A large, multicentre study in moderate Alzheimer’s disease has found that valproate doesn’t delay the emergence of agitation or psychosis, and doesn’t have a significant effect on cognitive decline (Tariot et al. Arch Gen Psychiatry 2011; 68: 853-861).
Neurology
Neuropathy in PD attributed to vitamin B12 deficiency
February 22, 2012A U.K. study reports that over one-third of patients with Parkinson’s disease develop neuropathy, which may be due to vitamin B12 deficiency arising from chronic levodopa exposure (Rajabally & Martey. Neurology 2011; 77:1947-1950).
Dopamine agonists in PD: need to explain risks of problem gambling
February 8, 2012An estimated 6-8% of PD patients treated with a dopamine agonist develop problem gambling, according to a new review of the literature (Djamshidian et al. Mov Disord 2011; 26: 1976-1984). Patients and their families need to be informed of the risks and to report any behavioural changes during treatment.
Vitamin B in MCI: VITACOG results
February 8, 2012A number of prospective studies have suggested that elevated serum total homocysteine (tHcy), and low folate and vitamin B12 levels are a risk factor for Alzheimer’s disease (Clarke et al. Arch Neurol 1998; 55: 1449-1455). In the Prospective Population Study of Women in Gothenburg, elevated tHcy in midlife was associated with a hazard ratio of 2.1 for developing AD and 2.4 for AD with no cerebrovascular disease (Zylberstein et al. Neurobiol Aging 2011; 32: 380-386). B vitamins (folate, B6, B12) are cofactors or substrates for enzymes in homocysteine metabolism.
Expert recommendations for determining tHcy levels and assessing risk of cognitive impairment were published in 2004 (Refsum et al. Clin Chem 2004; 50: 3-32; free full text at www.clinchem.org/cgi/content/full/50/1/3).
Psychoactive medications effective in TSC
February 8, 2012A majority of patients with psychiatric comorbidities secondary to tuberous sclerosis complex (TSC) respond to psychoactive medications, according to a single-centre analysis of clinical records (Chung et al. Ann Clin Psychiatry 2011; 23: 263-269).