Treatment of Alzheimer Disease: The Past, the Present, and the Future
Notice bibliographique
Résumé
Can J Psychiatry. 2011;56(10):577-578. Many thanks to the editor-in-chief for this timely opportunity to provide the readers of The Canadian Journal of Psychiatry (The CJP) with an update on the fast-moving field of Alzheimer disease (AD). As detailed in the reviews by Dr Fadi Massoud and Dr Gabriel C Leger1 and by Dr Clive Ballard and colleagues2 in this issue of The CJP, the current symptomatic drugs are only 1 0 years old, cognitive training is still under development, and disease-modifying drugs are under study. This past spring alone you will have seen the publication, in Alzheimer 's & Dementia: the Journal of the Alzheimer 's Association, of revised diagnostic criteria for AD probable at the traditional dementia stage,3 for AD at the predementia stage,4 and even for AD in the presymptomatic stage,5 in Brain, of cognitive training-related plasticity in people with mild cognitive impairment,6 and in The Lancet, of a seminar on the epidemiology and pathophysiology of AD.7 How is Canada doing in the field of AD? The Canadian Study on Health and Aging8 gave us a good head start, with incidence and prevalence figures across the country for the late 1980s against which we will compare later this decade. When Cholinesterase inhibitors (ChEIs) first became available, family doctors were allowed to prescribe these medications and they are following evidence-based guidelines for diagnosis and treatment common to all interested physicians, the latest revision being done in 20069 and the next one scheduled for 2012. A network of specialized memory clinics was created in the early 1990s to facilitate randomized clinical trials for AD in Canada: the Consortium of Canadian Centres for Clinical Cognitive Research (commonly referred to as C5R). This network is 1 of 5, worldwide, currently planning for global prevention studies.10 More recently, the Canadian Institutes of Health Research initiated the International Collaborative Research Strategy for Alzheimer's Disease (commonly referred to as ICRSAD), including partnership with the United States in the Alzheimer Disease Neuro-Imaging (commonly referred to as ADNI) program, with Germany, the United Kingdom, and other European countries in biomarkers and other technical platforms, and with China for 5-year studies. The Alzheimer Society of Canada has been a strong supporter of AD research in Canada, particularly in training young people from different disciplines. The less positive side of treatment of AD in Canada has been the difficulty in obtaining reimbursement for AD medications across the country. The rivastigmine patch is reimbursed only in 1 province, despite the evidence for better tolerability than the oral formulation, which allows 1 0 mg (current maximal dose), compared with 1 5 mg dosing, in a randomized study about to be concluded. Memantine is reimbursed in only 2 provinces, despite the evidence for benefit on agitation and speech impairment, and even in that 1 province memantine is reimbursed only as monotherapy; for example, not with a ChEI, despite growing evidence for the value of combining the 2 drug classes.1112 In the United States and France, these 2 classes of drugs are routinely combined in the moderate stage of AD. There are even greater challenges ahead: if and when treatments become available to significantly slow down disease progression, how will we convince payers to reimburse them? We need to do a better job of finding responders to treatment during phases II and III of drug development: age at onset of symptoms and severity of symptoms may modify which drug to use, apoE genotype and possibly other genes - the pharmacogenomics of AD.13 Clear start and stopping rules will have to be established. It is conceivable that reimbursement will be conditional on positive biomarkers, such as amyloid deposition measured by positron emission tomography scanning or abnormal beta-amyloid and tau protein levels in cerebrospinal fluid. …
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,006 | 0,010 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,007 | 0,009 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».