Treatment of Alzheimer disease.

Abstract:

:Alzheimer disease is the most common form of dementia, affecting nearly one-half [corrected] of Americans older than 85 years. It is characterized by progressive memory loss and cognitive decline. Amyloid plaque accumulation, neurofibrillary tau tangles, and depletion of acetylcholine are among the pathologic manifestations of Alzheimer disease. Although there are no proven modalities for preventing Alzheimer disease, hypertension treatment, omega-3 fatty acid supplementation, physical activity, and cognitive engagement demonstrate modest potential. Acetylcholinesterase inhibitors are first-line medications for the treatment of Alzheimer disease, and are associated with mild improvements in cognitive function, behavior, and activities of daily living; however, the clinical relevance of these effects is unclear. The most common adverse effects of acetylcholinesterase inhibitors are nausea, vomiting, diarrhea, dizziness, confusion, and cardiac arrhythmias. Short-term use of the N-methyl-D-aspartate receptor antagonist memantine can modestly improve measures of cognition, behavior, and activities of daily living in patients with moderate to severe Alzheimer disease. Memantine can also be used in combination with acetylcholinesterase inhibitors. Memantine is generally well tolerated, but whether its benefits produce clinically meaningful improvement is controversial. Although N-methyl-D-aspartate receptor antagonists and acetylcholinesterase inhibitors can slow the progression of Alzheimer disease, no pharmacologic agents can reverse the progression. Atypical antipsychotics can improve some behavioral symptoms, but have been associated with increased mortality rates in older patients with dementia. There is conflicting evidence about the benefit of selegiline, testosterone, and ginkgo for the treatment of Alzheimer disease. There is no evidence supporting the beneficial effects of vitamin E, estrogen, or nonsteroidal anti-inflammatory drug therapy.

journal_name

Am Fam Physician

authors

Winslow BT,Onysko MK,Stob CM,Hazlewood KA

subject

Has Abstract

pub_date

2011-06-15 00:00:00

pages

1403-12

issue

12

eissn

0002-838X

issn

1532-0650

pii

d8864

journal_volume

83

pub_type

杂志文章
  • Management of chronic tendon injuries.

    abstract::Chronic tendon injuries present unique management challenges. The assumption that these injuries result from ongoing inflammation has caused physicians to rely on treatments demonstrated to be ineffective in the long term. Nonsteroidal anti-inflammatory drugs should be limited in the treatment of these injuries. Corti...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Childress MA,Beutler A

    更新日期:2013-04-01 00:00:00

  • Lumbar disk disease: pathophysiology, management and prevention.

    abstract::Patients with symptomatic lumbar disk disease may present with back pain, referred leg pain, radicular leg pain, sensory changes and leg weakness. Because neurologic deficits are commonly localized to the L5 or S1 nerve roots, evaluation of patients with such symptoms should focus on these dermatomes and muscle groups...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Gilmer HS,Papadopoulos SM,Tuite GF

    更新日期:1993-04-01 00:00:00

  • Eczematous dermatitis: a practical review.

    abstract::Eczematous dermatitis is a common condition that can interfere with social function, sleep and employment. Its persistence and accompanying pruritus may be stressful and frustrating for patients. The most common and best characterized type of eczema, atopic dermatitis, appears to be increasing in incidence. Other comm...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Zug KA,McKay M

    更新日期:1996-09-15 00:00:00

  • Evaluation and management of herpes zoster ophthalmicus.

    abstract::Herpes zoster ophthalmicus occurs when the varicella-zoster virus is reactivated in the ophthalmic division of the trigeminal nerve. Herpes zoster ophthalmicus represents up to one fourth of all cases of herpes zoster. Most patients with herpes zoster ophthalmicus present with a periorbital vesicular rash distributed ...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Shaikh S,Ta CN

    更新日期:2002-11-01 00:00:00

  • Nonspecific work-related upper extremity disorders.

    abstract::The incidence of work-related repetitive motion disorders has increased rapidly during the past 20 years. While it appears that psychosocial factors have contributed largely to the increasing incidence of these disorders, ergonomic factors and other medical conditions also play a role. The most common single diagnosti...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Downs DG

    更新日期:1997-03-01 00:00:00

  • Primary immunodeficiencies.

    abstract::Primary immunodeficiencies include a variety of disorders that render patients more susceptible to infections. If left untreated, these infections may be fatal. The disorders constitute a spectrum of more than 80 innate defects in the body's immune system. Primary immunodeficiencies generally are considered to be rela...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Cooper MA,Pommering TL,Korányi K

    更新日期:2003-11-15 00:00:00

  • Acute bronchitis.

