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Sinnott C, Foley T, Horgan L, McLoughlin K, Sheehan C, Bradley C. Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment. BMJ Open 2019; 9:e024452. [PMID: 31439594 PMCID: PMC6707695 DOI: 10.1136/bmjopen-2018-024452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE General practitioners (GPs) report finding consultations on fitness to drive (FtD) in people with cognitive impairment difficult and potentially damaging to the physician-patient relationship. We aimed to explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated. METHODS Individual qualitative interviews were conducted with GPs (n=12) and patients/carers (n=6) in Ireland. We recruited a maximum variation sample of GPs using criteria of length of time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services and participating general practices. Interviews were audio-recorded, transcribed and analysed thematically by the multidisciplinary research team using an approach informed by the framework method. RESULTS The issue of FtD arose in consultations in two ways: introduced by GPs to proactively prepare patients for future driving cessation or by patients who urgently needed a medical report for an expiring driving license. The former strategy, implementable by GPs who had strong relational continuity with their patients, helped prevent crisis consultations from arising. The latter scenario became acrimonious if cognition had not been openly discussed with patients previously and was now potentially impacting on their right to drive. Patients called for greater clarity and empathy for the threat of driving cessation from their GPs. CONCLUSION GPs used their longitudinal relationship with cognitively impaired patients to reduce the potential for conflict in consultations on FtD. These efforts could be augmented by explicit discussion of cognitive impairment at an earlier stage for all affected patients. Patients would benefit from greater input into planning driving cessation and acknowledgement from their GPs of the impact this may have on their quality of life.
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Affiliation(s)
- Carol Sinnott
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Linda Horgan
- Department of Occupational Therapy, University College Cork, Cork, Ireland
| | | | - Cormac Sheehan
- Department of General Practice, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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Hwang AB, Boes S, Nyffeler T, Schuepfer G. Validity of screening instruments for the detection of dementia and mild cognitive impairment in hospital inpatients: A systematic review of diagnostic accuracy studies. PLoS One 2019; 14:e0219569. [PMID: 31344048 PMCID: PMC6657852 DOI: 10.1371/journal.pone.0219569] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/26/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION As the population ages, Alzheimer's disease and other subtypes of dementia are becoming increasingly prevalent. However, in recent years, diagnosis has often been delayed or not made at all. Thus, improving the rate of diagnosis has become an integral part of national dementia strategies. Although screening for dementia remains controversial, the case is strong for screening for dementia and other forms of cognitive impairment in hospital inpatients. For this reason, the objective of this systematic review was to provide clinicians, who wish to implement screening, an up-to-date choice of cognitive tests with the most extensive evidence base for the use in elective hospital inpatients. METHODS For this systematic review, PubMed, PsycINFO and Cochrane Library were searched by using a multi-concept search strategy. The databases were accessed on April 10, 2019. All cross-sectional studies that utilized brief, multi-domain cognitive tests as index test and a reference standard diagnosis of dementia or mild cognitive impairment as comparator were included. Only studies conducted in the hospital setting, sampling from unselected, elective inpatients older than 64 were considered. RESULTS Six studies met the inclusion criteria, with a total of 2112 participants. Diagnostic accuracy data for the Six-Item Cognitive Impairment Test, Cognitive Performance Scale, Clock-Drawing Test, Mini-Mental Status Examination, and Time & Change test were extracted and descriptively analyzed. Clinical and methodological heterogeneity between the studies precluded performing a meta-analysis. DISCUSSION This review found only a small number of instruments and was not able to recommend a single best instrument for use in a hospital setting. Although it was not possible to estimate the pooled operating characteristics, the included description of instrument characteristics, the descriptive analysis of performance measures, and the critical evaluation of the reporting studies may contribute to clinician's choice of the screening instrument that fits best their purpose.
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Affiliation(s)
- Aljoscha Benjamin Hwang
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Thomas Nyffeler
- Clinic for Neurology and Neurorehabilitation, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Guido Schuepfer
- Staff Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Narayan SW, Pearson SA, Litchfield M, Le Couteur DG, Buckley N, McLachlan AJ, Zoega H. Anticholinergic medicines use among older adults before and after initiating dementia medicines. Br J Clin Pharmacol 2019; 85:1957-1963. [PMID: 31046175 PMCID: PMC6710547 DOI: 10.1111/bcp.13976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS We investigated anticholinergic medicines use among older adults initiating dementia medicines. METHODS We used Pharmaceutical Benefits Scheme dispensing claims to identify patients who initiated donepezil, rivastigmine, galantamine or memantine between 1 January 2013 and 30 June 2017 (after a period of ≥180 days with no dispensing of these medicines) and remained on therapy for ≥180 days (n = 4393), and dispensed anticholinergic medicines in the 180 days before and after initiating dementia medicines. We further examined anticholinergic medicines prescribed by a prescriber other than the one initiating dementia medicines. RESULTS One-third of the study cohort (1439/4393) was exposed to anticholinergic medicines up to 180 days before or after initiating dementia medicines. Among patients exposed to anticholinergic medicines, 46% (659/1439) had the same medicine dispensed before and after initiating dementia medicines. The proportion of patients dispensed anticholinergic medicines increased by 2.5% (95% confidence interval [CI]: 1.3-3.7) after initiating dementia medicines. Antipsychotics use increased by 10.1% (95% CI: 7.6-12.7) after initiating dementia medicines; driven by increased risperidone use (7.3%, 95% CI: 5.3-9.3). Nearly half of patients dispensed anticholinergic medicines in the 180 days after (537/1133), were prescribed anticholinergic medicines by a prescriber other than the one initiating dementia medicines. CONCLUSION Use of anticholinergic medicines is common among patients initiating dementia medicines and this occurs against a backdrop of widespread campaigns to reduce irrational medicine combinations in this vulnerable population. Decisions about deprescribing medicines with questionable benefit among patients with dementia may be complicated by conflicting recommendations in prescribing guidelines.
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Affiliation(s)
- Sujita W Narayan
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Melisa Litchfield
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - David G Le Couteur
- Centre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia.,Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Nicholas Buckley
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Andrew J McLachlan
- Centre for Education and Research in Ageing, Concord Hospital, Sydney, Australia.,Sydney Pharmacy School, The University of Sydney, Sydney, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
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O'Malley M, Parkes J, Stamou V, LaFontaine J, Oyebode J, Carter J. Young-onset dementia: scoping review of key pointers to diagnostic accuracy. BJPsych Open 2019; 5:e48. [PMID: 31530311 PMCID: PMC6582217 DOI: 10.1192/bjo.2019.36] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Routine psychiatric assessments tailored to older patients are often insufficient to identify the complexity of presentation in younger patients with dementia. Significant overlap between psychiatric disorders and neurodegenerative disease means that high rates of prior incorrect psychiatric diagnosis are common. Long delays to diagnosis, misdiagnosis and lack of knowledge from professionals are key concerns. No specific practice guidelines exist for diagnosis of young-onset dementia (YOD). AIMS The review evaluates the current evidence about best practice in diagnosis to guide thorough assessment of the complex presentations of YOD with a view to upskilling professionals in the field. METHOD A comprehensive search of the literature adopting a scoping review methodology was conducted regarding essential elements of diagnosis in YOD, over and above those in current diagnostic criteria for disease subtypes. This methodology was chosen because research in this area is sparse and not amenable to a traditional systematic review. RESULTS The quality of evidence identified is variable with the majority provided from expert opinion and evidence is lacking on some topics. Evidence appears weighted towards diagnosis in frontotemporal dementia and its subtypes and young-onset Alzheimer's disease. CONCLUSIONS The literature demonstrates that a clinically rigorous and systematic approach is necessary in order to avoid mis- or underdiagnosis for younger people. The advent of new disease-modifying treatments necessitates clinicians in the field to improve knowledge of new imaging techniques and genetics, with the goal of improving training and practice, and highlights the need for quality indicators and alignment of diagnostic procedures across clinical settings. DECLARATION OF INTEREST None.
