Results of a randomised trial published in PLoS Medicine show no benefit in cognitive or neuropsychiatric outcomes from continuing neuroleptic drugs in patients with Alzheimer’s disease.
The researchers, led by Clive Ballard from King’s College hospital, London, recruited 165 patients from across the UK who were already being treated with neuroleptic drugs. They randomised half of the patients to continue treatment and half to discontinue treatment. At 6 and 12 months the patients that remained in each group were assessed for their cognitive status and neuropsychiatric symptoms. The researchers found that there were no differences between the two groups in terms of cognitive decline. They also found no overall differences between the two groups in the change in the number of neuropsychiatric symptoms. Patients with severe neuropsychiatric problems at the outset of the trial may have had some benefit from continued neuroleptic therapy, but this difference was not statistically significant.
Almost all older dementia patients will have some neuropsychiatric symptoms. These symptoms can include agitation, aggression, and psychosis. Neuroleptics (sometimes called antipsychotics) are the class of drugs often used to manage or control neuropsychiatric problems, but there have been questions about their safety and appropriateness. Safety concerns, in this group of patients especially, are an increased risk of stroke, parkinsonism, sedation, edema, and chest infections. There may also be a worsening of cognitive decline with prolonged use of neuroleptics.
The findings in the patients studied here do not indicate any benefit of continuing neuroleptic therapies in older patients with dementia. However, the numbers of patients studied in this trial is small. More studies are urgently needed to improve the management of these patients.
Citation: Ballard C, Lana MM, Theodoulou M, Douglas S, McShane R, et al. (2008) A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD Trial). PLoS Med 5(4): e76.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050076
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-04-ballard.pdf
CONTACTS:
Clive Ballard
King's College London
Wolfson Centre for Age-Related Diseases
Wolfson Building
Guy's Campus
London Bridge, London SE1 1UL
United Kingdom
+44 207 848 6568
+44 207 848 6569 (fax)
clive.ballard@kcl.ac.uk
Bridget Winkle
Alzheimer's Research Trust
Marketing & PR Officer
Cambridge
United Kingdom
+44 1223 843304
bwinkle@alzheimers-research.org.uk
FROM THE PLoS MEDICINE MAGAZINE SECTION:
Chile's good health status is due to public and not private health care services
While the World Bank and other international bodies present Chile's good health status as an example of the benefits of neoliberal policies including the privatization of health care, this view is "seriously misguided" according to a new analysis of the Chilean health system.
Based on their analysis of health system reforms in Chile from the era of Pinochet up until 2005, Professor Jean-Pierre Unger (Institute of Tropical Medicine, Antwerp, Belgium) and colleagues conclude that despite serious underfunding during the Pinochet years, the public health component "remains the backbone of the system and is responsible for the good health status of the Chilean population."
The Pinochet regime embarked on sweeping health sector reforms in 1979, based on neoliberal doctrines. A private health insurance system, ISAPRES, was developed alongside the state system and was intended to be the dominant one. But 75% of Chileans, say Professor Unger and colleagues, were unable to afford private insurance with ISAPRES, and the impact of ISAPRES on public health was marginal.
"The neoliberal health reform in Chile has created an unfair dual health system," they say—a dual system of public services for the poor and ISAPRES and other private services for the more affluent section of the population. The private system, they argue, is highly inefficient and has decreased solidarity between rich and poor, sick and healthy, and young and old.
The authors conclude that Chilean health reform has lessons for other countries in Latin America and elsewhere. "Privatisation of health insurance services may not have the expected results according to neoliberal doctrine. On the contrary, it may increase unfairness in financing and inequitable access to quality care."
Citation: Unger J-P, De Paepe P, Cantuarias GS, Herrera OA (2008) Chile’s neoliberal health reform: An assessment and a critique. PLoS Med 5(4): e79.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050079
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-04-unger.pdf
CONTACT:
Jean-Pierre Unger
Institute of Tropical Medicine, Antwerp
Department of Public Health
Antwerp
Belgium
+32 3 247 62 54
+32 3 247 62 58 (fax)
jpunger@itg.be
ldekinder@itg.be
Global HIV Vaccine Enterprise Working Group reports workshop outcomes
In 2005, the working group of the Global HIV Vaccine Enterprise (http://www.hivvaccineenterprise.org/), an alliance of independent organizations around the world dedicated to accelerating the development of a preventive HIV vaccine, reported its “Scientific Strategic Plan” in PLoS Medicine (see http://dx.doi.org/10.1371/journal.pmed.0020025). In this week’s PLoS Medicine, the working group publishes a follow up paper based on a meeting held in June 2007 in Du rham, North Carolina, USA. The aim of the meeting was to identify the key scientific issues in mucosal and innate immunity, as they pertain to immune protection against HIV infection, that have emerged since the strategic plan was first published.
Citation: Shattock RJ, Haynes BF, Pulendran B, Flores J, Esparza J, et al. (2008) Improving defences at the portal of HIV entry: Mucosal and innate immunity. PLoS Med 5(4): e81.
PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050081
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-05-04-shattock.pdf
CONTACT:
Robin Shattock
St. George's Hospital Medical School
Department of Cellular and Molecular Medicine, Infectious Diseases
London SW17 ORE
United Kingdom
+44 208 725 5855
+44 208 725 3487 (fax)
shattock@sgul.ac.uk
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org
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