Pharmacologic management of Alzheimer disease part II: Antioxidants, antihypertensives, and ergoloid derivatives

OBJECTIVE: To provide information about research evaluating antioxidants in Alzheimer disease (AD) and to discuss the potential role of beta-blockers, angiotensin-converting enzyme inhibitors, clonidine, guanfacine, nimodipin e, and ergoloid derivatives in AD therapy. DATA SOURCES: Studies, review articles, and editorials identified from MEDL INE searches (from 1989 to 1997) and bibliographies of identified cuticles. STUDY SELECTION: Studies and review articles addressing antioxidant, antihy pertensive, and ergoloid derivative pharmacotherapy research. DATA EXTRACTION: Pertinent information was selected and the data synthesize d into a review format. DATA SYNTHESIS: AD is a progressive neuropsychiatric disorder of unknown et iology. Studies evaluating the possible association between a free radical mechanism in PLD and the potential role of antioxidants are reviewed. Addit ionally, the role of beta-blockers, angiotensin-converting enzyme inhibitor s, clonidine, guanfacine, nimodipine, and ergoloid derivatives in AD manage ment are discussed. CONCLUSIONS: Preliminary evidence suggests that antioxidants may have a pro tective effect against the development of AD. Additional prospective, doubl e-blind. placebo-controlled studies are needed to determine the role of ant ioxidants in the prevention and management of AD. Understanding the role of antioxidants in AD may suggest alternative agents that have similar pharma cologic activity. beta-Blockers may be an option to control agitation in PL D patients for whom anxiolytics or antipsychotics are ineffective or are co ntraindicated because of their adverse effect profiles. Other agents that m ay have a role in AD therapy include angiotensin-converting enzyme inhibito rs, nimodipine, and ergoloid derivatives. Clonidine and guanfacine have thu s far shown little promise in improving cognitive function in AD. Further p rospective, double-blind, placebo-controlled trials will be necessary to el ucidate the rule of these agents in PLD management.