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Affiliation(s)
- Mary O'Malley
- Research Assistant, Faculty of Health and Society, University of Northampton, UK
| | - Jacqueline Parkes
- Professor, Faculty of Health and Society, University of Northampton, UK
| | - Vasileios Stamou
- Research Assistant, Centre for Applied Dementia Studies, University of Bradford, UK
| | - Jenny LaFontaine
- Research Fellow, Centre for Applied Dementia Studies, University of Bradford, UK
| | - Jan Oyebode
- Centre for Applied Dementia Studies, University of Bradford, UK
| | - Janet Carter
- Assistant Professor, Division of Psychiatry, University College London, UK
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Suh HW, Kim J, Kwon O, Cho SH, Kim JW, Kwak HY, Kim Y, Lee KM, Chung SY, Lee JH. Neurocircuitry of acupuncture effect on cognitive improvement in patients with mild cognitive impairment using magnetic resonance imaging: a study protocol for a randomized controlled trial. Trials 2019; 20:310. [PMID: 31146774 PMCID: PMC6543690 DOI: 10.1186/s13063-019-3446-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background Mild cognitive impairment (MCI) is defined as a decline in cognitive state with preservation of activities of daily living. Medications such as donepezil and rivastigmine have been commonly prescribed for MCI, but their use is controversial. Acupuncture has been widely used in Korea and has been shown to improve cognitive function. The aim of this study is to evaluate the efficacy of acupuncture for MCI and investigate the effect of acupuncture on structural and functional brain changes in patients with MCI. Methods This study is a randomized, assessor-blinded, sham-controlled trial. Fifty participants with MCI will be randomly assigned to the acupuncture group (n = 25) or sham acupuncture group (n = 25). The acupuncture group will receive acupuncture treatment at nine acupuncture points (GV20, EX-HN1, bilateral LI4, and ST36) twice a week for 12 weeks. The sham acupuncture group will receive sham acupuncture treatment at the same points with non-penetrating sham needles. Both groups will be restricted from all other treatments for the improvement of cognitive function. The primary outcome measure is the Digit Span Test (DST). The secondary outcome measures are the Digit Symbol Substitution Test (DSST), Korean version of Montreal Cognitive Assessment (MoCA-K), Seoul Neuropsychological Screening Battery-II (SNSB-II), Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), working memory (WM) task performance score, and structural/functional brain changes. Outcomes will be assessed at screening, baseline, 4 and 8 weeks, and after the end of treatment. We will also observe adverse events. In the statistical analysis, a full analysis set and per-protocol analysis will be performed. Discussion This randomized clinical trial aims to examine the efficacy of acupuncture treatment for MCI. Neuropsychological tests, psychological inventories for measuring depression and anxiety, and magnetic resonance imaging will be performed to investigate the underlying neurological mechanisms and the association between cognition, emotion, and brain networks following acupuncture treatment. The results of the trial will provide evidence supporting the efficacy of acupuncture and also add to the neurobiological understanding of acupuncture treatment for MCI. Trial registration Clinical Research Information Service, KCT0002896. Registered on 25 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3446-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyo-Weon Suh
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Jieun Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea
| | - Seung-Hun Cho
- Department of Neuropsychiatry, Kyung Hee University Medical Center Korean Medicine Hospital, Seoul, 02447, Republic of Korea
| | - Jong Woo Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea.,Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - Hui-Yong Kwak
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Yunna Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea.,Department of Neuropsychiatry, Kyung Hee University Medical Center Korean Medicine Hospital, Seoul, 02447, Republic of Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University Hospital, Seoul, 02447, Republic of Korea.,Department of Radiology, Kyung Hee University College of Medicine, Seoul, 02447, Republic of Korea
| | - Sun-Yong Chung
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, 02447, Republic of Korea. .,Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea.
| | - Jun-Hwan Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea. .,Korean Medicine Life Science, University of Science & Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea.
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Ranson JM, Kuźma E, Hamilton W, Muniz-Terrera G, Langa KM, Llewellyn DJ. Predictors of dementia misclassification when using brief cognitive assessments. Neurol Clin Pract 2019; 9:109-117. [PMID: 31041124 PMCID: PMC6461420 DOI: 10.1212/cpj.0000000000000566] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Brief cognitive assessments can result in false-positive and false-negative dementia misclassification. We aimed to identify predictors of misclassification by 3 brief cognitive assessments; the Mini-Mental State Examination (MMSE), Memory Impairment Screen (MIS) and animal naming (AN). METHODS Participants were 824 older adults in the population-based US Aging, Demographics and Memory Study with adjudicated dementia diagnosis (DSM-III-R and DSM-IV criteria) as the reference standard. Predictors of false-negative, false-positive and overall misclassification by the MMSE (cut-point <24), MIS (cut-point <5) and AN (cut-point <9) were analysed separately in multivariate bootstrapped fractional polynomial regression models. Twenty-two candidate predictors included sociodemographics, dementia risk factors and potential sources of test bias. RESULTS Misclassification by at least one assessment occurred in 301 (35.7%) participants, whereas only 14 (1.7%) were misclassified by all 3 assessments. There were different patterns of predictors for misclassification by each assessment. Years of education predicts higher false-negatives (odds ratio [OR] 1.23, 95% confidence interval [95% CI] 1.07-1.40) and lower false-positives (OR 0.77, 95% CI 0.70-0.83) by the MMSE. Nursing home residency predicts lower false-negatives (OR 0.15, 95% CI 0.03-0.63) and higher false-positives (OR 4.85, 95% CI 1.27-18.45) by AN. Across the assessments, false-negatives were most consistently predicted by absence of informant-rated poor memory. False-positives were most consistently predicted by age, nursing home residency and non-Caucasian ethnicity (all p < 0.05 in at least 2 models). The only consistent predictor of overall misclassification across all assessments was absence of informant-rated poor memory. CONCLUSIONS Dementia is often misclassified when using brief cognitive assessments, largely due to test specific biases.
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Affiliation(s)
- Janice M Ranson
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - Elżbieta Kuźma
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - William Hamilton
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - Graciela Muniz-Terrera
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - Kenneth M Langa
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
| | - David J Llewellyn
- University of Exeter Medical School (J.M.R., E.K., W.H., D.J.L.); Centre for Dementia Prevention, University of Edinburgh (G.M.-T.), United Kingdom; The Alan Turing Institute (D.J.L.), London, United Kingdom; and Medical School (K.M.L.), Institute for Social Research, Institute for Healthcare Policy and Innovation, Veterans Affairs Ann Arbor Healthcare System, University of Michigan
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Gaviola MA, Inder KJ, Dilworth S, Holliday EG, Higgins I. Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials. Australas J Ageing 2019; 39:10-20. [PMID: 30912616 DOI: 10.1111/ajag.12642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/11/2019] [Accepted: 02/18/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To summarise the evidence regarding the impact of individualised music listening on persons with dementia. METHODS Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non-music-based interventions. RESULTS Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited. CONCLUSIONS The limited evidence suggests individualised music listening has comparable efficacy to more resource-intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.
