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ADHD Medications May Treat Symptoms of Alzheimer Disease
Noradrenergic medications, atomoxetine and methylphenidate—both established treatments for attention-deficit/hyperactivity disorder (ADHD)—and guanfacine, may positively impact general cognition and apathy in people with Alzheimer disease.
Researchers, who published the systematic review and meta-analysis online in the Journal of Neurology, Neurosurgery & Psychiatry, said these drugs are worthy of further investigation in "appropriate patient subgroups."
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“However, several factors should be considered before designing future clinical trials,” researchers wrote. “These include targeting of appropriate patient subgroups and understanding the dose effects of individual drugs and their interactions with other treatments to minimize risks and maximize therapeutic effects.”
Because noradrenergic disruption occurs early in Alzheimer disease and contributes to cognitive and neuropsychiatric symptoms in some patients, the noradrenergic system offers a potential therapeutic target, the study explained. The systematic review and meta-analysis included a total 19 randomized controlled trials of noradrenergic medications in 1811 patients with mild cognitive impairment and Alzheimer disease. Six trials were deemed to be of good quality; 7 were of fair quality, and 6 were of poor quality.
Noradrenergic drugs offered effective treatment for general cognition and apathy associated with Alzheimer’s disease, meta-analyses suggested.
Meta-analysis of data from 10 studies involving 1300 patients showed a significant small positive effect (standardized mean difference 0.14) on global cognition on the Mini-Mental State Examination or Alzheimer Disease Assessment Scale-Cognitive Subscale, researchers reported. For apathy, meta-analysis of data from eight trials involving 425 patients identified a large positive effect (standardized mean difference of 0.45) that remained after outliers were removed to account for differences in trial design and intended outcomes.
Meta-analysis revealed no significant effect on measures of attention or episodic memory, according to the study.
“Based on this meta-analysis, and recognition of the importance of locus coeruleus-noradrenergic system in multiple neurodegenerative diseases, there is a case for further clinical trials of noradrenergic agents in Alzheimer disease and other neurodegenerative conditions,” researchers concluded.
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