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NSAIDs and corticosteroids have a short onset of action while DMARDs can take several weeks or months to demonstrate a clinical effect. Moreover, when the treatment regimen includes an anti-oxidant, like vitamin C, it may be difficult to obtain sufficient levels of the compound to counteract long-term, severe inflammation that is characteristic of advanced Alzheimer's disease. For instance, as shown in Figure 2, the level of 25-hydroxyvitamin D (25OHD) is highest in people with advanced Alzheimer's disease who had taken at least a 10-fold increase of the vitamin D, but this benefit is lost within months. As for vitamin D deficiency, a low level of 25OHD in the blood of people with dementia (defined by an elevated Tg25OHd) is associated with increased dementia, but in younger individuals with normal levels of vitamin D, it was not shown to be associated with any significant mortality difference between those whose 25OHD levels fell below 30 ng/ml (at age 31) and those whose 25OHD levels were 40 or greater. In people with impaired renal function, no significant difference in mortality was found between those who were 75 or above in 25OHD for whom the level was below 25 ng/ml and those with lower levels. The clinical relevance of the finding of a decreased mortality in vitamin D deficient older persons with AD is not established, and the data are limited to people who are vitamin D deficient (Figure 2). Another major limitation of DMARD is their lack of effectiveness; the results from animal and clinical studies have shown that these agents cause an increase in the development of cognitive impairment (3). Thus, their use as first-line treatments should be used carefully and to a limited extent until the safety and efficacy of DMARDs can be established. Summary AD is a progressive neurodegenerative disease where the immune system is compromised. It is associated with a variety of systemic, psychological and behavioral changes that may increase risk for a range of psychiatric problems. AD requires ongoing, well-coordinated anti-immune treatment to ameliorate the damage of this disease. At present, anti-inflammatory drugs are probably the most effective treatment for AD, though other medications are being evaluated. The most common anti-AD drugs, and the most effective anti-inflammatory agents, are vitamins C and E. These are the ones to be considered when the most aggressive therapies for AD are unavailable or cannot be used. References 1. Hölzl E, Lappalainen K et al. Vitamin E supplementation in patients with Alzheimer's disease. J Alzheimer's Dis 2010;26( Related Article:
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