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Affiliation(s)
- Minah Amor Gaviola
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kerry J Inder
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Sophie Dilworth
- Hunter Aged Care Assessment Team, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Elizabeth G Holliday
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Isabel Higgins
- School of Nursing & Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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McShane R, Westby MJ, Roberts E, Minakaran N, Schneider L, Farrimond LE, Maayan N, Ware J, Debarros J. Memantine for dementia. Cochrane Database Syst Rev 2019; 3:CD003154. [PMID: 30891742 PMCID: PMC6425228 DOI: 10.1002/14651858.cd003154.pub6] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Memantine is a moderate affinity uncompetitive antagonist of glutamate NMDA receptors. It is licensed for use in moderate and severe Alzheimer's disease (AD); in the USA, it is also widely used off-label for mild AD. OBJECTIVES To determine efficacy and safety of memantine for people with dementia. To assess whether memantine adds benefit for people already taking cholinesterase inhibitors (ChEIs). SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register of trials (http://www.medicine.ox.ac.uk/alois/) up to 25 March 2018. We examined clinical trials registries, press releases and posters of memantine manufacturers; and the web sites of the FDA, EMEA and NICE. We contacted authors and companies for missing information. SELECTION CRITERIA Double-blind, parallel group, placebo-controlled, randomised trials of memantine in people with dementia. DATA COLLECTION AND ANALYSIS We pooled and analysed data from four clinical domains across different aetiologies and severities of dementia and for AD with agitation. We assessed the impact of study duration, severity and concomitant use of ChEIs. Consequently, we restricted analyses to the licensed dose (20 mg/day or 28 mg extended release) and data at six to seven months duration of follow-up, and analysed separately results for mild and moderate-to-severe AD.We transformed results for efficacy outcomes into the difference in points on particular outcome scales. MAIN RESULTS Across all types of dementia, data were available from almost 10,000 participants in 44 included trials, most of which were at low or unclear risk of bias. For nearly half the studies, relevant data were obtained from unpublished sources. The majority of trials (29 in 7885 participants) were conducted in people with AD.1. Moderate-to-severe AD (with or without concomitant ChEIs). High-certainty evidence from up to 14 studies in around 3700 participants consistently shows a small clinical benefit for memantine versus placebo: clinical global rating (CGR): 0.21 CIBIC+ points (95% confidence interval (CI) 0.14 to 0.30); cognitive function (CF): 3.11 Severe Impairment Battery (SIB) points (95% CI 2.42 to 3.92); performance on activities of daily living (ADL): 1.09 ADL19 points (95% CI 0.62 to 1.64); and behaviour and mood (BM): 1.84 Neuropsychiatric Inventory (NPI) points (95% CI 1.05 to 2.76). There may be no difference in the number of people discontinuing memantine compared to placebo: risk ratio (RR) 0.93 (95% CI 0.83 to 1.04) corresponding to 13 fewer people per 1000 (95% CI 31 fewer to 7 more). Although there is moderate-certainty evidence that fewer people taking memantine experience agitation as an adverse event: RR 0.81 (95% CI 0.66 to 0.99) (25 fewer people per 1000, 95% CI 1 to 44 fewer), there is also moderate-certainty evidence, from three additional studies, suggesting that memantine is not beneficial as a treatment for agitation (e.g. Cohen Mansfield Agitation Inventory: clinical benefit of 0.50 CMAI points, 95% CI -3.71 to 4.71) .The presence of concomitant ChEI does not impact on the difference between memantine and placebo, with the possible exceptions of the BM outcome (larger effect in people taking ChEIs) and the CF outcome (smaller effect).2. Mild AD (Mini Mental State Examination (MMSE) 20 to 23): mainly moderate-certainty evidence based on post-hoc subgroups from up to four studies in around 600 participants suggests there is probably no difference between memantine and placebo for CF: 0.21 ADAS-Cog points (95% CI -0.95 to 1.38); performance on ADL: -0.07 ADL 23 points (95% CI -1.80 to 1.66); and BM: -0.29 NPI points (95% CI -2.16 to 1.58). There is less certainty in the CGR evidence, which also suggests there may be no difference: 0.09 CIBIC+ points (95% CI -0.12 to 0.30). Memantine (compared with placebo) may increase the numbers of people discontinuing treatment because of adverse events (RR 2.12, 95% CI 1.03 to 4.39).3. Mild-to-moderate vascular dementia. Moderate- and low-certainty evidence from two studies in around 750 participants indicates there is probably a small clinical benefit for CF: 2.15 ADAS-Cog points (95% CI 1.05 to 3.25); there may be a small clinical benefit for BM: 0.47 NOSGER disturbing behaviour points (95% CI 0.07 to 0.87); there is probably no difference in CGR: 0.03 CIBIC+ points (95% CI -0.28 to 0.34); and there may be no difference in ADL: 0.11 NOSGER II self-care subscale points (95% CI -0.35 to 0.54) or in the numbers of people discontinuing treatment: RR 1.05 (95% CI 0.83 to 1.34).There is limited, mainly low- or very low-certainty efficacy evidence for other types of dementia (Parkinson's disease and dementia Lewy bodies (for which CGR may show a small clinical benefit; four studies in 319 people); frontotemporal dementia (two studies in 133 people); and AIDS-related Dementia Complex (one study in 140 people)).There is high-certainty evidence showing no difference between memantine and placebo in the proportion experiencing at least one adverse event: RR 1.03 (95% CI 1.00 to 1.06); the RR does not differ between aetiologies or severities of dementia. Combining available data from all trials, there is moderate-certainty evidence that memantine is 1.6 times more likely than placebo to result in dizziness (6.1% versus 3.9%), low-certainty evidence of a 1.3-fold increased risk of headache (5.5% versus 4.3%), but high-certainty evidence of no difference in falls. AUTHORS' CONCLUSIONS We found important differences in the efficacy of memantine in mild AD compared to that in moderate-to-severe AD. There is a small clinical benefit of memantine in people with moderate-to-severe AD, which occurs irrespective of whether they are also taking a ChEI, but no benefit in people with mild AD.Clinical heterogeneity in AD makes it unlikely that any single drug will have a large effect size, and means that the optimal drug treatment may involve multiple drugs, each having an effect size that may be less than the minimum clinically important difference.A definitive long-duration trial in mild AD is needed to establish whether starting memantine earlier would be beneficial over the long term and safe: at present the evidence is against this, despite it being common practice. A long-duration trial in moderate-to-severe AD is needed to establish whether the benefit persists beyond six months.
