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BMJ 2008; 336 doi: (Published 13 March 2008) Cite this as: BMJ 2008;336:582

Drug treatments for dementia are better than placebo, but not much


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Drug treatments for dementia include the cholinesterase inhibitors donepezil, galantamine, rivastigmine, and tacrine and the neuropeptide modifying agent memantine. A systematic review of 59 trials of reasonable quality suggests that these drugs improve cognition, but probably not enough to make a real difference to patients or carers. In general, cholinesterase inhibitors and memantine produced small but statistically significant improvements in validated cognition scores and in a score of doctors’ global impressions, relative to placebo. Results for tacrine were the least convincing. The authors found only patchy and inconsistent data on behaviour and quality of life. All the drugs had side effects.

Most of the evidence applied to people with mild or moderate Alzheimer’s disease, rather than vascular or mixed dementias. Studies were generally short term so the authors couldn’t tell whether any of the five drugs helped delay the progress of dementia. They had little discernible effect on people with only mild cognitive impairment.

An updated US guideline, based on the review, urges doctors to make treatment decisions on a case by case basis, taking into consideration patients’ and carers’ preferences, tolerability, ease of use, and cost.

Genetic variations in alcohol metabolism support causal link between drinking and blood pressure


Alcohol dehydrogenase 2 helps eliminate alcohol from the body by removing its main metabolite acetaldehyde. Some people have a genetic polymorphism that produces a faulty enzyme. These people drink very little alcohol because the accumulated acetaldehyde makes them feel ill. Researchers recently exploited this genetic quirk to explore the well known link between alcohol consumption and blood pressure.

Their systematic review of 10 mainly cross sectional studies from Japan confirmed that men with two normal copies of the allele drank much more alcohol …

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