    abstract::Acute bronchitis is a lower respiratory tract infection that causes reversible bronchial inflammation. In up to 95 percent of cases, the cause, is viral. While antibiotics are often prescribed for patients with acute bronchitis, little evidence shows that these agents provide significant symptomatic relief or shorten ...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Hueston WJ,Mainous AG 3rd

    更新日期:1998-03-15 00:00:00

  • The neuromuscular junction. Part II: myasthenia gravis.

    abstract::Myasthenia gravis is characterized by variable ocular and skeletal muscle weakness. Peak incidence is in young women and older men. Thymomas are present in 30 percent of myasthenic patients over age 40. Binding of acetylcholine receptors by IgG antibodies may be the mechanism of the neuromuscular disorder. Repetitive ...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Brumback RA

    更新日期:1981-02-01 00:00:00

  • Diagnosis of heel pain.

    abstract::Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Tu P,Bytomski JR

    更新日期:2011-10-15 00:00:00

  • Premature rupture of the membranes: diagnostic and management strategies.

    abstract::Premature rupture of the membranes is associated with considerable neonatal and maternal morbidity when it leads to premature birth. In most cases, this condition occurs at term, does not require medical intervention and has a benign course. Although few effective preventive measures are available, the family physicia...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Greenwald JL

    更新日期:1993-08-01 00:00:00

  • The radiology of rheumatoid arthritis.

    abstract::Rheumatoid arthritis is a connective tissue disorder of unknown etiology that can involve any synovial-lined joint in the body. The most frequently involved joints are the small joints of the hands and feet, the wrists, knees and elbows, and the glenohumeral and acromioclavicular joints. The radiographic hallmarks of ...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Brown JH,Deluca SA

    更新日期:1995-10-01 00:00:00

  • Anergy and delayed hypersensitivity skin testing.

    abstract::Delayed hypersensitivity skin tests, when properly planned and performed, are both practical and sensitive in determining the status of cell-mediated immunity. They can be diagnostic of specific exposure, such as tuberculosis, or they can rule out anergy. Pitfalls include poor selection of antigens, inappropriate appl...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Vinson WM

    更新日期:1983-05-01 00:00:00

  • Serious soft tissue infections of the head and neck.

    abstract::The head and neck contain a number of spaces that can be invaded by organisms of the mouth or by spread of cervical osteomyelitis. Infection in these spaces may progress from superficial infection to cellulitis to the formation of an abscess requiring immediate drainage. Spread of infection between spaces depends on a...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Herr RD,Murdock RT,Davis RK

    更新日期:1991-09-01 00:00:00

  • Bone scanning.

    abstract::Scanning is based on the uptake of a nuclide by the crystal lattice of bone and is related to bone blood flow. Cancer cells do not take up the tracer. Normally, the scan visualizes the highly vascular bones. Scans are useful and are indicated in metastatic bone disease, primary bone tumors, hematologic malignancies an...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Greenfield LD,Bennett LR

    更新日期:1975-03-01 00:00:00

  • Management of Spontaneous Vaginal Delivery.

    abstract::Most of the nearly 4 million births in the United States annually are normal spontaneous vaginal deliveries. In the first stage of labor, normal birth outcomes can be improved by encouraging the patient to walk and stay in upright positions, waiting until at least 6 cm dilation to diagnose active stage arrest, providi...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Dresang LT,Yonke N

    更新日期:2015-08-01 00:00:00

  • Diagnosis of ear pain.

    abstract::Many patients in primary care present with ear pain (otalgia). When the ear is the source of the pain (primary otalgia), the ear examination is usually abnormal. When the ear is not the source of the pain (secondary otalgia), the ear examination is typically normal. The cause of primary otalgia is usually apparent on ...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Ely JW,Hansen MR,Clark EC

    更新日期:2008-03-01 00:00:00

  • Evaluation and treatment of orthostatic hypotension.

    abstract::Orthostatic hypotension is defined as a decrease of at least 20 mm Hg in systolic blood pressure when an individual moves from a supine position to a standing position. Nonneurogenic causes of orthostatic hypotension are related to cardiac pump failure, reduced intravascular volume, venous pooling or a medication side...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Engstrom JW,Aminoff MJ

    更新日期:1997-10-01 00:00:00

  • AIDS and the brain.

    abstract::AIDS dementia complex is a major source of disability for many AIDS patients. Less commonly, the spinal cord or peripheral nerves are affected by HIV infection. Physicians working with AIDS patients must differentiate these manifestations from those caused by the infectious, neoplastic and vascular complications. ...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Clifford DB

    更新日期:1987-12-01 00:00:00

  • Over-the-counter foot remedies.

