caa a22 4500 445376368 CHVBK 20180317143003.0 cr unu---uuuuu 170323e20110901xx s 000 0 eng 10.1007/s00702-011-0678-6 doi (NATIONALLICENCE)springer-10.1007/s00702-011-0678-6 Ames David National Ageing Research Institute, Royal Melbourne Hospital, University of Melbourne, PO Box 2127, 3050, Parkville, VIC, Australia aut Negative argument for debate with V. O. Emery for J Neural Transmission [Elektronische Daten] Alzheimer's disease: are we intervening too late? No we are not [David Ames] Alzheimer's disease (AD) represents a major public health challenge. It is the most common cause of dementia, the worldwide prevalence of which will double every 20years in the foreseeable future. It would be good if it were possible to treat AD early to diminish its impact, but current evidence does not support early intervention. Vitamin E was no more effective than placebo in a study of vitamin E and donepezil against placebo in mild cognitive impairment (MCI). Vitamin E is associated with a higher rate of haemorrhagic events than is placebo. Neither donepezil nor galantamine has been shown to be helpful in retarding progression from MCI to AD. Gingko biloba was ineffective in delaying the onset of AD in a large prospective trial involving over 6,000 participants. Gamma secretase inhibitors have not yet been shown to retard the progression of AD and they seem to have a high incidence of adverse effects, especially rashes. Antibody therapy has not yet been shown to be helpful in the treatment of established AD, let alone its prevention. Metalloproteinase modifiers such as PBT2 may be useful AD therapies, but current evidence gives no support to their immediate use in pre-symptomatic AD. No evidence can yet be adduced to support the use of antibody therapies in MCI or early AD. Thus, it is clear that the early treatment of AD cannot be justified as yet, no matter how desirable this goal may be. Treatment of established AD with cholinesterase inhibitors and memantine, coupled with referral of interested patients to evaluative drug trials, is the best we can do at present. Springer-Verlag, 2011 Alzheimer's disease nationallicence Treatment nationallicence Early intervention nationallicence Cholinesterase inhibitors nationallicence Novel therapies nationallicence Evidence nationallicence Journal of Neural Transmission Springer Vienna 118/9(2011-09-01), 1379-1381 0300-9564 118:9<1379 2011 118 702 https://doi.org/10.1007/s00702-011-0678-6 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00702-011-0678-6 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Ames David National Ageing Research Institute, Royal Melbourne Hospital, University of Melbourne, PO Box 2127, 3050, Parkville, VIC, Australia aut NATIONALLICENCE 773 0- Journal of Neural Transmission Springer Vienna 118/9(2011-09-01), 1379-1381 0300-9564 118:9<1379 2011 118 702 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer