Clinical Briefs

Am Fam Physician. 1998 Mar 1;57(5):1148-1152.

Progress Report on Alzheimer's Disease

The Alzheimer's Disease Education and Referral (ADEAR) Center of the National Institute on Aging (NIA) has published a document titled “Progress Report on Alzheimer's Disease, 1997.” The 46-page report describes recent research focusing on changes in the brain in patients with Alzheimer's disease, genetic factors in Alzheimer's disease, advances in identifying risk factors for the disorder, and advances in diagnosing, treating and preventing Alzheimer's disease. It also includes summaries of research conducted by eight other components of the National Institutes of Health along with the future directions that researchers will take.

According to ADEAR, Alzheimer's disease is the most common cause of dementia among persons 65 years of age or older. It affects approximately 4 million Americans; slightly more than one half of these persons receive care at home. The prevalence of Alzheimer's disease doubles every five years beyond age 65 years. The report notes that some studies indicate nearly one half of all persons 85 years of age or older have symptoms of Alzheimer's disease.

There are two types of Alzheimer's disease: familial, which is found in families in which the disease follows a certain inheritance pattern, and sporadic or random disease, in which no obvious inheritance pattern is seen. Almost all cases of familial disease are early-onset, and many of these involve defects in three genes located on three different chromosomes (chromosomes 1, 14 and 21).

The report emphasizes that Alzheimer's disease is not caused by one factor. It is caused by a number of factors that interact differently in different people. Age is the strongest risk factor that is known so far. In addition, having both apolipoprotein E4 (apoE4) allele on chromosome 19 and a severe head injury that leads to even a brief loss of consciousness may increase a person's risk of developing Alzheimer's disease later in life.

The ADEAR Center now offers publications and research news on the Internet at www.nia.nih.gov/alzheimers. The Web site includes the text of the progress report and other selected publications, as well as information on how to order other publications free of charge. In addition, announcements from the NIA are included on the Web site. For a free copy of the report, call the ADEAR Center at 800-438-4380 or write to ADEAR Center, P.O. Box 8250, Silver Spring, MD 20907-8250.

Booklet on Systemic Lupus Erythematosus

A comprehensive booklet titled “Handout on Health: Systemic Lupus Erythematosus” has been published by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The booklet contains information about the diagnosis and treatment of lupus as well as current research supported by NIAMS and other components of the National Institutes of Health. Highlights of the booklet include discussions regarding diagnostic tools, drug treatments, lupus “flares” (the warning signals and prevention) and promising areas of research.

Copies of the booklet are available free of charge from NIAMS Clearinghouse, 1 AMS Circle, Bethesda, MD 20892-3675; telephone: 301-495-4484; fax: 301-587-4352. The text is also on the Internet at http://www.nih.gov/niams/healthinfo/slehandout/.

Use of Aspirin in Cardiovascular Disease

The American Heart Association (AHA) has issued a scientific statement for health care professionals regarding the use of aspirin in the treatment and prevention of cardiovascular disease. The statement was published in the October 21, 1997, issue of Circulation.

According to the AHA, aspirin therapy is of proven value in the treatment of acute myocardial infarction as well as long-term use in patients with a wide range of manifestations of cardiovascular disease. The statement notes that “aspirin therapy in acute myocardial infarction remains underused and increased administration of aspirin to virtually all patients with acute myocardial infarction would save an additional 5,000 to 10,000 lives in the United States each year.”

The AHA recommends that an initial minimum loading dose of 162 mg be used in patients with acute myocardial infarction. If an enteric-coated aspirin is the only preparation available, the first tablet should be chewed or crushed before administration. Directions on aspirin labels approved by the U.S. Food and Drug Administration indicate an initial dose of 160.0 to 162.5 mg to be continued daily for at least 30 days. Daily aspirin therapy should be considered for all patients at elevated risk of subsequent vascular events. For patients with transient ischemic attacks or stroke, at least 75 to 325 mg of aspirin a day is indicated. The AHA emphasizes that aspirin therapy should always be an adjunct, not an alternative, to management of other risk factors. More data are necessary before aspirin can be considered for use in apparently healthy individuals.

First Topical Antifungal Prescription Spray

Terbinafine hydrochloride solution (Lamisil Solution 1 percent) has been approved by the U.S. Food and Drug Administration. It is the first prescription spray indicated for the topical treatment of tinea versicolor caused by Malassezia furfur (formerly Pityrosporum ovale), tinea corporis (ringworm), tinea pedis (athlete's foot) and tinea cruris (jock itch) caused by Trichophyton rubrum, Trichophyton mentagrophytes or Epidermophyton floccosum.

In clinical trials, the majority of patients had relief of signs and symptoms within the one-week treatment period with continued improvement occurring over a period of two to seven weeks after treatment concluded. Adverse reactions were burning or irritation of the application site, itching, skin exfoliation and erythematous rash.

The solution should be applied twice daily in the treatment of tinea pedis and tinea versicolor, and once daily for the indications of tinea corporis and tinea cruris. The medication should be used for one week even though symptoms may improve.

FDA Warning on Mibefradil

The U.S. Food and Drug Administration (FDA) has issued a new warning in the labeling of mibefradil (Posicor), a treatment for hypertension and chronic angina. The label now provides additional information about two risks associated with the drug: extremely low heart rates, and, when mibefradil is taken with certain cholesterol-lowering drugs, a risk of muscle injury that can be life-threatening.

The cholesterol-lowering drugs that should not be taken with mibefradil are lovastatin and simvastatin. The new label also warns against the simultaneous use of mibefradil, any statin, and either of the immunosuppressants tacrolimus or cyclosporine.

Health care professionals should report any adverse events related to the use of mibefradil to Roche Laboratories (telephone: 800-526-6367) or to the FDA (telephone: 800-332-1088; fax: 800-332-0178). Reports can also be made to the FDA by using the MedWatch form at the back of Physicians' Desk Reference and mailing the form to MedWatch (HF-2), FDA, 5600 Fishers Lane, Rockville, MD 20857.

AAP Policy on Gonorrhea in Prepubertal Children

The Committee on Child Abuse and Neglect of the American Academy of Pediatrics (AAP) has updated a statement on gonorrhea in prepubertal children to remind physicians that sexual abuse should be considered when a gonorrheal infection is diagnosed in a child after the newborn period and before the onset of puberty.

The AAP emphasizes that there are very few exceptions in which the presence of Neisseria gonorrhoeae infection in a child does not point to sexual abuse. In some cases, it may be the only physical evidence of sexual abuse.

The AAP reminds physicians that cases of gonorrhea in children must be reported to the health department, and a report should also be made to a child protective services agency. Such children should be examined for the presence of other sexually transmitted diseases, and children living in the same environment as the infected child should also be investigated, according to the AAP.


Copyright © 1998 by the American Academy of Family Physicians.
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