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Affiliation(s)
- Rupert McShane
- University of OxfordRadcliffe Department of MedicineJohn Radcliffe HospitalLevel 4, Main Hospital, Room 4401COxfordOxfordshireUKOX3 9DU
| | - Maggie J Westby
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Emmert Roberts
- King's College LondonDepartment of Psychological Medicine and National Addiction CentreWeston Education CentreLondonLondonUKSE5 9RJ
| | - Neda Minakaran
- Moorfields Eye Hospital NHS Foundation TrustDepartment of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Lon Schneider
- Keck School of Medicine of the University of Southern California1540 Alcazar Street, CHP 216Los AngelesCAUSA90033
| | - Lucy E Farrimond
- Oxford University Hospitals NHS Foundation TrustNeurosciences DepartmentJohn Radcliffe HospitalOxfordUKOX3 9DU
| | - Nicola Maayan
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Jennifer Ware
- University of OxfordCochrane Dementia and Cognitive Improvement GroupOxfordUKOX3 9DU
| | - Jean Debarros
- University of OxfordNuffield Department of Clinical Neurosciences (NDCN)Level 6, West Wing, John Radcliffe HospitalOxfordUKOX3 9DU
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Beishon LC, Batterham AP, Quinn TJ, Nelson CP, Panerai RB, Robinson T, Haunton VJ. Addenbrooke’s Cognitive Examination III (ACE-III) and mini-ACE for the detection of dementia and mild cognitive impairment. Hippokratia 2019. [DOI: 10.1002/14651858.cd013282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lucy C Beishon
- University of Leicester; Department of Cardiovascular Sciences; Clinical Sciences Building Leicester Royal Infirmary Leicester UK LE2 7LX
| | - Angus P Batterham
- University of Leicester; Leicester Medical School; Maurice Shock Building, University Road Leicester UK LE1 7RH
| | - Terry J Quinn
- University of Glasgow; Institute of Cardiovascular and Medical Sciences; New Lister Campus Glasgow Royal Infirmary Glasgow UK G4 0SF
| | - Christopher P Nelson
- University of Leicester; Department of Cardiovascular Sciences; Clinical Sciences Building Leicester Royal Infirmary Leicester UK LE2 7LX
| | - Ronney B Panerai
- University of Leicester; Department of Cardiovascular Sciences; Clinical Sciences Building Leicester Royal Infirmary Leicester UK LE2 7LX
| | - Thompson Robinson
- University of Leicester; Cardiovascular Sciences; BHF Cardiovascular Research Centre, The Glenfield Hospital Groby Road Leicester UK LE3 9QP
| | - Victoria J Haunton
- University of Leicester; Cardiovascular Sciences; BHF Cardiovascular Research Centre, The Glenfield Hospital Groby Road Leicester UK LE3 9QP
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Reeve E, Farrell B, Thompson W, Herrmann N, Sketris I, Magin PJ, Chenoweth L, Gorman M, Quirke L, Bethune G, Hilmer SN. Deprescribing cholinesterase inhibitors and memantine in dementia: guideline summary. Med J Aust 2019; 210:174-179. [DOI: 10.5694/mja2.50015] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Emily Reeve
- NHMRC Cognitive Decline Partnership CentreKolling Institute of Medical ResearchNorthern Clinical SchoolUniversity of Sydney Sydney NSW
- Dalhousie University and Nova Scotia Health Authority Halifax Canada
| | - Barbara Farrell
- Bruyère Research Institute Ottawa Canada
- University of Ottawa Ottawa Canada
| | | | - Nathan Herrmann
- Sunnybrook Health Sciences Centre Toronto Canada
- University of Toronto Toronto Canada
| | | | - Parker J Magin
- University of Newcastle Newcastle NSW
- NSW and ACT Research and Evaluation UnitGP Synergy Regional Training Organisation Sydney NSW
| | - Lynn Chenoweth
- Centre for Healthy Brain AgeingUNSW Sydney NSW
- University of Notre Dame Sydney NSW
| | - Mary Gorman
- Dalhousie University Halifax Canada
- St Martha's Regional Hospital Antigonish Canada
| | - Lyntara Quirke
- Consumer NetworkAlzheimer's Australia Canberra ACT
- Dementia Training Australia
| | | | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership CentreKolling Institute of Medical ResearchNorthern Clinical SchoolUniversity of Sydney Sydney NSW
- Royal North Shore Hospital and University of Sydney Sydney NSW
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Magklara E, Stephan BCM, Robinson L. Current approaches to dementia screening and case finding in low- and middle-income countries: Research update and recommendations. Int J Geriatr Psychiatry 2019; 34:3-7. [PMID: 30247787 DOI: 10.1002/gps.4969] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
Abstract
Approximately 47 million people have dementia worldwide, with this figure, it is expected to almost triple by 2050. Most people with dementia (approximately two-thirds) live in low- and middle-income countries (LMICs). This presents a significant challenge for such countries that often have limited financial resources and less well-developed health and social care systems. In the absence of a cure, reducing the future costs of dementia care and burden of disease may be best achieved by a greater emphasis on (1) more timely diagnosis with earlier intervention to maintain functional independence and (2) undertaking "screening" in groups at high risk of developing dementia, case finding, and using brief cognitive assessment instruments. In clinical settings, a wide range of instruments for dementia screening and diagnosis are currently available; however, few cognitive assessment tools have been developed specifically for clinical use within LMIC settings. Screening for dementia and cognitive impairment in LMICs largely relies on tools adapted from high-income countries (HICs); these often lack validation in these settings leading to education, literacy, and cultural biases. Research is urgently needed to develop cognitive assessment tools and dementia diagnostic approaches that are appropriate and feasible for clinical use in LMIC settings.
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Affiliation(s)
- Eleni Magklara
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom C M Stephan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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Peoples H, Pedersen LF, Moestrup L. Creating a meaningful everyday life: Perceptions of relatives of people with dementia and healthcare professionals in the context of a Danish dementia village. DEMENTIA 2018; 19:2314-2331. [PMID: 30582716 DOI: 10.1177/1471301218820480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The world's aging population contributes to an increase in people living with dementia, which is perceived as one of the main causes of disability and dependency for older people. The first dementia village in Denmark was established in 2015, with the intention of providing a safe and meaningful everyday life for people with dementia. The purpose of the study was to explore the way in which relatives of people with dementia and healthcare professionals create and maintain a meaningful everyday life for the residents in a Danish dementia village. METHODS A methodology for user involvement in public service development and evaluation called 'The BIKVA methodology' was used followed by a thematic analysis. A purposive sample of 32 participants took part in the study. RESULTS The analysis revealed one main theme, 'Enabling a familiar and meaningful everyday life in the dementia village', with three corresponding subthemes, reflecting the way in which relatives of people with dementia and healthcare professionals create and maintain a meaningful everyday life for the residents in a Danish dementia village. CONCLUSION The findings showed that relatives of people with dementia and healthcare professionals were committed to creating and maintaining a meaningful everyday life for the residents, but also revealed different understandings of when, where, and how this could be understood and best be achieved. Furthermore, people with advanced dementia may not be able to benefit from the activities and possibilities provided by the dementia village, since this required resources beyond what could be provided.
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Affiliation(s)
- Hanne Peoples
- Faculty of Health Sciences, Health Sciences Research Centre, UCL and University College, Odense, Denmark
| | | | - Lene Moestrup
- Faculty of Health Sciences, Health Sciences Research Centre, UCL and University College, Odense, Denmark; Nursing Education, UCL and University College, Svendborg, Denmark
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Williams A, Sera L, McPherson ML. Anticholinergic Burden in Hospice Patients With Dementia. Am J Hosp Palliat Care 2018; 36:222-227. [PMID: 30213190 DOI: 10.1177/1049909118800281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND End-of-life (EOL) patients with dementia have an increased risk for anticholinergic toxicities due to age-related pharmacokinetic and physiologic changes in conjunction with an increased susceptibility to drug-induced cognitive impairments. Despite this well-documented risk, the use of drugs with anticholinergic properties (DAPs) remains prevalent in EOL patients with dementia. OBJECTIVE The aims of this study were to describe prescribing patterns and characterize anticholinergic burden among hospice patients with dementia, as measured by the Anticholinergic Cognitive Burden (ACB) scale. METHODS This was a retrospective review of a national hospice patient information database. Patients included were admitted on January 1, 2016, discharged by death by December 31, 2016, and had a primary diagnosis of dementia. Patients' anticholinergic burden was calculated using ACB scores. RESULTS A total of 1283 patients met the inclusion criteria. Of those, 37.1% (n = 476) were prescribed at least 1 DAP. Specifically, 28.9% (n = 371) were prescribed 1 DAP, 6.6% (n = 84) were prescribed 2 DAPs, 1.6% (n = 20) were prescribed 3 DAPs, and 0.08% (n = 1) were prescribed 4 DAPs. The majority of patients prescribed a DAP had an ACB score of 3 (n = 359, 75.4%) and an average ACB score of 3.8. The most common DAPs prescribed in patients with an ACB score of 2 or higher were quetiapine (n = 202, 42.4%), atropine (n = 155, 32.6%), hyoscyamine (n = 61, 12.8%), olanzapine (n = 46, 9.6%), and scopolamine (n = 35, 7.4%). CONCLUSION Due to the limited benefit and increased harms with the use of DAPs, providers should aim to maximize nonpharmacologic options. By reducing the use of the top 5 DAPs identified in this study, the quality of life and care for EOL patients with dementia can potentially be improved.
