Prednisone is a corticosteroid drug that is being prescribed in many countries for conditions ranging from severe allergic reactions to arthritis, asthma, and certain autoimmune disorders such as multiple sclerosis and lupus. Prednisone temporarily attracted interest in Alzheimer's research in the late 1990s as a potential treatment option to test the inflammatory hypothesis of Alzheimer's disease. This approach failed and therapeutic testing moved on to non-steroidal anti-inflammatory drugs such as naproxen and ibuprofen.
The Alzheimer's Disease Cooperative Study conducted a multicenter trial of 138 patients with Alzheimer's disease who were randomized to take placebo or 20 mg predisone per day for a month, followed by 10 mg daily for a year and gradual tapering off over an additional four months. Treated patients showed no benefit over placebo recipients on the primary outcome, the ADAS-cog, or on a secondary analysis of only those patients who completed the full course. The main differences between the placebo and treatment groups were a worsening of behavioral symptoms and an increase in blood glucose levels on prednisone (Aisen et al., 2000; Koch and Szecsey, 2000; Aisen et al., 2003).
This trial ended clinical evaluation of prednisone as an Alzheimer's therapy. Even so, a small study subsequently reported reduction of CSF AD biomarkers with prednisone treatment of other diseases, and an argument was made for short-term, high-dose intrathecal infusion of prednisone in AD (Tokuda et al., 2002; Alisky, 2008). Long-term use of prednisone has been reported to cause a reversible form of dementia (Sacks and Shulman, 2005).
- Aisen PS, Davis KL, Berg JD, Schafer K, Campbell K, Thomas RG, Weiner MF, Farlow MR, Sano M, Grundman M, Thal LJ. A randomized controlled trial of prednisone in Alzheimer's disease. Alzheimer's Disease Cooperative Study. Neurology. 2000 Feb 8;54(3):588-93. PubMed.
- Koch HJ, Szecsey A. A randomized controlled trial of prednisone in Alzheimer's disease. Neurology. 2000 Oct 10;55(7):1067. PubMed.
- Aisen PS, Berg JD, Craft S, Peskind ER, Sano M, Teri L, Mulnard RA, Thomas RG, Thal LJ. Steroid-induced elevation of glucose in Alzheimer's disease: relationship to gender, apolipoprotein E genotype and cognition. Psychoneuroendocrinology. 2003 Jan;28(1):113-20. PubMed.
- Tokuda T, Oide T, Tamaoka A, Ishii K, Matsuno S, Ikeda S. Prednisolone (30-60 mg/day) for diseases other than AD decreases amyloid beta-peptides in CSF. Neurology. 2002 May 14;58(9):1415-8. PubMed.
- Alisky JM. Intrathecal corticosteroids might slow Alzheimer's disease progression. Neuropsychiatr Dis Treat. 2008 Oct;4(5):831-3. PubMed.
- Sacks O, Shulman M. Steroid dementia: an overlooked diagnosis?. Neurology. 2005 Feb 22;64(4):707-9. PubMed.
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