[Impact of treatment with acetylcholinesterase inhibitors, valproic acid and antipsychotics on aggressive behaviour in Alzheimer's type dementia]. / Wplyw farmakoterapii inhibitorami acetylocholinesterazy, kwasem walproinowym i lekami przeciwpsychotycznymi na zachowania agresywne w przebiegu otepienia typu Alzheimera.

UNLABELLED: Aggressive and impulsive behaviour are common in Alzheimer's dementia. Therapy of these disorders is an important but difficult practical question. AIM: The purpose of this study was to determine the effect of pharmacological treatment of aggressive behaviour, while taking into account the dynamics of disease progression during observation. In the assessment of treatment acetylcholinesterase inhibitors (IAChE), valproic acid (VA), and antipsychotics were considered. METHOD: The study was based on a two-year naturalistic observation of nursing homes' residents with a diagnosis of possible Alzheimer's disease (NINCDS/ADRDA criteria) in its mild and moderate stage (at least 12 points in MMSE). Aggressive behaviour was measured by Cohen-Mansfield Agitation Inventory (CMAI), and the severity of dementia by ADAS--Cog. Examination was performed twice: at baseline (0) and after two years of observation (2). All treatment administered during this time has been taken into account. 71 people diagnosed with Alzheimer's disease were enrolled to the observation. The average age was 77.10 (SD = 8.39), the level of cognitive impairment by ADAS--Cog = 20.40 points (SD = 5.24). The second examination was conducted in 43 individuals. RESULTS: In the group treated with IAChE there was a lesser increase of aggressive and impulsive behaviour in comparison to other persons. The differences between the examination (2) and (0) for the CMAI global scale were, respectively, 2.76 and 9.09 points. Similar results were obtained for subjects treated with VA (1.0 and 8.65). Antipsychotic drugs revealed a similar correlation (3.0 and 8.65), but this has not proven statistically relevant, while in the group treated with antipsychotics a significantly greater progression of dementia was observed. CONCLUSION: Acetylcholinesterase inhibitors may have beneficial effects on aggressive behaviour in the course of Alzheimer's Disease, similar to that seen with the use of valproic acid and antipsychotics.

[Sleep disorders in the preclinical period of the Alzheimer's disease]. / Zaburzenia snu w okresie przedklinicznym choroby Alzheimera.

AIM: The aim of the study was to assess the prevalence of sleep disorders in the preclinical period of the Alzheimer's disease (AD). METHOD: The initial population consisted of care centers residents, who had had the presence of dementia excluded. The enrolled patients (n = 2910) underwent the assessment of cognitive functions by means of the ADAS-cog scale, as well as of the severity of sleep disorders on the basis of the NPI-NH scale and the AMDP scale. The diagnosis of dementia was verified at the end of the observation period, after seven years, and annually during the follow-up tests. Dementia in the Alzheimer's disease was diagnosed based on the NINCDS-ADRDA criteria. RESULTS: After seven years of observation, 150 patients were qualified to the final analysis. 25 of them were diagnosed to suffer from the AD, while 111 people (forming the control group) did not meet the criteria of dementia. The control group was compared with the AD group in terms of incidence and severity of sleep disorders assessed based on the elements of the NPI-NH scale and the AMDP scale. Disturbances in the assessed categories were more pronounced in the AD group, reaching statistical significance in the qualitative assessment and with regard to the depth of the ascertained disorders. CONCLUSION: The patients in the preclinical period of dementia experienced sleep disturbances more frequently and with greater intensity, which in combination with other factors may have some prognostic value.