Re: Alzheimer dementia, cholinesterase inhibitors, and impartiality

The authors of the BCMJ theme issue “The new era of treatable Alzheimer disease” (September 2004;[7]:332-347) strongly condone the efficacy of cholinesterase inhibitors such as donepezil (Aricept) in the treatment of Alzheimer dementia.

Three months earlier in June 2004 and published in the Lancet were the findings of the AD 2000 Collaborative Group conducting an RCT on donepezil treatment in 565 patients (Lancet 363:2105-2115). The authors were at great pains to remove bias: the partaking physicians had to be uncertain that a patient would benefit from donepezil before randomization, and unlike previous major studies, AD 2000 was undertaken independently of any commercial interests and at arm’s length from the pharmaceutical industry. The study period was four times longer than in previous trials.

The AD 2000 study agreed with previous ones to the effect that donepezil produces small improvements in cognition and ADL in patients with mild to moderate Alzheimer’s. Cognitive improvement in the donepezil-treated patients was by less than one point on the MMSE scale. Compared to controls there were no significant differences in behavioral symptoms, well-being, or caregiver time, and no differences in the two primary end points of the study, namely rate of institutionalization and progress of disability. Worrisome potential findings of serious adverse events were recorded. An editorial comment (pages 2100 to 2101) in the same issue of the Lancet read, “the AD 2000 results are incompatible with many drug-company-sponsored observational studies.”

Many BCMJ readers (including presumably those close to the topic) will have learned of AD 2000 in the lay press during May. Because of the publication time line of the BCMJ theme issue it may not have been possible for the BCMJ authors to incorporate into their texts the AD 2000 findings. However, the last article of the theme issue, that pertaining to the TREAD conference, was able to incorporate reference number 5 accessed in June 2004. Was it not possible for the authors to produce an addendum acknowledging the existence of AD 2000, which despite imperfections was arguably the best-conducted study to have appeared so far on this matter?

—Peter Rees, PhD, FRCPC
Burnaby

Peter Rees, PhD, FRCPC. Re: Alzheimer dementia, cholinesterase inhibitors, and impartiality. BCMJ, Vol. 46, No. 10, December, 2004, Page(s) 500 - Letters.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply