Drs. Rabins and Zarin Reply

To the Editor: The following is a response to the letters of Dr. Browning and Dr. Zanetti and colleagues on the Alzheimer’s disease practice guideline.

Dr. Browning is correct in noting that the task force did not recommend the use of nonsteroidal anti-inflammatory drugs to delay onset or progression of Alzheimer’s disease because there are no prospective trials supporting their effectiveness. He is also correct in noting that this class of drugs has significant side effects that militate against their use in a casual fashion. Trials are in the planning stages. It will be important to determine whether the psychiatric side effects are as Dr. Browning suggests.

Dr. Zanetti and co-workers are correct in pointing out that procedural memory is relatively spared when compared with other forms of memory in the early and moderate stages of Alzheimer’s disease. Clearly, some patients in these stages of the disease are able to learn some new material. What has yet to be demonstrated is whether any particular method or technique of nonpharmacologic cognition enhancement produces an improvement in cognition that is both clinically meaningful and persistent.