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Enter the Alzheimer's Disease Knowledge Centre

Alzheimer's Disease

Alzheimer's disease (AD) is a progressive, neurodegenerative disease which will affect most of us at one point in time, and it’s prevalence increases with age.

In the early stages in particular, dementia is often difficult to diagnose, since many symptoms are not recognized as such or are trivialized by the patient. 20% of actual dementia cases are reported to be incorrectly diagnosed as a different disease.

In early dementia the symptoms of Alzheimer’s disease include memory loss, disorientation and confusion. These symptoms are caused by the loss of neurons and worsen with continuous neurodegeneration. The pathology of dementia is not solely the result of a cholinergic deficit. It is known that, chronically and pathologically elevated glutamate concentrations play an important role.

In general two main groups of dementia can be distinguished, requiring different types of treatment:

Depending on the stage of the disease, clinical symptoms of varying intensity dominate. With the progression of AD, treatment is aimed particularly at improving and stabilizing personal everyday functions, so as to keep patients independent for as long as possible.

Anti-Infectives Knowledge Centre

The last decade has seen an increase in the incidence and severity of Clostridium difficile infections (CDI), making it one of the most talked about disease topics with many recent congresses focusing on the disease.

As the leading cause of nosocomial diarrhoea in industrialised countries¹ detection and treatment of CDI is extremely important. The ESCMID guidelines recommend that diagnosis is based upon both signs and symptoms and laboratory evidence of toxin producing C. difficile in stools.^1,2 In addition antibiotic treatment to eradicate severe C. difficle infection is recommended in these guidelines.²

The management of systemic fungal infections is also a major challenge for healthcare professionals. Due to the invasive nature of fungal infections, many treatments are pre-emptive and are therefore initiated without identifying the specific fungus involved. Targeted approaches will become a more viable option as the speed and delivery of diagnostic methods improve.

The Anti-infectives Knowledge Centre aims to provide you with the most recent information in the areas of both CDI and systemic fungal infections with regularly updated content to help assist in the fight against these diseases.

The Knowledge Centre currently provides information on CDI, including:

Prevalence – the incidence of CDI and the factors that have been attributed to the rise in these infections
Symptoms – the symptoms of CDI, including how pseudomembranous colitis manifests
Recurrence – the impact of recurring infection on patient outcomes
Diagnosis – the importance of early diagnosis and the diagnostic tests available
Treatment – treatment options recommended by the current ESCMID guidelines

Additional information on systemic fungal infections will be added soon.

Enter the Anti-infectives Knowledge Centre

References
1. Crobach MJ, et al. Clin Microbiol Infect 2009; 15: 1053‐1066
2. Bauer MP, et al. Clin Microbiol Infect 2009; 15: 1067‐1079

Date of preparation November 2012 AI/12/0038/EUc

Diabetes

Diabetes is a disease that currently affects approximately 285 million people worldwide and this figure is only expected to increase¹. For Europe, the IDF estimates that 55.2 million, or 8.5% of the population aged 20 to 79 years, have diabetes. This is expected to rise to 66.2 million (10.0%) by 2030. Further information on the scale of the type 2 diabetes problem can be found in the overview section of the knowledge centre.

Complications associated with diabetes mellitus include hypertension, cardiovascular disease, retinopathy, kidney damage, foot ulceration and nerve damage. Discover more about the complications connected to diabetes mellitus, as well as acceptable blood glucose and HbA_1C levels and how these differ in people with diabetes mellitus here.

The majority of patients with type 2 diabetes are obese and/or have an increased proportion of visceral fat, factors which in themselves are associated with insulin resistance. Other risk factors include increasing age and sedentary lifestyle. There is also a strong genetic predisposition to type 2 diabetes².

Chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction and failure of various organ systems. Early diagnosis, adequate treatment to control hyperglycaemia, and management of associated risk factors and complications therefore are all essential to reduce the burden of diabetes. Effective screening strategies are therefore of particular importance in reducing this burden. Discover the diagnostic tests necessary to diagnose type 2 diabetes mellitus and intermediate hyperglycaemia or pre-diabetes.

The early and aggressive treatment and management of diabetes mellitus is important for a successful long term outcome in patients with diabetes mellitus. The use of oral agents and lifestyle changes are the generally accepted early treatments followed later by insulin therapy. Current treatment algorithms and IDF guidelines should be used to find the appropriate treatment regime for individual patients.

As with many diseases, our knowledge of diabetes mellitus is increasing through research. Recent developments include the use of new treatments and guidelines in clinical practice. There has been an update to the IDF guidelines concerning GLP-1 agonists. DPP-4 inhibitors are now used in the treatment of diabetes, and SGLT-2 inhibitors are being investigated for this use.

References

1. Unwin, N. et al. The IDF Diabetes Atlas: Providing Evidence, Raising Awareness and Promoting Action. Diabetes Res Clin Pract 87, 2-3 (2010).

2. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 33 Suppl 1, S62-9 (2010).

Heart Failure

Heart Failure is a progressive chronic disorder that results in the inability of the heart to pump blood efficiently to the body’s tissues.

