title: Catecholamine-Based Treatment in AD Patients: Expectations and Delusions.
abstract: In Alzheimer disease, the gap between excellence of diagnostics and efficacy of therapy is wide. Despite sophisticated imaging and biochemical markers, the efficacy of available therapeutic options is limited. Here we examine the possibility that assessment of endogenous catecholamine levels in cerebrospinal fluid (CSF) may fuel new therapeutic strategies. In reviewing the available literature, we consider the effects of levodopa, monoamine oxidase inhibitors, and noradrenaline (NE) modulators, showing disparate results. We present a preliminary assessment of CSF concentrations of dopamine (DA) and NE, determined by HPLC, in a small dementia cohort of either Alzheimer's disease (AD) or frontotemporal dementia patients, compared to control subjects. Our data reveal detectable levels of DA, NE in CSF, though we found no significant alterations in the dementia population as a whole. AD patients exhibit a small impairment of the DA axis and a larger increase of NE concentration, likely to represent a compensatory mechanism. While waiting for preventive strategies, a pragmatic approach to AD may re-evaluate catecholamine modulation, possibly stratified to dementia subtypes, as part of the therapeutic armamentarium.
authors.affiliation: Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy ; IRCCS Fondazione Santa Lucia , Rome , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stefani
authors.affiliation: Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Olivola
authors.affiliation: Policlinico Tor Vergata, Neurofisiopatologia , Rome , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Liguori
authors.affiliation: St George's University of London , London , UK.
authors.forename: Atticus H
authors.initials: AH
authors.lastname: Hainsworth
authors.affiliation: Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Saviozzi
authors.affiliation: Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy.
authors.forename: Giacoma
authors.initials: G
authors.lastname: Angileri
authors.affiliation: Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy.
authors.forename: Vincenza
authors.initials: V
authors.lastname: D'Angelo
authors.affiliation: Neurocenter Svizzera Italiana , Lugano , Switzerland.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Galati
authors.affiliation: Department of System Medicine, Università di Roma Tor Vergata , Rome , Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Pierantozzi
keywords: Alzheimer’s disease; CSF; catecholamine; dopamine; monoaminooxidase inhibitors