In Alzheimer's disease, cognition now responds to several drugs. Anti-cholinesterase’s target the acetylcholine deficit. In mild-to-moderate Alzheimer's disease, they all provide significant benefit versus placebo on the Alzheimer's Disease Assessment Schedule Cognitive section (ADAS-Cog), side effects, in 5% to 15% of cases, include nausea, vomiting, diarrhea, anorexia and dizziness. Tacrine, the leading anti-cholinesterase, caused frequent hepatic enzyme elevation and was withdrawn; once-daily donepezil spares the liver and improves global measures of change in severe dementia; rivastigmine is indicated in comorbid vascular disease; at the same time as galaniamine modulates the cerebral nicotinic acetylcholine receptors that potentiate the reaction to acetylcholine. Alternative agents encompass the N-Methyl-D-Aspartate (NMDA) receptor antagonist, memaniine, certified in Europe for fairly extreme to severe Alzheimer's disease; it acts on a different neurotransmitter gadget present in 70% of neurons, protective towards pathologic glutamergic activation at the same time as keeping or restoring physiologic glutamergic activation. The clinician's armamentarium in AD has by no means been greater.
Motor dysfunction increases in the moderate and severe stages of dementia. However, there is still no consensus on changes in mobility during its early stages. This meta-analysis aimed to measure the level of single-task functional mobility in older subjects with Mild Cognitive Impairment (MCI) and/or Alzheimer’s Disease (AD). In a search of the PubMed, ISI Web of knowledge and Scopus databases, 2,728 articles were identified. At the end of the selection, a total of 18 studies were included in the meta-analysis. Functional mobility was investigated using the Timed Up and Go (TUG) test in all studies. when compared to Healthy Elderly (HE) adults, the following Mean Differences (MD) in seconds were found for the investigated subgroups: No amnestic MCI (MD=0.26; CI 95%=-0.77, 1.29), amnestic MCI (MD=0.86; CI 95%=-0.02, 1.73), very mild AD (MD=1.32; CI 95%=0.63, 2.02), mild AD (MD=2.43; CI 95%=1.84, 3.01), mild-moderate AD (MD=3.01; CI 95%=2.47, 3.55) and mild-severe AD (MD=4.51; CI 95%=1.14, 7.88); for the groups, the following MD were found: MCI (MD=0.97; CI 95% =0.51, 1.44) and AD (MD=2.66; CI 95%=2.16, 3.15). These results suggest a transition period in motor capacity between healthy aging and dementia, wherein functional mobility analysis in a single-task (TUG) can contribute to the diagnosis and staging of predementia states and AD.
Published Date: 2024-07-29; Received Date: 2020-07-28