Chronic heart failure is an increasing public health problem; the growing prevalence in industrialised countries means that 1-2% of the adult population of these countries are now thought to have chronic heart failure.^1-3 Estimates suggest that the prevalence in Europe, USA and Japan could increase by approximately 16.5% over the next ten years.⁴

The prevalence of post-myocardial infarction heart failure is less well known as it is difficult to distinguish between pre-existing and incident heart failure. However current estimates suggest that approximately 1 in 5 patients hospitalised with an acute coronary syndrome either present with heart failure or develop heart failure during their hospital stay.⁵

Many of the signs and symptoms of heart failure are non-specific and vary in severity depending on the disease class. The most common of these are breathlessness, fatigue, exercise intolerance, and fluid retention as evidenced by ankle swelling, peripheral oedema, and an elevated jugular venous pressure.⁶

Due to the non-specific nature of symptoms, the diagnosis of heart failure can be difficult. Tests can include echocardiogram, ECG, chest X-ray, laboratory tests. Following a positive diagnosis heart failure is classified into functional classes that relate to disease severity.

Management of heart failure involves lifestyle modifications, pharmacological treatment and occasionally surgery. In patients with chronic heart failure, optimal therapy involves treatment with diuretics, ACE inhibitors, certain β-blockers and a mineralocorticoid receptor antagonist.

The Heart Failure Knowledge Centre brings together current information related to chronic heart failure and post-myocardial infarction, including:

Epidemiology
Symptoms and Diagnosis
Classification
Treatment Options

Enter the Heart Failure Knowledge Centre

References

Zannad F, et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Journal of the American College of Cardiology 1999; 33(3):734-742.
Cowie MR, et al. The epidemiology of heart failure. European Heart Journal 1997;18(2):208-225.
Mosterd A, Hoes A. Clinical epidemiology of heart failure. Heart 2007; 93:1137-1146.
Decision Resources. Chronic Heart Failure. Cardium Study No.4 A Pharmacor Service. 2008.
Steg PG, Dabbous OH, et al. Determinants and prognostic impact of heart failure complicating acutecoronary syndromes. Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation2004;109:494-9.
NICE Clinical Guideline No 108. Chronic Heart Failure. National clinical guideline for diagnosis and management in primary and secondary care. 2010.

Enter the Insomnia Knowledge Centre

Insomnia

Insomnia is a very common and debilitating disease with major morbidity and social consequences. Despite the negative impact on the ability to function well during the day, insomnia is underdiagnosed and undertreated. Insomnia is therefore, important to treat. However, treatment has been difficult due to concerns over current treatment options, both from a patient and physician perspective.

Various methods are used to monitor the different stages of sleep. Sleep is not homogenous – its structure, characterised by a sequence of sleep stages, is referred to as ‘sleep architecture’

Traditionally insomnia has been diagnosed on the basis of quantity of sleep

Sleep latency (time taken to get to sleep)
Sleep duration (length of time spent asleep)

While it is important not to ignore quantity of sleep, epidemiological surveys show that poor quality of sleep has a greater negative impact on health, well-being and satisfaction with life than the quantity of sleep a person gets.^1,2

Hormones released in the body are involved in certain aspects of homeostasis, including regulating the circadian rhythms established by the SCN of the hypothalamus. Melatonin is an endocrine hormone that is principally produced and released into the blood by the pineal gland. The levels of melatonin fluctuate according to light exposure (highest during darkness and sleep, and lowest in bright sunlight) and it is proposed that melatonin acts as a time ‘cue’, entraining the body’s circadian rhythm to conventional environmental patterns.

Although behavioural and psychological factors have been shown to play an important causative role in many sleep disorders, non-pharmacological /behavioural approaches are underused in the management of these conditions.^3,4

A number of resources for both patients and physicians are avaliable within this Insomnia website.

References

1. Zammit GK, Weiner J, Damato N et al. Quality of life in people with insomnia. Sleep 1999; 22 Suppl 2: S379-85
2. Pilcher JJ. Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res. 1997; 42(6): 583-96
3. National Institute of Health. NIH State of the Science Conference statement on manifestations and management of chronic insomnia in adults statement. J Clin Sleep Med 2005; 1 (4): 412–421.
4. Subramanian S, Surani S. Sleep disorders in the elderly. Geriatrics 2007; 62 (12): 10–32.

Enter the Knowledge Centre

Prostate Cancer

The Prostate Cancer Knowledge Centre is an interactive resource which provides healthcare professionals with the latest information in the field of prostate cancer.

Globally, at least 913,000 people are diagnosed with prostate cancer each year, accounting for 13.8% of new cancer cases in men. Of these approximately 385,500 new cases were identified in 2008 in Europe alone, making prostate cancer a major cause of morbidity and mortality in Europe.¹

The diagnosis rate of prostate cancer is higher in the developed world following the increased usage of PSA screening,¹ resulting in the diagnosis of many asymptomatic tumours. This is combined with other detection methods for a diagnosis to be achieved.

Age, family history and ethnicity are all well established risk factors of prostate cancer.² However many risk factors usually associated with the development of other types of cancer, such as smoking, alcohol and a sedentary lifestyle, are not thought to be associated with prostate cancer.³

Following screening the majority of men are diagnosed with a low gleason-grade, hormone-sensitive prostate cancer,² which is managed through watchful waiting and active surveillance. This is later treated with radiotherapy, radical prostatectomy and hormonal therapies. Disease progression will lead to patients being diagnosed with castrate-resistant prostate cancer. These patients will require chemotherapy treatment according to the current guidelines.²

The Prostate Cancer Knowledge Centre brings together current and detailed information relating to:

References

Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127(12):2893–2917.
European Association of Urology. Guidelines on prostate cancer, 2012.
Grönberg H. Prostate cancer epidemiology. Lancet 2003;361:859-64.

Developed by EPG Online in partnership with, and financial support from, Astellas Pharma Europe Ltd
Date of preparation September 2012 EGD/12/016/EUi

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