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Fall 2004

Treatments for Dementia Initiated Earlier

“Some studies suggest that 15 percent of people with MCI go on to develop dementia every year,” notes George Bartzokis, M.D., director of UCLA’s Memory Disorders and Alzheimer’s Disease Clinic. “People with MCI reveal memory impairment upon neuropsychological testing, but still function well in their daily lives.”

Many dementia treatments are being tested in clinical trials on people with MCI to see if early intervention can reduce progression to dementia and if memory improves.

Estimates project that almost half of individuals will develop dementia by the time they reach 85 years of age. Research has shown that the disease may be present 20 years before diagnosis. “Unless we can find ways to slow this progression, the number of people with Alzheimer’s disease (whichaccounts for 70 percent of dementias) will quadruple in the next 15 to 20 years,” notes Gary Small, M.D., director of UCLA’s Center on Aging. Currently treatments for dementia include:

• Acetocholinesterase inhibitors—used to treat mild to moderate Alzheimer’s disease—hinder the enzyme that breaks down choline, a neurochemical key to memory, which is reduced in people with Alzheimer’s disease.

• Uncompetitive NMDA antagonist (memantine)— inhibits the excitatory receptor in the brain known as NMDA; too much NMDA can cause neuron “burnout.”

• Vitamin E—an antioxidant—reduces oxidation damage known to occur with Alzheimer’s disease and has been shown in one large study to slow the rate of mental decline caused by dementia. The high dosage tested in the study (2,000 IU) is not recommended as a preventive treatment for people without a dementia diagnosis.

• Experimental treatments, currently in various stages of clinical trials, include multiple ways to try to decrease the toxicity of the amyloid beta protein (thought to be central to the progression of Alzheimer’s disease), nicotine patches, and additional antioxidants.

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