    abstract::Several effective and inexpensive over-the-counter treatments are available for minor but troubling foot problems. In most cases, one week of therapy with topical terbinafine is effective for interdigital tinea pedis. Treatment of plantar warts with 17 percent salicylic acid with lactic acid in a collodion base is as ...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Bedinghaus JM,Niedfeldt MW

    更新日期:2001-09-01 00:00:00

  • Carpal tunnel syndrome: a practical review.

    abstract::Carpal tunnel syndrome is the most common focal entrapment syndrome. Forceful repetitive activity and vibration may be important workplace risk factors for carpal tunnel syndrome. Although systematic study has suggested that carpal tunnel syndrome is work-related, no clear "dose-response" curve has been found between ...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Katz RT

    更新日期:1994-05-01 00:00:00

  • Congenital hearing impairment.

    abstract::Although early management of children with hearing loss is extremely important, diagnosis is often delayed because the development of hearing-impaired children parallels that of normal infants until the age of nine months. A high-risk registry aids in recognition of hearing-impaired children, but fails to identify tho...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: McCurdy JA Jr

    更新日期:1980-03-01 00:00:00

  • Diagnosis and management of Lyme disease.

    abstract::Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common tick-borne illness in the United States. Transmission occurs primarily through the bite of an infected deer tick (Ixodes scapularis). Identification of an erythema migrans rash following a tick bite is the only clinical manifestation suffic...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Wright WF,Riedel DJ,Talwani R,Gilliam BL

    更新日期:2012-06-01 00:00:00

  • Photosensitivity reactions: a case report involving NSAIDs.

    abstract::Photosensitivity reactions associated with the use of prescription or over-the-counter drugs may be classified as phototoxic (caused by potentiation of solar energy by a drug) or photoallergic (in which the combination of a photosensitizing agent and light evokes a true cell-mediated hypersensitivity response). A case...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Mammen L,Schmidt CP

    更新日期:1995-08-01 00:00:00

  • Esophagogastroduodenoscopy for the family physician.

    abstract::Esophagogastroduodenoscopy is most commonly performed for evaluation of epigastric pain, severe heartburn, chronic nausea and other dyspepsia syndromes that are not relieved by medical therapy. It should not be performed as an in-office procedure in patients with unstable angina, respiratory failure, active upper gast...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Hocutt JE Jr,Rodney WM,Zurad EG,Tucker RS,Norris T

    更新日期:1994-01-01 00:00:00

  • Bowenoid papulosis.

    abstract::Bowenoid papulosis usually appears as small papules on the penis or vulva. Histologically, these lesions display the atypia of Bowen's disease (squamous cell carcinoma in situ). Bowenoid papulosis is now considered to be a sexually transmitted disease, probably caused by human papillomavirus type 16. Malignant transfo...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Rogozinski TT,Janniger CK

    更新日期:1988-07-01 00:00:00

  • Promoting smoking cessation.

    abstract::Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians sh...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Larzelere MM,Williams DE

    更新日期:2012-03-15 00:00:00

  • Procedural sedation in the acute care setting.

    abstract::Many patients require sedation during diagnostic or therapeutic procedures. Ideally, procedural sedation minimizes the patient's awareness and discomfort while maintaining the patient's safety. Appropriate monitoring by trained personnel is the key to successful procedural sedation. These techniques should be used onl...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Brown TB,Lovato LM,Parker D

    更新日期:2005-01-01 00:00:00

  • Nocturnal asthma and sudden death.

    abstract::Asthmatics may develop a considerable increase in airways obstruction during the night or early hours of the morning. In most patients, this causes only mild symptoms. In others, the effects may be severe, resulting in sudden death. Greater awareness of the potential severity of nocturnal asthma, together with actual ...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Spiro SG

    更新日期:1976-12-01 00:00:00

  • Identifying and managing preparatory grief and depression at the end of life.

    abstract::Grief and depression present similarly in patients who are dying. Conventional symptoms (e.g., frequent crying, weight loss, thoughts of death) used to assess for depression in these patients may be imprecise because these symptoms are also present in preparatory grief and as a part of the normal dying process. Prepar...

    journal_title:American family physician

    pub_type: 杂志文章

    doi:

    authors: Periyakoil VS,Hallenbeck J

    更新日期:2002-03-01 00:00:00

  • Postexposure prophylaxis against human immunodeficiency virus.

    abstract::Family physicians often encounter situations in which postexposure prophylaxis (PEP) with antiretroviral medications against human immunodeficiency virus (HIV) may be indicated. When the exposure source's HIV status is unknown and testing of the source is possible, use of a rapid HIV test kit may facilitate decision m...

    journal_title:American family physician

    pub_type: 杂志文章,评审

    doi:

    authors: Tolle MA,Schwarzwald HL

    更新日期:2010-07-15 00:00:00