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Articles by Curtis L. Meinert
Total Records ( 2 ) for Curtis L. Meinert
  John C. Breitner , Laura D. Baker , Thomas J. Montine , Curtis L. Meinert , Constantine G. Lyketsos , Karen H. Ashe , Jason Brandt , Suzanne Craft , Denis E. Evans , Robert C. Green , M. Saleem Ismail , Barbara K. Martin , Michael J. Mullan , Marwan Sabbagh and Pierre N. Tariot
  Background Epidemiologic evidence suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) delay onset of Alzheimer‘s dementia (AD), but randomized trials show no benefit from NSAIDs in patients with symptomatic AD. The Alzheimer‘s Disease Anti-inflammatory Prevention Trial (ADAPT) randomized 2528 elderly persons to naproxen or celecoxib versus placebo for 2 years (standard deviation = 11 months) before treatments were terminated. During the treatment interval, 32 cases of AD revealed increased rates in both NSAID-assigned groups. Methods We continued the double-masked ADAPT protocol for 2 additional years to investigate incidence of AD (primary outcome). We then collected cerebrospinal fluid (CSF) from 117 volunteer participants to assess their ratio of CSF tau to Aβ1-42. Results Including 40 new events observed during follow-up of 2071 randomized individuals (92% of participants at treatment cessation), there were 72 AD cases. Overall, NSAID-related harm was no longer evident, but secondary analyses showed that increased risk remained notable in the first 2.5 years of observations, especially in 54 persons enrolled with cognitive impairment––no dementia (CIND). These same analyses showed later reduction in AD incidence among asymptomatic enrollees who were given naproxen. CSF biomarker assays suggested that the latter result reflected reduced Alzheimer-type neurodegeneration. Conclusions These data suggest a revision of the original ADAPT hypothesis that NSAIDs reduce AD risk, as follows: NSAIDs have an adverse effect in later stages of AD pathogenesis, whereas asymptomatic individuals treated with conventional NSAIDs such as naproxen experience reduced AD incidence, but only after 2 to 3 years. Thus, treatment effects differ at various stages of disease. This hypothesis is consistent with data from both trials and epidemiological studies.
  Lea T. Drye , Zahinoor Ismail , Anton P. Porsteinsson , Paul B. Rosenberg , Daniel Weintraub , Daniel Weintraub , Daniel Weintraub , Constantine Frangakis , Peter V. Rabins , Cynthia A. Munro , Curtis L. Meinert , D.P. Devanand , Jerome Yesavage , Jacobo E. Mintzer , Lon S. Schneider , Bruce G. Pollock and Constantine G. Lyketsos
  Background Agitation is one of the most common neuropsychiatric symptoms of Alzheimer‘s disease (AD), and is associated with serious adverse consequences for patients and caregivers. Evidence-supported treatment options for agitation are limited. The citalopram for agitation in Alzheimer‘s disease (CitAD) study was designed to evaluate the potential of citalopram to ameliorate these symptoms. Methods CitAD is a randomized, double-masked, placebo-controlled multicenter clinical trial, with two parallel treatment groups assigned in a 1:1 ratio and randomization stratified by clinical center. The study included eight recruiting clinical centers, a chair‘s office, and a coordinating center located in university settings in the United States and Canada. A total of 200 individuals having probable AD with clinically significant agitation and without major depression were recruited for this study. Patients were randomized to receive citalopram (target dose of 30 mg/d) or matching placebo. Caregivers of patients in both treatment groups received a structured psychosocial therapy. Agitation was compared between treatment groups using the NeuroBehavioral Rating Scale and the AD Cooperative Study- Clinical Global Impression of Change, which are the primary outcomes. Functional performance, cognition, caregiver distress, and rates of adverse and serious adverse events were also measured. Conclusion The authors believe the design elements in CitAD are important features to be included in trials assessing the safety and efficacy of psychotropic medications for clinically significant agitation in AD.
 
 
 
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