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Affiliation(s)
- Anne Williams
- School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Leah Sera
- School of Pharmacy, University of Maryland, Baltimore, MD, USA
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Deciding upon Transition to Residential Care for Persons Living with Dementia: why Do Iranian Family Caregivers Living in Sweden Cease Caregiving at Home? J Cross Cult Gerontol 2018; 33:21-42. [PMID: 29170865 PMCID: PMC5845599 DOI: 10.1007/s10823-017-9337-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Previous research has shown how filial piety is strong among people of Iranian background and that traditional Iranian culture result in most families' preferring to care for their elderly (and sick) family members at home. While acknowledging this, this article highlights what living in diaspora could mean in terms of cultural adaption and changing family values. By interviewing people with Iranian background living in Sweden (n = 20), whom all have been former primary caregivers to a relative living with dementia, we are able to show how the decision to cease caregiving at home is taken, and what underlying factors form the basis for such decision. Results indicate that although the existence of a Persian profiled dementia care facility is crucial in the making of the decision, it is the feeling of 'sheer exhaustion' that is the main factor for ceasing care at home. And, we argue, the ability to make such a decision based upon 'being too tired' must be understood in relation to transition processes and changes in lifestyle having an affect upon cultural values in relation to filial piety. Because, at the same time the changes on cultural values might not change accordingly among the elderly who are the ones moving into residential care, resulting in them quite often being left out of the actual decision.
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Sakata N, Okumura Y. Thyroid function tests before prescribing anti-dementia drugs: a retrospective observational study. Clin Interv Aging 2018; 13:1219-1223. [PMID: 30013333 PMCID: PMC6038886 DOI: 10.2147/cia.s168182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Treatable causes of cognitive dysfunction, such as hypothyroidism, should be excluded by physicians before prescribing anti-dementia drugs. Many clinical guidelines for dementia recommend a thyroid function test (TFT) as one of the standard screening tests for cognitive dysfunction. This study aimed to investigate the national implementation rate of TFTs during the 365 days before the initiation of anti-dementia drugs. Patients and methods In this retrospective observational study, using Japan’s nationwide claim database, we enrolled ≥65-year-old patients who were newly prescribed anti-dementia drugs between April 2015 and March 2016. The outcome of this study was the implementation of TFTs in the 365 days prior to the index date. We used demographic data, including age, sex, comorbidities, home-based/institutional care, and provider type, as covariates. Results We identified 262,279 patients newly prescribed anti-dementia drugs; of these, only 32.6% underwent TFTs before the initiation of anti-dementia drug treatment. Patients treated in dementia care centers were twice as likely to undergo TFTs as those treated in clinics (57% vs 26%; adjusted risk ratio: 2.17; 95% confidence interval: 2.01–2.33). Conclusion In Japan, patients with dementia often do not undergo TFTs before being prescribed anti-dementia drugs, particularly in a primary care setting. This suggests that the practice of screening treatable cognitive dysfunction should be audited.
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Affiliation(s)
- Nobuo Sakata
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan,
| | - Yasuyuki Okumura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan, .,Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan,
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Case-finding in clinical practice: An appropriate strategy for dementia identification? ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:288-296. [PMID: 30090849 PMCID: PMC6077836 DOI: 10.1016/j.trci.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Earlier diagnosis of dementia is increasingly being recognized as a public health priority. As screening is not generally recommended, case-finding in clinical practice is encouraged as an alternative dementia identification strategy. The approaches of screening and case-finding are often confused, with uncertainty about what case-finding should involve and under what circumstances it is appropriate. We propose a formal definition of dementia case-finding with a clear distinction from screening. We critically examine case-finding policy and practice and propose evidence requirements for implementation in clinical practice. Finally, we present a case-finding pathway and discuss the available evidence for best practice at each stage, with recommendations for research and practice. In conclusion, dementia case-finding is a promising strategy but currently not appropriate due to the substantial gaps in the evidence base for several components of this approach. A formal definition of dementia case-finding is proposed. There is currently insufficient evidence to support dementia case-finding. The appropriate criteria for targeting high-risk patient groups are currently unknown.
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Heckman GA, Franco BB, Lee L, Hillier L, Boscart V, Stolee P, Crutchlow L, Dubin JA, Molnar F, Seitz D. Towards Consensus on Essential Components of Physical Examination in Primary Care-based Memory Clinics. Can Geriatr J 2018; 21:143-151. [PMID: 29977429 PMCID: PMC6028174 DOI: 10.5770/cgj.21.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Primary care-based memory clinics were established to meet the needs of persons with memory concerns. We aimed to identify: 1) physical examination maneuvers required to assess persons with possible dementia in specialist-supported primary care-based memory clinics, and 2) the best-suited clinicians to perform these maneuvers in this setting. Methods We distributed in-person and online surveys of clinicians in a network of 67 primary care-based memory clinics in Ontario, Canada. Results 90 surveys were completed for an overall response rate of 66.7%. Assessments of vital signs, gait, and for features of Parkinsonism were identified as essential by most respondents. There was little consensus on which clinician should be responsible for specific physical examination maneuvers. Conclusions While we identified specific physical examination maneuvers deemed by providers to be both necessary and feasible to perform in the context of primary care-based memory clinics, further research is needed to clarify interprofessional roles related to the examination.
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Affiliation(s)
- George A Heckman
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo
| | - Bryan B Franco
- School of Public Health and Health Systems, University of Waterloo, Waterloo
| | - Linda Lee
- Department of Family Medicine, McMaster University, Hamilton
| | - Loretta Hillier
- Specialized Geriatric Services, St. Joseph's Health Care London and Parkwood Institute, London
| | - Veronique Boscart
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo.,School of Health & Life Sciences and Community Services, Conestoga College, Kitchener
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo
| | | | - Joel A Dubin
- Department of Statistics and Actuarial Science, School of Public Health and Health Systems, University of Waterloo, Waterloo
| | - Frank Molnar
- Department of Medicine, University of Ottawa.,Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyere Research Institute, Ottawa, Canada
| | - Dallas Seitz
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Bohlken J, Jacob L, van den Bussche H, Kostev K. The Influence of Polypharmacy on the Initiation of Anti-Dementia Therapy in Germany. J Alzheimers Dis 2018; 64:827-833. [PMID: 29889071 DOI: 10.3233/jad-180382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin, Germany
| | - Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
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Tsukada T, Sato I, Matsuoka N, Imai T, Doi Y, Arai M, Fujii Y, Matsunaga T, Kawakami K. Prescription of Antidementia Drugs and Antipsychotics for Elderly Patients in Japan: A Descriptive Study Using Pharmacy Prescription Data. J Geriatr Psychiatry Neurol 2018; 31:194-202. [PMID: 30016896 DOI: 10.1177/0891988718785775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antipsychotics are commonly used for managing behavioral and psychological symptoms of dementia among elderly patients with dementia receiving antidementia drugs (ADDs). However, the use of antipsychotics among these patients has not been investigated since 3 ADDs were approved in 2011 in Japan. METHOD We conducted a descriptive study using pharmacy prescription data and identified patients aged ≥65 years who were newly prescribed donepezil, memantine, rivastigmine, and galantamine between January 1, 2012, and September 30, 2014. We determined the proportion of antipsychotic prescription and the factors affecting antipsychotic prescription using multivariable Cox proportional hazard models. RESULT Of 13 876 patients, 1705 were memantine users, and the proportion of antipsychotic prescription among them was the highest (11.1%). Adjusted hazard ratios for donepezil, rivastigmine, and galantamine were 0.66, 0.56, and 0.66, respectively, relative to that for memantine. CONCLUSION Compared to other ADD users, new memantine users were most likely to be prescribed antipsychotics.
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Affiliation(s)
- Takahisa Tsukada
- 1 Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Izumi Sato
- 1 Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,2 The Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan
| | | | - Takumi Imai
- 4 Department of Clinical Biostatistics, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Yuko Doi
- 5 Ain Holdings Inc, Sapporo, Hokkaido, Japan
| | | | | | | | - Koji Kawakami
- 1 Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Piers R, Albers G, Gilissen J, De Lepeleire J, Steyaert J, Van Mechelen W, Steeman E, Dillen L, Vanden Berghe P, Van den Block L. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care 2018; 17:88. [PMID: 29933758 PMCID: PMC6014017 DOI: 10.1186/s12904-018-0332-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual’s preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Methods Following the Belgian Centre for Evidence-Based Medicine’s procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Results Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. Conclusion No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.
