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Medications ineffective to prevent cognitive decline or dementia
Clinical Question
Are there any medications that can prevent or delay cognitive decline, cognitive impairment, or dementia?
Bottom line
No. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
These researchers searched 4 databases, including the Cochrane Library, to identify randomized and nonrandomized controlled trials in English that enrolled adults without dementia. They also searched reference lists of previous studies and included a previous report that evaluated interventions to prevent cognitive decline. Two reviewers evaluated the quality of the studies and 1 reviewer extracted the data from the studies, which was checked by another reviewer. This wide-ranging review identified 3 studies of acetylcholinesterase inhibitors, though most of the impact was from a single study of donepezil (Aricept) in 512 patients with pre-existing cognitive deficit. After 3 years, active treatment did not affect the progression to Alzheimer disease nor affect any cognitive test result as compared with placebo. Other treatments were also ineffective, including antihypertensives, diabetes medication, lipid-lowering medication, nonsteroidal antiinflammatory drugs, and testosterone. Estrogen alone or with progestin increased the risk for dementia in 1 low-quality trial. High-dose raloxifene (Evista), but not the usual dose of 60 mg daily, decreased the likelihood of developing mild cognitive impairment, but not dementia, in a single study (low-quality evidence).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
but i still see many geriatrician still prescribe ..
i wonder ..?
Well conducted studies showing no association between intervention and outcome are far less likely to see publication than the majority of studies we read. I think the editors are to be congratulated.
We new the data was marginal for our main dementia treatments (cholinesterase inhibitors), and they have side effects - this is interesting - need to pick over this in more detail...
What about effect on behaviour outside of cognition?
I have felt this to be the case for many years and am pleased to see it in print. Medicine is being driven by "Big Pharma" and must review evidence for all drug therapies!
And yet we are prescribing these things......HELP!
No.
ha. if anything, the succinct responses are classic.
Drugs don't help in dementia. However, shifting from a high carbohydrate diet to a ketogenic diet does. The brain's ability to use glucose decreases with age, but it's ability to use ketones does not. Those who are in mild ketosis are able to supplement the brain's metabolic needs with ketones, increasing cerebral blood flow and oxygen use. Memory testing also showed improvement.
Hyperinsulinemia impairs autophagy in neurons which results in accumulations of beta-amyloid and tau protein tangles. Hyperinsulinemia is the underlying disorder of T2DM, which is a major risk factors for Alzheimer's. It's not the hyperglycemia, it's the hyperinsulinemia which is the problem.
Low carbohydrate diet and Time Limited Eating, or Intermittent Fasting help lower insulin levels and insulin resistance.
dilemma
This is no surprise. We've been warned by the data for a long time that these meds weren't miracles.
Perhaps they work somewhat for some people for some amount of time.
The problem with the existance of these drugs is that they give false expectations to a certain type of family member. The search for a pill to "set things back the way it was" can delay the necessary adaptations of the family menber to "the way that things are".