A dementia drug may be no more effective than a placebo.
* THE QUESTION Some people with Alzheimer's disease have shown improvement in cognitive skills when given cholinesterase inhibitors. Do these drugs also affect behavior, perhaps delaying the need for institutionalization?
* THIS STUDY randomly assigned 486 people with mild to moderate Alzheimer's to take the cholinesterase inhibitor donepezil (sold in the United States as Aricept) or a placebo. After two years, those taking the drug showed, on average, small gains in cognition. After three years, minimal differences were noted in the proportion of participants who had become more disabled by Alzheimer's (donepezil, 42 percent; placebo, 44 percent) and institutionalized (55 percent vs. 53 percent).
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with Alzheimer's disease. About 4.5 million Americans have this disease, double the total in 1980.
* CAVEATS The study did not test what effect cholinesterase inhibitors might have on people with more severe Alzheimer's.
* BOTTOM LINE People who are considering donepezil should be aware that this study found the drug had "disappointingly little overall benefit."
* FIND THIS STUDY June 26 issue of The Lancet; study available online at www.thelancet.com.
* LEARN MORE ABOUT treating Alzheimer's disease at www.alz.org and at www.alzheimers.org.
CORONARY ARTERY DISEASE
Extra folate does not seem to help keep arteries unclogged.
* THE QUESTION After a stent, a wire mesh tube, has been inserted to hold open a once-constricted coronary artery, people often change their diet and lifestyle to prevent the artery from narrowing again. Does it help to take vitamins high in folic acid, or folate -- which is known to lower levels of homocysteine, an amino acid that can increase the risk for heart and blood vessel disease?
* THIS STUDY randomly assigned 636 people who recently had a metal stent placed in a coronary artery to take either daily doses of folic acid and vitamins B6 and B12 or a placebo. After six months, blood tests revealed a 25 percent drop in homocysteine levels for those taking the folate therapy; levels stayed the same for the placebo group. However, about 35 percent of those taking folate, compared with 26 percent in the placebo group, once again had arteries that were more than 50 percent clogged.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone who has undergone coronary stenting.
* CAVEATS Contrary to the overall results, folate therapy reduced the risk of recurrent constriction in women, people with diabetes and those who began the study with higher homocysteine levels.
* BOTTOM LINE People with stents may wish to discuss with their doctor whether folate therapy might make a recurrence of clogged arteries more likely.
* FIND THIS STUDY June 24 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
* LEARN MORE ABOUT coronary stents at www.fda.gov (search for "stent") and coronary artery disease at www.mayoclinic.com.
A radiofrequency technique may make recovery easier.
* THE QUESTION When tonsils need to be removed, doctors today frequently use some form of heat-driven technology, such as electrocauterization or laser surgery. Might coblation, a newer procedure that uses radiofrequency energy and saline to dissolve tissue, offer faster and more comfortable recovery?
* THIS STUDY randomly assigned 89 children who needed tonsillectomies to have either conventional electrosurgery or coblation. Surgeons rated the procedures as equally effective. Daily diaries kept by the children (who were aged 3 to 12) and their parents for two weeks after surgery showed that, on average, the coblation patients used painkillers one day less than those who had electrosurgery, and they took smaller doses of these drugs. Fewer in the coblation group reported nausea, and fewer contacted a doctor about complications.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Children who need a tonsillectomy. Today, tonsillitis (infected tonsils) often is treated with antibiotics, with surgery recommended only if breathing or swallowing is affected or if the problem returns frequently.
* CAVEATS These findings may not apply to teens and adults. A doctor's expertise with coblation could affect outcomes. The study was funded by ArthroCare Corp., which makes coblation products.
* BOTTOM LINE Parents of a child needing a tonsillectomy may want to ask their doctor about coblation.
* FIND THIS STUDY June issue of Otolaryngology -- Head and Neck Surgery; abstract available online at www.sciencedirect.com/science/journal/01945998.
* LEARN MORE ABOUT tonsils and tonsillectomies by searching for "tonsils" at www.kidshealth.org and www.entnet.org.
-- Linda Searing