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Affiliation(s)
- Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Gwenda Albers
- Flanders Federation for Palliative Care, Vilvoorde, Belgium
| | - Joni Gilissen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Jan Steyaert
- Department of Sociology, University of Antwerp, Antwerp, Belgium.,Flemish Expertise Centre on Dementia Care, Antwerp, Belgium
| | - Wouter Van Mechelen
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Els Steeman
- Academic Centre for Nursing and Midwifery, KULeuven, Leuven, Belgium
| | - Let Dillen
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
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Organizational and environmental factors associated with transfers of nursing home residents to emergency departments. Eur Geriatr Med 2018; 9:339-346. [PMID: 34654246 DOI: 10.1007/s41999-018-0059-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND/OBJECTIVES The emergency department transfer (EDT) rate of residents from nursing homes (NHs) to emergency departments is an important public health issue. The purpose of this study was to examine whether organizational and geographical factors were associated with EDT among older adults living in NHs. DESIGN Retrospective analysis using information from patients' medical charts regarding hospitalization in the last 12 months. Information came from the baseline data of the IQUARE clinical trial. PARTICIPANTS 5926 residents (86.0 years old, standard deviation, SD = 2.9), from 175 NHs with available data on EDT. OUTCOME MEASURE The EDT rate was estimated for each NH, from the number of residents who were transferred to an emergency department (one transfer or more) in the previous 12 months. RESULTS 1119 (18.9%, SD = 11.5) residents were transferred to an emergency department at least once during the past year. In adjusted multiple linear regression, NHs located in rural areas had an EDT rate significantly lower than those in urban areas (confidence interval, 95% CI - 10.15, - 2.16, p = 0.003), with an absolute EDT rate of 16.4% (SD = 9.1) versus 20.4% (SD = 12.5); pharmacy for internal use was significantly associated with a lower EDT rate compared with the NHs with no PUI [11.9% (SD = 9.2); 19.1% (SD = 10.1), 95% CI - 16.33, - 3.09, p = 0.004] and the implementation of a personalized care project in NHs was significantly associated with a lower EDT rate [18.6% (SD = 11.4), 22.4% (SD = 12.4), 95% CI - 11.67, - 0.63, p = 0.03]. CONCLUSION Our study suggests that a structured plan of care, a strategy to improve medication and being located in rural areas reduce the EDT rate in NH residents. IQUARE STUDY TRIAL REGISTRATION NUMBER NCT01703689.
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Di Pucchio A, Vanacore N, Marzolini F, Lacorte E, Di Fiandra T, Gasparini M. Use of neuropsychological tests for the diagnosis of dementia: a survey of Italian memory clinics. BMJ Open 2018; 8:e017847. [PMID: 29599390 PMCID: PMC5875680 DOI: 10.1136/bmjopen-2017-017847] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 11/04/2022] Open
Abstract
AIM Providing an overview of the neuropsychological tests used in Italian memory clinics (defined as Centers for Cognitive Disorders and Dementias-CCDD in Italy) for the diagnosis of cognitive disorders and dementias. METHODS A total of 501 CCDD, out of all 536 active CCDD, were surveyed between February 2014 and August 2015 to verify the characteristics of the centres who performed a comprehensive neuropsychological assessment (NPA), defined as the administration of at least one test for verbal and visual episodic memory, attention, constructional praxis, verbal fluency and executive functions (minimum core tests-MCTs), as part of the diagnostic process. RESULTS A total of 45.7% of Italian CCDD performed a comprehensive MCT as part of the diagnostic process. The logistic regression model showed that the probability of including at least one psychologist in the team was higher in the CCDD that reported using a comprehensive NPA (OR 4.55; 95% CI 2.92 to 7.1), that CCDD in Southern Italy had a lower probability of using an MCT (OR 0.56; 95% CI 0.35 to 0.89) and that the use of an MCT was higher in university/Institute for Scientific Research and Healthcare CCDD (OR 10.97; 95% CI 3.85 to 31.25). CONCLUSION Almost half of the CCDD administered a set of MCTs; while the remaining centres only performed few tests or screening procedures. The neuropsychological tests used in Italian CCDD were comparable with those used in other European countries. Performing a comprehensive NPA remains the best way to assess and monitor cognitive deficits over time, thus further debate on the current status of NPAs in clinical practice is needed.
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Affiliation(s)
- Alessandra Di Pucchio
- National Centre for Disease Prevention and Health Promotion, National Institutes of Health, Rome, Italy
| | - Nicola Vanacore
- National Centre for Disease Prevention and Health Promotion, National Institutes of Health, Rome, Italy
| | - Fabrizio Marzolini
- National Centre for Disease Prevention and Health Promotion, National Institutes of Health, Rome, Italy
| | - Eleonora Lacorte
- National Centre for Disease Prevention and Health Promotion, National Institutes of Health, Rome, Italy
| | | | | | - Marina Gasparini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
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73
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Möhler R, Renom A, Renom H, Meyer G. Personally tailored activities for improving psychosocial outcomes for people with dementia in long-term care. Cochrane Database Syst Rev 2018; 2:CD009812. [PMID: 29438597 PMCID: PMC6491165 DOI: 10.1002/14651858.cd009812.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. Offering them activities which are tailored to their individual interests and preferences might improve their quality of life and reduce challenging behaviour. OBJECTIVES ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities.∙ To describe the components of the interventions.∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 16 June 2017 using the terms: personally tailored OR individualized OR individualised OR individual OR person-centred OR meaningful OR personhood OR involvement OR engagement OR engaging OR identity. We also performed additional searches in MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science (ISI Web of Science), ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up to date and as comprehensive as possible. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interests in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS Two authors independently checked the articles for inclusion, extracted data and assessed the methodological quality of included studies. For all studies, we assessed the risk of selection bias, performance bias, attrition bias and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS We included eight studies with 957 participants. The mean age of participants in the studies ranged from 78 to 88 years and in seven studies the mean MMSE score was 12 or lower. Seven studies were randomised controlled trials (three individually randomised, parallel group studies, one individually randomised cross-over study and three cluster-randomised trials) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, two studies an active control intervention (activities which were not personally tailored) and one study included both an active control and usual care. Personally tailored activities were mainly delivered directly to the participants; in one study the nursing staff were trained to deliver the activities. The selection of activities was based on different theoretical models but the activities did not vary substantially.We found low-quality evidence indicating that personally tailored activities may slightly improve challenging behaviour (standardised mean difference (SMD) -0.21, 95% confidence interval (CI) -0.49 to 0.08; I² = 50%; 6 studies; 439 participants). We also found low-quality evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). There was very little evidence related to our other primary outcome of quality of life, which was assessed in only one study. From this study, we found that quality of life rated by proxies was slightly worse in the group receiving personally tailored activities (moderate-quality evidence, mean difference (MD) -1.93, 95% CI -3.63 to -0.23; 139 participants). Self-rated quality of life was only available for a small number of participants, and there was little or no difference between personally tailored activities and usual care on this outcome (low-quality evidence, MD 0.26, 95% CI -3.04 to 3.56; 42 participants). We found low-quality evidence that personally tailored activities may make little or no difference to negative affect (SMD -0.02, 95% CI -0.19 to 0.14; I² = 0%; 6 studies; 589 participants). We found very low quality evidence and are therefore very uncertain whether personally tailored activities have any effect on positive affect (SMD 0.88, 95% CI 0.43 to 1.32; I² = 80%; 6 studies; 498 participants); or mood (SMD -0.02, 95% CI -0.27 to 0.23; I² = 0%; 3 studies; 247 participants). We were not able to undertake a meta-analysis for engagement and the sleep-related outcomes. We found very low quality evidence and are therefore very uncertain whether personally tailored activities improve engagement or sleep-related outcomes (176 and 139 participants, respectively). Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects persisted only during the delivery of the activities. Two studies reported information about adverse effects and no adverse effects were observed. AUTHORS' CONCLUSIONS Offering personally tailored activities to people with dementia in long-term care may slightly improve challenging behaviour. Evidence from one study suggested that it was probably associated with a slight reduction in the quality of life rated by proxies, but may have little or no effect on self-rated quality of life. We acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities may have little or no effect on negative affect and we are uncertain whether they improve positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one specific theoretical model rather than another. Our findings leave us unable to make recommendations about specific activities or the frequency and duration of delivery. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
