News in brief - July 26, 2004

Gains in treating Alzheimer's - Rapidly rising PSA linked to prostate cancer mortality - CDC again recommending third dose of pneumococcal vaccine - Doubt cast on Alzheimer's drugs

Gains in treating Alzheimer's

People who have early stage Alzheimer's disease may be capable of learning new techniques that enable them to better perform daily tasks, according to two small studies.

In one study, a group of 25 mildly impaired Alzheimer's patients who were trained in methods to improve face and name recognition had faster mental processing speeds and were better oriented to time and place than were subjects in a control group. The study was published in the July American Journal of Geriatric Psychiatry.

In the second study, published in the June 10 Neuron, researchers determined that the implicit memory of items familiar from earlier years was still active in patients with early Alzheimer's.

"Taken together, these studies introduce the exciting notion that older people who are in the early stages of AD can be taught techniques to help stay engaged in everyday life," said Neil Buckholtz, PhD, head of the dementias of aging branch at the National Institute of Aging, which funded both studies.

Rapidly rising PSA linked to prostate cancer mortality

A new finding that links a sharp rise in prostate-specific antigen to a man's risk of dying from prostate cancer may help make the difficult decision of how to treat the cancer a bit easier.

The study, published in the July 8 New England Journal of Medicine, found that men with rapidly rising PSA velocity -- more than 2.0 ng/mL per year -- had a greater risk of dying from the cancer than did men with more slowly rising scores.

The study analyzed data from more than 1,000 men who had undergone surgery for prostate cancer.

While a substantial proportion of men in the age group most affected by prostate cancer die of other causes, the death rate from the disease remains high, with 82 men dying of the cancer every day, write Johns Hopkins physicians Mario Eisenberger, MD, and Alan Partin, MD, PhD, in an editorial in the same issue.

CDC again recommending third dose of pneumococcal vaccine

Children should once again be receiving a third shot of pneumococcal conjugate vaccine, according to a statement issued this month by the Centers for Disease Control and Prevention. The fourth dose remains deferred.

Public health officials recommended that physicians provide catch-up vaccinations at the next regular visit of children who did not receive the third dose when they were supposed to. Parents who do not bring their children in should be notified that their child may be underimmunized.

Doubt cast on Alzheimer's drugs

The cholinesterase inhibitors widely used to treat Alzheimer's have only minimal efficacy and do not delay institutionalization or disability, according to a study published in a June The Lancet.

Researchers at the University of Birmingham in the United Kingdom, randomized more than 500 patients with the disease to receive donepezil, one drug in this family, or placebo. After two years, they found that the drug did improve mental and functional ability, although not very much. There was no difference, however, in how disabled these patients were or if they were still able to remain in their homes. The drug also had no impact on behavioral and psychological symptoms, care costs, caregiver time, adverse events or deaths.

Authors of the paper questioned whether these drugs were worth the cost.

"Clinicians and health care funders can validly question whether other uses of the scarce resources allocated to dementia care would provide better value," said Dr. Richard Gray, study leader and professor of medical statistics.

Patient advocates cautioned that the study should not impact care decisions and drug manufacturers defended their product in light of other studies that have had better results.

"They are effective, and result in considerable, meaningful differences in patients," said Susan Bro, spokeswoman for Pfizer Inc., the drug's manufacturer.