a potential etiological role of vascular injury in dementia in diabetes,” Dr. Exalto said.

The average age of the individuals without peripheral arterial disease was 70.4 years which was significantly younger than those who had peripheral arterial disease (72.4 years; P <.0001).

More of the patients (47%) without peripheral arterial disease were women compared with those who had peripheral arterial disease (33%; P <.0001). Those without peripheral arterial disease had a shorter duration of a diabetes diagnosis (11.3 years) compared with those with peripheral arterial disease (14.9 years; P <.0001). There was no significant difference in glycosylated haemoglobin A1C levels between the 2 groups.

The researchers adjusted their model to account for age, gender, race, education level, medical utilisation, diabetes related factors, and vascular related factors.

Dr. Exalto suggested that clinicians should recognise the role that peripheral arterial disease plays in development of dementia and to counsel patients accordingly.

- MFP Wire Services
- 07-27-2012

By: Ed Susman

VANCOUVER, BRITISH COLUMBIA, CANADA – A higher dose of the rivastigmine-containing patch appears to slow the progression of mild to moderate Alzheimer’s disease better than treatment with the standard-dose patch, researchers said at the 2012 Alzheimer’s Association International Conference.

“We observed that fewer patients discontinued the higher dose 13.3 mg/24 hour patch and those on the 9.5 mg/24-hour patch, suggesting better efficacy without increasing adverse events,” said Sandra Black, MD, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario.

In several measurements of effect, the higher dose patch was consistently exhibited superior effectiveness than the standard dose patch, which is currently approved for treatment of mild to moderate Alzheimer’s disease.

For example, the least square mean analysis showed that the reduction in the Alzheimer’s Disease Cooperative Study-Activities of Daily Living score was 4 points with the 13.3-mg patch but was 6 points with the 9.5-mg patch (P =.028 at 48 months). The difference in effect was seen across all analyses, according to Dr. Black. Significant differences were also observed at week 16, week 24, and week 32.

Although adverse events occurred more frequently in the higher dose patch — 210 events among 280 patients on the high-dose patch compared with193 events in 283 patients on the low-dose patch — she noted that discontinuations caused by adverse events occurred in 9.6% of the high-dose group versus 12.7% of the low-dose group.

“This suggests that the higher dose would enable more patients to achieve therapeutic doses and therefore achieve optimal therapeutic outcomes,” said Dr. Black.

Patients in the study had been diagnosed with Alzheimer’s disease for about 4 years when they were enrolled in the study.

Dr. Black explained that in the clinical trials that were conducted to approve rivastigmine as a transdermal patch, the higher dose patches were shelved because they tended to produce higher adverse events.

Funding for this study was provided by Novartis Pharma AG.

- MFP Wire Services
- 07-26-2012

By: Ed Susman

VANCOUVER, BRITISH COLUMBIA, CANADA – Administration of cholinesterase inhibitors to patients with mild Alzheimer’s disease appears to result in stronger recovery of cognition that in patients diagnosed with moderate disease status, researchers said at the 2012 Alzheimer’s Association International Conference.

Using a formula that considered baseline severity of disease, researchers reported that patients with mild disease — defined as a Mini-Mental State Examination score ≥24 points — achieved a 55% recovery compared with moderate patients who achieved a more modest 25% recovery.

“Initiation of cholinesterase inhibitor treatment in patients with mild Alzheimer’s disease results in more substantial percentage improvements in cognitive performance compared with initiating treatment in patients with moderate disease,” said Sarah Wakefield, University of Sheffield, Sheffield, United Kingdom.

She noted that although the difference between non-responders based on disease severity was small, those with mild disease performed numerically better than those diagnosed with a moderate disease status.

“This suggests that there is an effect on progression of disease in addition to alleviation of symptoms,” she said.

In the study, the research team enrolled 56 patients — 17 diagnosed with mild Alzheimer’s disease and 39 diagnosed with moderate disease. Their Mini Mental State Examination was performed at baseline, at a first follow-up that was about 4 months later, and at a second follow-up after about 11 months.

As a group, Wakefield noted that the improvement in cognitive symptoms was 6.93% at the first follow-up visit and about 1% at the second follow-up, when compared with baseline. When stratified by response to treatment, the researchers observed a 32% increase in recovery amongst the responders compared with an 8% decrease amongst non-responders. At the second follow-up, a 25% recovery was seen in responders compared with a 12% decline in non-responders.

“Even in the absence of a detectable response, performance of patients in the mild stage appears to decrease to a lesser extent than that observed in non-responders who are in the moderate stage of the disease,” Wakefield said.

She said her study results would indicate that treatment with cholinesterase inhibitors at an earlier stage of the disease would be more beneficial than waiting to the disease reaches a moderate level.

- MFP Wire Services
- 07-25-2012