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Medication Use as a Confounding Factor in the Use of the Cerebrospinal Fluid tau/β-Amyloid42 Ratio

Medication Use as a Confounding Factor in the Use of the Cerebrospinal Fluid tau/β-Amyloid42 Ratio Fagan and colleagues1 reported on the use of the CSF tau/Aβ42 ratio in predicting cognitive decline in nondemented older adults. Although they stated that participants in the study had no systemic medical illness that could contribute importantly to dementia, they made no mention of the participants' medication profiles. Statins have been thought to play a role in preventing cognitive decline2 and possibly in altering CSF biomarkers3 among patients with Alzheimer disease (AD). In the preliminary results of a randomized controlled trial, the use of atorvastatin in patients with mild to moderate AD was shown to be beneficial in improving their cognitive scores on the Alzheimer's Disease Assessment Scale at 6 and 12 months.2 In addition, CSF levels of ptau were reduced among patients treated with simvastatin.3 These effects of statins could have been confounding factors in the results of the study by Fagan and colleagues. Other common medications have also been suggested as possible treatments to slow the progression of AD. Medications that inhibit cyclooxygenase-1 such as indomethacin and diclofenac/misoprostol continue to be studied due to their anti-inflammatory effects.4 Patients with mild AD or MCI who received rosiglitazone were shown to exhibit better delayed recall and selective attention at 6 months.5 Administration of high-dose estradiol also significantly improved attention, verbal memory, and visual memory compared with placebo among postmenopausal women with AD.6 Because the use of statins, nonsteroidal anti-inflammatory drugs, thiazolidinediones, and estrogen is so ubiquitous among patients in the 60- to 91-year-old demographic that Fagan and colleagues studied, the profile of medication use among the study participants would be quite relevant in determining the validity of the study results. Back to top Article Information Correspondence: Dr Wong, John A. Burns School of Medicine, University of Hawaii, PO Box 23377, Honolulu, HI 96823 (wongvict@hawaii.edu). Financial Disclosure: None reported. References 1. Fagan AMRoe CMXiong CMintun MAMorris JCHoltzman DM Cerebrospinal fluid tau/β-amyloid42 ratio as a prediction of cognitive decline in nondemented older adults. Arch Neurol 2007;64 (3) 343- 349PubMedGoogle ScholarCrossref 2. Sparks DLSabbagh MNConnor DJ et al. Atorvastatin for the treatment of mild to moderate Alzheimer disease: preliminary results. Arch Neurol 2005;62 (5) 753- 757PubMedGoogle ScholarCrossref 3. Riekse RGLi GPetrie EC et al. Effect of statins on Alzheimer's disease biomarkers in cerebrospinal fluid. J Alzheimers Dis 2006;10 (4) 399- 406PubMedGoogle Scholar 4. McGeer PLMcGeer EG NSAIDs and Alzheimer disease: epidemiological, animal model and clinical studies. Neurobiol Aging 2007;28 (5) 639- 647PubMedGoogle ScholarCrossref 5. Watson GSCholerton BAReger MA et al. Preserved cognition in patients with early Alzheimer disease and amnestic mild cognitive impairment during treatment with rosiglitazone: a preliminary study. Am J Geriatr Psychiatry 2005;13 (11) 950- 958PubMedGoogle Scholar 6. Asthana SBaker LDCraft S et al. High-dose estradiol improves cognition for women with AD: results of a randomized study. Neurology 2001;57 (4) 605- 612PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Medication Use as a Confounding Factor in the Use of the Cerebrospinal Fluid tau/β-Amyloid42 Ratio

Archives of Neurology , Volume 64 (9) – Sep 1, 2007

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Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0003-9942
DOI
10.1001/archneur.64.9.1357-a
pmid
17846282
Publisher site
See Article on Publisher Site

Abstract

Fagan and colleagues1 reported on the use of the CSF tau/Aβ42 ratio in predicting cognitive decline in nondemented older adults. Although they stated that participants in the study had no systemic medical illness that could contribute importantly to dementia, they made no mention of the participants' medication profiles. Statins have been thought to play a role in preventing cognitive decline2 and possibly in altering CSF biomarkers3 among patients with Alzheimer disease (AD). In the preliminary results of a randomized controlled trial, the use of atorvastatin in patients with mild to moderate AD was shown to be beneficial in improving their cognitive scores on the Alzheimer's Disease Assessment Scale at 6 and 12 months.2 In addition, CSF levels of ptau were reduced among patients treated with simvastatin.3 These effects of statins could have been confounding factors in the results of the study by Fagan and colleagues. Other common medications have also been suggested as possible treatments to slow the progression of AD. Medications that inhibit cyclooxygenase-1 such as indomethacin and diclofenac/misoprostol continue to be studied due to their anti-inflammatory effects.4 Patients with mild AD or MCI who received rosiglitazone were shown to exhibit better delayed recall and selective attention at 6 months.5 Administration of high-dose estradiol also significantly improved attention, verbal memory, and visual memory compared with placebo among postmenopausal women with AD.6 Because the use of statins, nonsteroidal anti-inflammatory drugs, thiazolidinediones, and estrogen is so ubiquitous among patients in the 60- to 91-year-old demographic that Fagan and colleagues studied, the profile of medication use among the study participants would be quite relevant in determining the validity of the study results. Back to top Article Information Correspondence: Dr Wong, John A. Burns School of Medicine, University of Hawaii, PO Box 23377, Honolulu, HI 96823 (wongvict@hawaii.edu). Financial Disclosure: None reported. References 1. Fagan AMRoe CMXiong CMintun MAMorris JCHoltzman DM Cerebrospinal fluid tau/β-amyloid42 ratio as a prediction of cognitive decline in nondemented older adults. Arch Neurol 2007;64 (3) 343- 349PubMedGoogle ScholarCrossref 2. Sparks DLSabbagh MNConnor DJ et al. Atorvastatin for the treatment of mild to moderate Alzheimer disease: preliminary results. Arch Neurol 2005;62 (5) 753- 757PubMedGoogle ScholarCrossref 3. Riekse RGLi GPetrie EC et al. Effect of statins on Alzheimer's disease biomarkers in cerebrospinal fluid. J Alzheimers Dis 2006;10 (4) 399- 406PubMedGoogle Scholar 4. McGeer PLMcGeer EG NSAIDs and Alzheimer disease: epidemiological, animal model and clinical studies. Neurobiol Aging 2007;28 (5) 639- 647PubMedGoogle ScholarCrossref 5. Watson GSCholerton BAReger MA et al. Preserved cognition in patients with early Alzheimer disease and amnestic mild cognitive impairment during treatment with rosiglitazone: a preliminary study. Am J Geriatr Psychiatry 2005;13 (11) 950- 958PubMedGoogle Scholar 6. Asthana SBaker LDCraft S et al. High-dose estradiol improves cognition for women with AD: results of a randomized study. Neurology 2001;57 (4) 605- 612PubMedGoogle ScholarCrossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Sep 1, 2007

References