Prevention in dementia: antidepressants

To determine whether escitalopram (ESC) treatment would decrease CSF beta 42 amyloid levels compared to placebo (Aβ42), a study has recently been conducted (Effect of escitalopram dose and treatment duration on CSF Aβ levels in healthy older adults. A controlled clinical trial. Yvette I. Sheline, B. Joy Snider, Joanne C. Beer, Darsol Seok, Anne M. Fagan, Raymond F. Suckow, Jin-Moo Lee, Teresa Waligorska, Magdalena Korecka, Irem Aselcioglu, John C. Morris, Leslie M. Shaw, John R. Cirrito Neurology Sep 2020)

Using lumbar punctures (LP) to sample CSF levels before and after a course of CME treatment, cognitively normal older adults (n = 114) were assigned to: placebo; 20 mg of CME × 2 weeks; 20 mg of CME × 8 weeks or 30 mg of CME × 8 weeks with CSF samples before and after treatment and the percentage change within the subject at Aβ42 was used as the main result in subsequent analyses.

A 9.4% greater overall reduction in CSF Aβ42 was found in groups treated with ESC compared to groups treated with placebo (P < 0.001; 95% CI [4.9%-14.2%]; d = 0.81).

In conclusion, short-term longitudinal doses of ESC decreased the CSF Aβ42 in cognitively normal older adults, the target group for the prevention of AD.