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Affiliation(s)
- Ralph Möhler
- Medical Center, Faculty of Medicine, University of FreiburgInstitute for Evidence in Medicine (for Cochrane Germany Foundation)Breisacher Str. 153FreiburgGermany79110
| | - Anna Renom
- Parc de Salut MarDepartment of GeriatricsCarrer Llull, 410BarcelonaSpain08019
| | - Helena Renom
- Hospital de la Santa Creu i Sant PauPhysical Medicine and Rehabilitation (MFRHB)Carrer Sant Antoni Maria Claret, 167BarcelonaBarcelonaSpain08025
| | - Gabriele Meyer
- Martin Luther University Halle‐WittenbergInstitute of Health and Nursing SciencesMagdeburger Straße 8Halle (Saale)Germany06112
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Renn BN, Asghar-Ali AA, Thielke S, Catic A, Martini SR, Mitchell BG, Kunik ME. A Systematic Review of Practice Guidelines and Recommendations for Discontinuation of Cholinesterase Inhibitors in Dementia. Am J Geriatr Psychiatry 2018; 26:134-147. [PMID: 29167065 PMCID: PMC5817050 DOI: 10.1016/j.jagp.2017.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 01/08/2023]
Abstract
Cholinesterase inhibitors (ChEIs) are the primary pharmacological treatment for symptom management of Alzheimer disease (AD), but they carry known risks during long-term use, and do not guarantee clinical effects over time. The balance of risks and benefits may warrant discontinuation at different points during the disease course. Indeed, although there is limited scientific study of deprescribing ChEIs, clinicians routinely face practical decisions about whether to continue or stop medications. This review examined published practice recommendations for discontinuation of ChEIs in AD. To characterize the scientific basis for recommendations, we first summarized randomized controlled trials of ChEI discontinuation. We then identified practice guidelines by professional societies and in textbooks and classified them according to 1) whether they made a recommendation about discontinuation, 2) what the recommendation was, and 3) the proposed grounds for discontinuation. There was no consensus in guidelines and textbooks about discontinuation. Most recommended individualized discontinuation decisions, but there was essentially no agreement about what findings or situations would warrant discontinuation, or even about what domains to consider in this process. The only relevant domain identified by most guidelines and textbooks was a lack of response or a loss of effectiveness, both of which can be difficult to ascertain in the course of a progressive condition. Well-designed, long-term studies of discontinuation have not been conducted; such evidence is needed to provide a scientific basis for practice guidelines. It seems reasonable to apply an individualized approach to discontinuation while engaging patients and families in treatment decisions. .
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Affiliation(s)
- Brenna N Renn
- Veterans Affairs HSR&D Houston Center of Innovation, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Ali Abbas Asghar-Ali
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Veterans Affairs Puget Sound Health Care System, Seattle, WA
| | - Angela Catic
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine-Section of Geriatrics, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX
| | - Sharyl R Martini
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Neurology, Baylor College of Medicine, Houston, TX
| | - Brian G Mitchell
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Mark E Kunik
- Veterans Affairs HSR&D Houston Center of Innovation, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; Department of Medicine-Section of Health Services Research, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Houston, TX.
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75
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Molony SL, Kolanowski A, Van Haitsma K, Rooney KE. Person-Centered Assessment and Care Planning. THE GERONTOLOGIST 2018; 58:S32-S47. [DOI: 10.1093/geront/gnx173] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 11/13/2022] Open
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76
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A preclinical screen to evaluate pharmacotherapies for the treatment of agitation in dementia. Behav Pharmacol 2018; 28:199-206. [PMID: 28234659 DOI: 10.1097/fbp.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Agitation associated with dementia is frequently reported clinically but has received little attention in preclinical models of dementia. The current study used a 7PA2 CM intracerebroventricular injection model of Alzheimer's disease (AD) to assess acute memory impairment, and a bilateral intrahippocampal (IH) injection model of AD (aggregated Aβ1-42 injections) and a bilateral IH injection model of dementia with Lewy bodies (aggregated NAC61-95 injections) to assess chronic memory impairment in the rat. An alternating-lever cyclic-ratio schedule of operant responding was used for data collection, where incorrect lever perseverations measured executive function (memory) and running response rates (RRR) measured behavioral output (agitation). The results indicate that bilateral IH injections of Aβ1-42 and bilateral IH injections of NAC61-95 decreased memory function and increased RRRs, whereas intracerebroventricular injections of 7PA2 CM decreased memory function but did not increase RRRs. These findings show that using the aggregated peptide IH injection models of dementia to induce chronic neurotoxicity, memory decline was accompanied by elevated behavioral output. This demonstrates that IH peptide injection models of dementia provide a preclinical screen for pharmacological interventions used in the treatment of increased behavioral output (agitation), which also establish detrimental side effects on memory.
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Affiliation(s)
- HyunChul Youn
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Korea University Research Institute of Mental Health, Seoul, Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Korea University Research Institute of Mental Health, Seoul, Korea
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78
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Gilbert J, Ward L, Gwinner K. Quality nursing care in dementia specific care units: A scoping review. DEMENTIA 2017; 18:2140-2157. [DOI: 10.1177/1471301217743815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit. Design and methods Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Findings: Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design ( n = 1), focus group interviews ( n = 1), cross sectional survey ( n = 6), semi structured interviews ( n = 3), narrative review ( n = 1), survey ( n = 2), literature review ( n = 3), systematic review ( n = 1), and prospective longitudinal cohort study ( n = 2). Conclusions The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes quality nursing care in dementia specific care units is recommended.
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Affiliation(s)
- Julia Gilbert
- School of Nursing and Midwifery, Federation University, Australia
| | - Louise Ward
- Mental Health Nursing, La Trobe University, Australia
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79
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Wong CW. Pharmacotherapy for Dementia: A Practical Approach to the Use of Cholinesterase Inhibitors and Memantine. Drugs Aging 2017; 33:451-60. [PMID: 27154396 DOI: 10.1007/s40266-016-0372-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cholinesterase inhibitors and memantine are the only classes of drugs approved for the treatment of dementia due to Alzheimer's disease. This article provides evidence-based recommendations to address the issues regarding the use of cholinesterase inhibitors and memantine in clinical practice. It includes their efficacy, timing, assessment, use in institutionalized patients, combined use, and use in other dementia types. However, most of the studies are of short duration (<1 year) and are mainly focused on cognitive and global improvement, whereas the practical issue of their use in daily practice such as optimal duration of treatment, long-term efficacy and delaying institutionalization are limited.
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Affiliation(s)
- Chit Wai Wong
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong, China.
