Dr. Bob's Psychopharmacology Tips

Selegiline for Alzheimer's

Date: Tue, 13 Oct 1998 19:44:30 -0700
From: DGrant <grantde@worldnet.att.net>
Subject: Selegiline for Alzheimer's

There is a recent study: Sano M, Ernesto C, Thomas RG, Klauber MR, Schafer K, Grundman M, Woodbury P, Growdon J, Cotman CW, Pfeiffer E, Schneider LS, Thal LJ, A controlled trial of selegiline, alpha-tocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study. New England Journal of Medicine. 336 (17): 1216-22, 1997 Apr 24. Comments: N Engl J Med 336 (17): 1245-7, 1997 Apr 24; 337 (8): 572, discussion 573, 1997 Aug 21; 337 (8): 572-3, 1997 Aug 21; ACP J Club 127 (3): 67, 1997 Nov-Dec.

The conclusion was that "in patients with moderately severe impairment from Alzheimer's disease, treatment with selegiline or alpha-tocopherol slows the progression of the disease."

From: "Kevin Franklin Gray, MD" <jahsteel@cyberramp.net>
Subject: Selegiline for Alzheimer's
Date: Fri, 16 Oct 1998 16:34:02 -0500

Given the fact that vitamin E worked slightly (although not statistically) better than selegiline in that trial, it has become the agent of choice, mainly due to the high cost of selegiline -- approximately $90-$110/month for 10 mg/day dosing.

In addition, the potential for side-effects with selegiline, plus general disenchantment with it -- as a neuroprotective agent -- in the Parkinson's crowd has made it a relatively minor player in Alzheimer's therapy...

However... there are some intriguing yet conflicting older studies looking at behavioral and cognitive benefits from selegiline in Alzheimer's patients:

• SR Tolbert and MA Fuller. Selegiline in treatment of behavioral and cognitive symptoms of Alzheimer disease. Annals of Pharmacotherapy 30 (10): 1122-1129, 1996.

• WJ Burke, WH Roccaforte, SP Wengel, BL Bayer, AE Ranno, and NK Willcockson. L-deprenyl in the treatment of mild dementia of the Alzheimer type: results of a 15-month trial. Journal of the American Geriatrics Society 41: 1219-1225, 1993.

• LS Schneider, JT Olin, and S Pawluczyk. A double-blind crossover pilot study of l-deprenyl (selegiline) combined with cholinesterase inhibitor in Alzheimer's disease. American Journal of Psychiatry 150: 321-323, 1993.

• G Finali, M Piccirilli, C Oliani, and GL Piccinin. L-deprenyl therapy improves verbal memory in amnesic Alzheimer patients. Clinical Neuropharmacology 14: 523-536, 1991.

• DL Goad, CM Davis, P Liem, CC Fuselier, JR McCormack, and KM Olsen. The use of selegiline in Alzheimer's patients with behavior problems. Journal of Clinical Psychiatry 52: 342-345, 1991.

• LS Schneider, VE Pollock, MF Zemansky, RP Gleason, R Palmer, and RB Sloane. A pilot study of low-dose L-deprenyl in Alzheimer's disease. Journal of Geriatric Psychiatry & Neurology 4: 143-148, 1991.

• N Campi, GP Todeschini, and L Scarzella. Selegiline versus L-acetylcarnitine in the treatment of Alzheimer-type dementia. Clinical Therapeutics 12: 306-314, 1990.

• A Falsaperla, PA Monici Preti, and C Oliani. Selegiline versus oxiracetam in patients with Alzheimer-type dementia. Clinical Therapeutics 12: 376-384, 1990.

• T Sunderland, RM Cohen, S Molchan, BA Lawlor, AM Mellow, PA Newhouse, PN Tariot, EA Mueller, and DL Murphy. High-dose selegiline in treatment-resistant older depressive patients. Archives of General Psychiatry 51: 607-615, 1994.

• W Kuhn and T Muller. The clinical potential of Deprenyl in neurologic and psychiatric disorders. Journal of Neural Transmission. Supplementum 48: 85-93, 1996.

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