After several years of donepezil therapy, donepezil (but not memantine) conferred modest benefits.

A man with Alzheimer disease (AD) has been taking donepezil (Aricept or a generic), and his dementia is progressing. Do you continue or stop the drug? Do you substitute or add memantine (Namenda)? To answer these questions, U.K. researchers conducted a partially industry-supported, randomized, placebo-controlled trial involving 295 community-dwelling patients with moderate-to-severe AD (mean Mini-Mental State Exam [MMSE] score, 9 out of 30) who had received donepezil for several years. Patients were assigned to continue donepezil alone, stop donepezil and start memantine, take both drugs, or take neither drug.

Many patients with mild-to-moderate asthma have persistently noneosinophilic disease.

Asthma is considered an eosinophilic disorder, and anti-inflammatory treatment (i.e., inhaled corticosteroids [ICS]), is aimed at eosinophilic airway inflammation. However, because many asthma patients do not respond to traditional therapy, recent attention has focused on the heterogeneity of this disorder.

Experimental Drug Provides Neuroprotection in Monkeys with Induced Stroke

Neurological function — not just infarct size — was substantially improved by an agent that may lessen the neurotoxicity caused by ischemia.

The Incremental Relation Between Fasting Glucose and Glycosylated Hemoglobin

The relation is affected, in part, by the degree of fasting hyperglycemia and use of oral antidiabetes drugs.

Each approach has certain advantages.

Advantages of open versus laparoscopic repair of inguinal hernia are debated frequently in the general surgery literature. In this meta-analysis of 27 randomized trials that involved 7200 patients, researchers compared open and laparoscopic approaches for treatment of unilateral inguinal hernia. Laparoscopic approaches were classified further as transabdominal preperitoneal (TAPP; the peritoneal cavity is entered) or totally extraperitoneal (TEP).

In a meta-analysis, benefits were modest.

Botulinum toxin A is approved for prophylactic treatment of chronic migraine (?15 headaches per month). The recommended regimen — 31 injections at specified sites in head and neck muscles — may be repeated at 12-week intervals. In a meta-analysis, researchers examined the effectiveness of botulinum toxin A prophylaxis for headaches.

A U.S. Trial of Flexible Sigmoidoscopy for Colorectal Cancer Screening

Screening lowered both cancer incidence and cancer-specific mortality.

In the colorectal cancer screening arm of the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) trial, 156,000 people (age range, 55–74) were randomized to either flexible sigmoidoscopy (with a second screening 3 or 5 years later) or usual care. The researchers now report outcomes after a median follow-up of 12 years.

Hyperglycemia at Admission Is Associated with Excess Mortality Among Pneumonia Patients

But, whether treating hyperglycemia lowers mortality risk is unknown.