Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Proton pump inhibitors and the risk of Alzheimer’s disease and non-Alzheimer’s dementias

Proton pump inhibitors (PPIs) are among the most prescribed medications. Previous epidemiological studies have presented contradictory results about PPIs and the risk of dementia. Our objective was to investigate the association between the use of PPIs and an increasing risk of incident AD or non-AD dementias. A community-based retrospective cohort study was conducted based on the data available from 1st January 2002 to 31st December 2015 in the Catalan health service (CatSalut) system. This cohort included all PPI users (N = 36,360) and non-users (N = 99,362). A lag window of 5 years was considered between the beginning of the PPI treatment and the diagnosis of dementia. PPI use was not associated with the risk of AD (adjusted odds ratio (OR) 1.06) (95% CI 0.93–1.21; p = 0.408). A weakly but significantly increased risk of non-AD dementias was observed among PPI users (adjusted OR 1.20, 95% CI 1.05–1.37; p = 0.007). A higher dose of PPIs was not associated with an increased risk of either AD or non-AD dementias (OR 1.20; 95% CI 0.91–1.61 and OR 0.95; 95% CI 0.74–1.22, respectively). Regarding the number of PPIs used, we observed an increased risk of AD (OR 1.47; 95% CI 1.18–1.83) and non-AD dementias (OR 1.38; 95% CI 1.12–1.70) in users of two types of PPIs compared with those who used only one type. We did not find a higher incidence of AD among PPI users, but a weak increase in the risk of non-AD dementias among PPI users was observed.

Music Cognition in Frontotemporal Dementia and Non-Alzheimer’s Dementias

This chapter examines how music knowledge is affected in non-Alzheimer’s dementias, with a focus on frontotemporal dementia syndromes. It discusses the clinical and neurobiological rationale for studying music knowledge in non-Alzheimer’s dementia. It describes some of the ways in which music knowledge has been investigated in these patients, what musical abilities are lost or preserved in non-Alzheimer’s dementia, and how this information helps us improve our knowledge of how the brain processes music. The social role of music in evolution is briefly discussed. The chapter examines how emotions generated by and recognized in music are processed differently in frontotemporal dementia compared to healthy individuals and Alzheimer’s disease patients, including the phenomenon of musicophilia, the abnormally enhanced craving for music. Finally it explains how the differences in emotion processing between dementia diseases highlight the need for some selectivity in designing music-based therapies.

Cognitive Enhancement in Non-Alzheimer’s Dementias

Cognitive enhancement in non-Alzheimer’s dementias has not been studied as extensively as that in Alzheimer’s dementia. This chapter reviews the research on cognitive enhancement for three types of dementia: vascular dementia, dementia with Lewy bodies, and frontal lobe dementia. The chapter reviews both pharmacological and nonpharmacological approaches for treatment of dementia. The focus is on randomized controlled trials for currently available medications, specifically cholinesterase inhibitors and memantine. Major advances in physical and cognitive rehabilitation during the past decade have inspired clinicians and researchers to explore the role of potential cognitive enhancers in different types of dementias. This chapter also examines the effects of therapeutic interventions such as exercise, physical rehabilitation, cognitive rehabilitation, and electrical stimulation of the brain on cognition in non-Alzheimer’s dementias.