Journal 1

1. Tittle : Determining the impact of Dementia on antideprasant treatment response in older

adults

2. authors : corine, E Pischer, M.D, et.all

3. publisher : J. Neuropsychiatry and neurosci 2011

Major depression is a common diagnosis in older individuals, with an estimated

prevalence of 3% 4%. Rates of depression increase in individuals with cognitive disorders such
as Alzheimers disease (AD). According to a recent rereview of antidepressants by Montgomery
and colleagues, published evidence indicates that SSRIs are likely the first-line treatment for
depression in elderly patients without dementia, similar in effectiveness to older, tricyclic
medications, but having a superior side effect profile. Evidence on use in depressed patients
with dementia, versus placebo, is less compelling butcertainly exists for certain SSRIs, including
citalopram and sertraline.
The goal of this pilot study was to compare antidepressant treatment with sertraline in
patients with and without dementia to assess whether treatment response varied with underlying
diagnosis, using standard depression rating scales for patients both with and without
dementia. We selected sertraline as the study medication because it had been previously used in
clinical trials involving older persons. We hypothesized, based on studies done to-date, that both
treatment groups would respond, but that response would be greater in the non-dementia
subgroup.
All participant swere started on an antidepressant treatment (sertraline), which was
titrated from a starting dose of 25 mg to a minimum therapeutic dose of 50 mg and maximum
dose of 200 mg over a period of 4 weeks. Titration would occur at a rate of 25 mg50 mg every 4
days, as tolerated. After titration, participants remained on their target dose for a 12-week period
and were seen on a biweekly basis after titration to monitor for drug tolerability. Depressive
symptoms were measured monthly up to 16 weeks
There were no significant differences between the two subgroups on any of the baseline
data, including age gender, baseline depression inventories, Quality of Life or Mini-Mental State
Exam score. All depressed patients who started sertraline tolerated it well and felt subjectively
better. The study does suggest that although depressed persons with dementia may derive benefit
from antidepressant treatment, depressed patients without dementia may derive significantly
more benefit.
Journal 2

1. Title 1 : Alzheimers disease and vitamin E

2. Authors : empey, matthew, university of California

3. Publisher : Escholanship, 1998

The only factors which are consistently associated with AD in all epidemiological studies are
age and family history of dementia. Certain agents have recently been identified which may
protect against the development of the disease or ameliorate its progression. These include
estrogen, nonsteroidal anti-inflammatory drugs (NSAIDs), and, as discussed subsequently,
antioxidants such as vitamin E. Their effects are normally neutralized by natural antioxidants
such as vitamins C and E.
Vitamin E is another of the well-known antioxidants; since it is fat-soluble, vitamin E can
interact with and pass through cell membranes and effectively trap free radicals, prevent lipid
peroxidation, and forestall cellular damage. But has any research been conducted regarding
the specific effect of vitamin E in AD pathology? This is a quite recent area of research, but some
preliminary studies do suggest a connection. One of the first investigations of this question
concluded that vitamin E does indeed protect neurons from amyloid b protein toxicity. When the
experiment was repeated in the presence of vitamin E, the cells were almost completely
protected from peptide toxicity.The researchers also suggested that vitamin E may slow the
clinical progression of AD.
Journal 3

1. Tittle : Nutrition and dementia

2. Author : compass group and Alzheimer disease international

3. Publisher : Alzheimer disease international

The global epidemic of Alzheimers disease and other types of dementia is recognised by the
World Health Organization as a public health priority. It is estimated that 36 million people
worldwide live with dementia, with numbers affected doubling every 20 years, toreach 115
million by 2050. Older people are also at risk of micronutrient deficiency (vitamins and
minerals). Nutrition can influence our risk of developing dementia, and our chances of living
well with dementia if we develop the condition.
Good nutrition contributes to healthy brain development, which may protect against the
onset of dementia in late life
Obesity in midlife and diets rich in saturated fat, which predispose to cardiovascular
disease, also increase the risk of developing dementia in late life
The onset of dementia is associated with a decades long gradual decline in body mass
Maintaining an adequate diet is challenging for people with dementia, leading to a
particularly high prevalence of undernutrition.

Biological mechanisms suggesting a role for micronutrient deficiency :

1. Antioxidants (eg vitamins C and E)
Oxidative stress directly damages cell components, resulting in damage to synapses and
nerve cell death. Antioxidants are thought to protect against neurodegeneration by
limiting generation of toxic substances and by reducing damage by free radicals
2. Folate and B12
These have related roles in DNA metabolism and protein synthesis. They are both
essential for the remethylation of homocysteine to methionine. When folate or Vitamin
B12 are deficient, homocysteine levels rise, which may contribute to amyloid and tau
protein accumulation and neuronal death. Homocysteine stimulates apoptosis and
neurotoxicity (leading to nerve cell death), and platelet activation (contributing to white
matter lesions, vascular injury and ischaemic strokes).
3. Omega-3 long-chain
Polyunsaturated fatty acids (PFAs) PFAs may reduce amyloid pathology,improve blood
flow in the brain, and help to maintain the structural integrity of neuronal membranes. Of
the three main types of PFA, docosahexaenoic acid (DHA) is the most relevant to the
central nervous system, being the main component of membrane phospholipids and also
involved in reducing free radicals and oxidative stress
Aplikasi kepada pasien :
1. Menurut jurnal ke-1, pasien yang telah berusia > 65 tahun wajib dilakukan MMSE
untuk mengukur tingkat demensia seseorang. Pada pasien telah dilakukan MMSE dan
hasil skor 18. Dari skor tersebut didapatkan kesimpulan pasien kemungkinan
mengalami gangguan kognitif dari skor yang ada (17-23). Pada pasien tidak
ditemukan gejala depresi. Maka menurut jurnal ke-1 walaupun tidak ada tanda
depresi maka bias diberikan pengobatan anti depressant seperti citalopram dan
sertraline.
2. Menurut jurnal ke-2 dan ke-3, pasien yang telah berusia > 65 tahun wajib diberikan
vitamin E untuk membantu penghambatan terjadinya demensia. Pasien juga
disarankan untuk tidak membatasi makanan yang dimakan (makan bergizi). Sehingga
makronutrient dan micronutrient yang terkandung dalam makanan tersebut bias
membantu kesehatan pasien, khususnya micronutrient yang membantu menghambat
terjadinya demensia (antioksidan : vitamin E)