etot ~'fott~Y


1991~G~A171-| 174

CORRESPONDENCE Letters of 600 words or less, with minimal allowance for tables, figures, and references, will be considered for publication. Rules regarding prior publication, conflict of interest, etc., are the same as for J ~ manuscripts. All letters are subject to editing and condensation. Proofs will not be ~ .

Calcium Channel Blocker Nimodipine for Primary Degenerative Dementia

week period) "dndpatients are known to ~ ~ t y reach platea,~ tE.~g ~ Stcr=ndt I ~ ; Katzman et al 1988), it .;s my opinion that we clinician-scientists have a duty to be ~ c u l a d y careful in assessing such ac~.on of potential new ~ . It is ~ easy to engender false hope in families as well as the public media, all eager for news o f : break,~ough.

To the Editor: As one of the investigators participating in the multicenter clinical trial of nimodipine in patients with Alzheimer's disease, I am pleased that the data so laboriously collected ha~,c been analyzed and tmbfished O'ollefson 1990_), thus o ~ n i n g a forum for Lis~ F Jarvik discussion. Dr. Tollefson justly draws only modest conclu- Veterans Administration Medical Center sions from this study; he refers more than once to the West Los Angeles limited clinical relevance of the observed delay in Los Angeles, CA 90073 deterioration between patients receiving 30 mg of nimodipine TID and those receiving placebo. I do have some concerns, however, especially References regarding the large number of comparisons. I am not sure that correction was made for this fact when test- Berg L, Storandt M (1988): The longitudinal course of ~ d senile dementia of the Alzheimer type. In Bergener M, ing for statistical significance. As retardation of the Ermini M, Stahelin liB (eds), The 1988 Sandoz Lectures decline was observed on some tests and not others, in Gerontology: Crossroads in Aging. London: Acaand since it was not specified a priori which tests demic Press, i988. were expected to show such retardation of decline, l Kaizm~ R, Terry R, DeTeresa R, et al (1988): ~ c a l , pathological, and nethmchemical changes in dementia: believe that the conclusions need to be even more A subgroup with preserved mental status and numerous cautiously drawn. What are the post hoc corrections? neocortical plaques. Ann Neurol 23:138--144. They are not identified. What were the differences in McKhann G, Drachman D, Folstein M, ~ R, Price mean baseline scores of these two groups on these D, Stadlan EM (1984): Clinical diagnosis of Alzmeasures? In the discussion of baseline differences heimer's disease: Report of the NINCDS-ADRDA Work between treatment gmann.s, I" . . . . . . . ..I-- *t.pi "t" r~,,,, ,-,¢ H ~ h h and > - - - - - g - - • differences . . . . . . . . . . . . . in baseline test Human Services Task Force on Alzheimer's ~ . scores are not mentioned. Confidence in the reported Neurology 34:939-944. results is also impaired by certain inconsistencies. For example, the statement " . . . severai biogenic Tollefson GD (I990): Short-term effects of the calcium channel blocker nirnodipine (Bay-e-9736) in the manamines have been reported to be normal in the AD agement of primary degenerative dementia. Biol Psypatient" appears in the Introducfion---I assume it should chiatry 27:1133-1142. have said abnormal; on p. 1134, one of the inclusion criteria is " . . . a diagnosis of primary degenerative dementia, probable AD (DSM-IH) . . . . " DSM-III Response: does not contain a diagnosis of "'probable AD"; the To the Editor: criteria for that diagnosis come from the NINCDSIt is difficult to argue with Dr. Jarvik's comment ADRDA Work Group (McKhann et al 1984). There that clinician scientists have a duty to be particularly also are ouestions about Table 2 (e.g., the p-value careful in assessing potential new treatments. I did of 0.84 for the main effect of drug on CGI). not wish to falsely engender hope in families or the Because it is difficult to measure slowing of the media, but only to present interesting and preliminary "AD-related cognitive decline" (especially over a 12-

© 1991 Societyof BiologicalPsychiatry


Calcium channel blocker nimodipine for primary degenerative dementia.

etot ~'fott~Y 1171 1991~G~A171-| 174 CORRESPONDENCE Letters of 600 words or less, with minimal allowance for tables, figures, and references, will...
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