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Title: Sertraline Associated with Cognitive and Behavioural Improvements in Mild Alzheimer's Disease: Presented at AGS

"Sertraline Associated with Cognitive and Behavioural Improvements in Mild Alzheimer's Disease: Presented at AGS"

By Emma Hitt, PhD BALTIMORE, MD -- May 17 2003 -- Short-term use of the serotonin-reuptake inhibitor (SSRI) sertraline may improve cognitive and behavioural symptoms in untreated patients with mild Alzheimer's disease (AD), new research suggests. Mark D. Pass, MD, of The Memory Disorders Institute, Meridian Hospitals Corporation, Manchester, New Jersey, presented the findings here May 16th at the 2003 Annual Scientific Meeting of the American Geriatrics Society. "An improvement with the use of sertraline has not been previously reported in non-depressed patients, although there is a wealth of data on improving cognitive ability in depressed patients," Dr. Pass said in an interview. The researchers evaluated 274 patients diagnosed with possible mild AD according to criteria set out by the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and a mini mental state exam (MMSE) score of 15 to 24. Among enrolled patients, mean MMSE score was 19. The study excluded previously treated patients and those with depressive symptoms. Sertraline was started at 25 mg/day for 1 week and then increased to 50 mg/day. Patients were followed prospectively for 12 weeks, during which time an MMSE was administered at 6 weeks and 12 weeks. Average MMSE score increased by 1.4 points at 6 weeks (P<0.05) and decreased by 0.2 points at 12 weeks. According to Dr. Pass, the cognitive benefits of increasing the amount of serotonin in the neural clefts are temporary, which may explain the decrease in MMSE score at 12 weeks. "However, improvements in behaviour -- decreased depression, anxiety, obsessive-compulsive disorders -- are long-lasting," he noted. Improvements in depression, anxiety and agitation were reported in 59.4% of patients, and there was no behavioural deterioration. Cognitive improvement as reported by caregivers was noted in 77.3% of patients. At 6 weeks, 20.8% of caregivers asked not to add additional medication to improve cognition, and 5% declined at 12 weeks. "SSRIs may have an important role to play in the treatment of AD," Dr. Pass said. "The paradigm is shifting," he continued. "We used to believe that cholinergic therapy was the only treatment for AD, but we now know that acetylcholine, calcium, and glutamate affects memory." "It would be unwise of us to believe that norepinephrine and serotonin are left out of this group of chemicals," he said. [Study title: Sertraline (Zoloft) in the treatment of mild Alzheimer's disease: The Clinical and caregivers Impression. A Prospective Study. Abstract 300]

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