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Progress in Clinical Neurosciences: Canadian Guidelines for the Development of Antidementia Therapies: A Conceptual Summary

Published online by Cambridge University Press:  02 December 2014

Howard H. Feldman ,
Serge Gauthier ,
Howard Chertkow ,
David K. Conn ,
Morris Freedman ,
Chris MacKnight  and
for the 2nd Canadian Conference on Antidementia Guidelines
Howard H. Feldman*
Affiliation:
Division of Neurology, Department of Medicine, University of British Columbia, Clinic for Alzheimer's Disease and Related Disorders, Vancouver Coastal Health, Vancouver, BC
Serge Gauthier
Affiliation:
Department of Psychiatry, Neurology & Neurosurgery, Medicine, Faculty of Medicine, McGill University, Alzheimer Disease & Related Disorders Unit, McGill Center for studies in Aging, Montreal, QC
Howard Chertkow
Affiliation:
Department of Neurology and Neurosurgery, McGill University, Memory Clinic, Department of Neurology, Sir Mortimer B. Davis, Jewish General Hospital, Montreal, QC
David K. Conn
Affiliation:
Department of Psychiatry, University of Toronto, Department of Psychiatry, Baycrest Centre for Geriatric Care, Toronto, ON
Morris Freedman
Affiliation:
Department of Medicine, Division of Neurology, Mount Sinai Hospital, University Health Network and University of Toronto and the Behavioural Neurology Program and Rotman Research Institute, Baycrest Centre For Geriatric Care, Toronto, ON
Chris MacKnight
Affiliation:
Department of Medicine, Dalhousie University, Centre for Health Care of the Elderly, Capital District Health Authority, Halifax, Nova Scotia
*
Division of Neurology, University of British Columbia, S192-2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada.
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Abstract:

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The magnitude of the problems faced by an aging Canadian society has been clearly identified. Perhaps the single most important problem is the increasing incidence of dementia. Alzheimer's disease (AD) accounts for 50-60% of the dementias in later life within a spectrum of other contributing dementias. Regulatory approval has been given to Acetylcholinesterase inhibitors for the symptomatic treatment of mild to moderate AD, and conditional approval to memantine for the symptoms of moderate to severe AD. There has been no regulatory approval for the treatment of the degenerative dementias beyond AD. The very rapid progress in the past decade in biotechnology and in the molecular biology of the dementias is supporting a new generation of innovative treatment strategies that will more directly target the underlying disease pathogenic mechanisms. Such treatments will foreseeably include immunotherapies, anti-aggregants that may prevent misfolding and deposition of proteins, and neuroregenerative interventions. These Guidelines follow the 2nd Canadian Conference on the Development of Antidementia Therapies, held in 2004, which covered a range of design, methodological and ethical issues facing clinical researchers and regulatory authorities. They are intended to provide a common point of reference and guidance in Canada for therapeutic development of the dementias.

Résumé

RÉSUMÉ

L'amplitude du problème auquel fait face la société canadienne vieillissante a été clairement identifiée. Le problème le plus important est l'incidence croissante de la démence. De 50 à 60% des cas de démence chez les gens âgés sont dus à la maladie d'Alzheimer (MA). Des inhibiteurs de l'acétylcholinestérase ont été approuvés pour le traitement symptomatique de la MA légère ou modérée et la mémantine a reçu une approbation conditionnelle pour le traitement des symptômes modérés ou sévères de la MA. Aucun traitement des démences dégénératives autres que la MA n'a été approuvé. Les progrès très rapides de la recherche sur les démences en biotechnologie et en biologie moléculaire pendant la dernière décennie sont à l'origine d'une nouvelle génération de stratégies novatrices de traitement qui cibleront plus directement les mécanismes pathogéniques de la maladie sous-jacente. Il est probable que différentes stratégies seront utilisées dont l'immunothérapie, les anti-agrégants qui préviennent le pliage erroné de protéines et leur dépôt et les interventions neurorégénératrices. Ces lignes directrices sont émises suite à la deuxième conférence canadienne sur le développement de traitements anti-démence en 2004. Cette conférence a examiné plusieurs questions de modèles, de méthodologies et d'éthique auxquels sont confrontés les cliniciens chercheurs et les organismes réglementaires. Elles offrent un point de référence commun et une orientation pour le développement de traitements des démences au Canada.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 33 , Issue 1 , February 2006 , pp. 6 - 26
Copyright
Copyright © The Canadian Journal of Neurological 2006

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