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80
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Turró-Garriga O, Calvó-Perxas L, Vilalta-Franch J, Hernández-Ferrándiz M, Flaqué M, Linares M, Cullell M, Gich J, Casas I, Perkal H, Garre-Olmo J. Adherence to Clinical Practice Guidelines during Dementia Work-Up in a Real-World Setting: A Study from the Registry of Dementias of Girona. J Alzheimers Dis 2017; 59:997-1007. [PMID: 28697570 DOI: 10.3233/jad-170284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There are several position statements and clinical practice guidelines (CPG) for diagnosing dementia. OBJECTIVE Our aims were to evaluate the adherence to CPG among specialists in the 7 memory clinics included in the Registry of Dementias of Girona (ReDeGi), and to compare the results between 2007-2011 and 2012-2015. We also determined the time and number of visits required to achieve a diagnosis, the supplementary tests ordered, and the drugs prescribed according to dementia subtypes. METHODS Medical charts of a stratified random sample of 475 ReDeGi cases were reviewed. Basic dementia work-up was evaluated using as a reference evidence-based CPG. An Index of Adherence (AI) was calculated using the following items in the medical chart: cognitive symptomatology; functional disability evaluation; physical examination; neurological examination; psychiatric examination; brief cognitive examination; activities of daily living performance examination; blood test; structural neuroimaging (CT-scan or MRI). RESULTS The mean AI to CPG among specialists was of 8.2 points, and it improved from 7.9 points in 2007-2011 to 8.5 points in 2012-2015 (Cohen's d = 0.46). A lower adherence was detected in the most severe cases. A dementia diagnosis required 3.5 visits, regardless of the subtype of dementia, although milder cases required more time, more visits, and more supplementary tests than severe cases. CONCLUSION The adherence to CPG in the catchment area of the ReDeGi is high, and an epidemiological surveillance system such as the ReDeGi may help in improving it. Dementia guidelines should establish procedures adapted to clinical practice, with simplified recommendations for most severe cases.
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Affiliation(s)
- Oriol Turró-Garriga
- Girona Biomedical Research Institute (IDIBGI), Salt, Girona, Spain.,Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain
| | | | - Joan Vilalta-Franch
- Girona Biomedical Research Institute (IDIBGI), Salt, Girona, Spain.,Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain.,Department of Medicine, University of Girona, Spain
| | | | | | - Marta Linares
- Department of Neurology, Hospital d'Olot, Olot, Spain
| | - Marta Cullell
- Neurology Unit, Hospital de Figueres, Figueres, Spain
| | - Jordi Gich
- Neurodegenerative Disease Unit, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Isabel Casas
- Department of Neurology, Hospital de Campdevánol, Campdevánol, Spain
| | - Héctor Perkal
- Department of Geriatrics and Neurology, Hospital de Blanes, Blanes, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGI), Salt, Girona, Spain.,Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain.,Department of Medicine, University of Girona, Spain
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81
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Lin VYW, Chung J, Callahan BL, Smith L, Gritters N, Chen JM, Black SE, Masellis M. Development of cognitive screening test for the severely hearing impaired: Hearing-impaired MoCA. Laryngoscope 2017; 127 Suppl 1:S4-S11. [PMID: 28409842 DOI: 10.1002/lary.26590] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To develop a version of the Montreal Cognitive Assessment (MoCA) to be administered to the severely hearing impaired (HI-MoCA), and to assess its performance in two groups of cognitively intact adults over the age of 60. STUDY TYPE Test development followed by prospective subject recruitment. METHODS The MoCA was converted into a timed PowerPoint (Microsoft Corp., Redmond, WA) presentation, and verbal instructions were converted into visual instructions. Two groups of subjects over the age of 60 were recruited. All subjects passed screening questionnaires to eliminate those with undiagnosed mild cognitive impairment. The first group had normal hearing (group 1). The second group was severely hearing impaired (group 2). Group 1 received either the MoCA or HI-MoCA test (T1). Six months later (T2), subjects were administered the test (MoCA or HI-MoCA) they had not received previously to determine equivalency. Group 2 received the HI-MoCA at T1 and again at T2 to determine test-retest reliability. RESULTS One hundred and three subjects were recruited into group 1, with a score of 26.66 (HI-MoCA) versus 27.14 (MoCA). This was significant (P < 0.05), but scoring uses whole numerals and the 0.48 difference was found not clinically significant using post hoc sensitivity analyses. Forty-nine subjects were recruited into group 2. They scored 26.18 and 26.49 (HI-MoCA at T1 and T2). No significance was noted (P > 0.05), with a test-retest coefficient of 0.66. CONCLUSION The HI-MoCA is easy to administer and reliable for screening cognitive impairment in the severely hearing impaired. No conversion factor is required in our prospectively tested cohort of cognitively intact subjects. LEVEL OF EVIDENCE 1b. Laryngoscope, 127:S4-S11, 2017.
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Affiliation(s)
- Vincent Y W Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Janet Chung
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brandy L Callahan
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Leah Smith
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nils Gritters
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Joseph M Chen
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mario Masellis
- Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Durepos P, Wickson-Griffiths A, Hazzan AA, Kaasalainen S, Vastis V, Battistella L, Papaioannou A. Assessing Palliative Care Content in Dementia Care Guidelines: A Systematic Review. J Pain Symptom Manage 2017; 53:804-813. [PMID: 28063859 DOI: 10.1016/j.jpainsymman.2016.10.368] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/18/2016] [Accepted: 10/30/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Families of persons with dementia continue to report unmet needs during end of life (EOL). Strategies to improve care and quality of life for persons with dementia include development of clinical practice guidelines (CPGs) and an integrative palliative approach. OBJECTIVES We aimed to assess palliative care content in dementia CPGs to identify the presence or limitations of recommendations and discussion pertaining to common issues or domains affected by illness as described by the Canadian Hospice Palliative Care Association "Square of Care." DESIGN A systematic review of databases and gray literature was conducted for recent CPGs. Guidelines meeting inclusion criteria were evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument. Quality CPGs were analyzed through organizational template analysis using illness domains described by the "Canadian Hospice Palliative Care Association Model." The study protocol is registered at PROSPERO (CRD 42015025369). RESULTS Eleven CPGs were selected and analyzed from 3779 citations. Nine guidelines demonstrated the maximum level of content regarding physical, psychological, and social care. Conversely, spiritual care was either absent (three) or minimal (three) in CPGs. Six CPGs did not address loss or grief, and seven CPGs did not address or had minimal content regarding EOL care. CONCLUSIONS The lack of content surrounding grief represents a gap for this population at high risk for complicated grief and chronic sorrow. Results of this review require attention by CPG developers and researchers to develop evidence-based recommendations surrounding spiritual care, EOL, and grief.
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Affiliation(s)
- Pamela Durepos
- School of Nursing, McMaster University, Hamilton, Canada.
| | | | - Afeez Abiola Hazzan
- Hamilton Health Sciences, Hamilton, Canada; Geriatric Education and Research in Aging Sciences (GERAS) Centre at McMaster University and Hamilton Health Sciences/St. Peter's Hospital, Hamilton, Canada
| | | | | | - Lisa Battistella
- Hamilton Health Sciences, Hamilton, Canada; Geriatric Education and Research in Aging Sciences (GERAS) Centre at McMaster University and Hamilton Health Sciences/St. Peter's Hospital, Hamilton, Canada
| | - Alexandra Papaioannou
- Hamilton Health Sciences, Hamilton, Canada; Geriatric Education and Research in Aging Sciences (GERAS) Centre at McMaster University and Hamilton Health Sciences/St. Peter's Hospital, Hamilton, Canada
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83
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Garay RP, Grossberg GT. AVP-786 for the treatment of agitation in dementia of the Alzheimer's type. Expert Opin Investig Drugs 2016; 26:121-132. [PMID: 27936965 DOI: 10.1080/13543784.2017.1267726] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Agitation is common and distressing in patients with Alzheimer-type dementia, but safe, effective treatments remain elusive. Psychological treatments are first-line options, but they have limited efficacy. Off-label psychotropic medications are frequently used, but they also have limited effectiveness, and their use may have harmful side effects, including death. Areas covered: This review discusses the history leading to the conception of AVP-786 (deuterated (d6)-dextromethorphan/quinidine), its pharmacokinetic and pharmacodynamic profiles and safety issues, together with an overview of recent clinical trials. Data were found in the medical literature, in US and EU clinical trial registries and in information provided by the manufacturer. Expert opinion: AVP-786 is one of six investigational compounds in recent phase III clinical development for agitation in Alzheimer disease (AD). Quinidine and deuteration appear to prolong dextromethorphan's plasma half-life and facilitate brain penetration. The FDA granted fast-track designation to AVP-786 and allowed use of data generated on dextromethorphan-quinidine (AVP-923, Nuedexta®) for regulatory filings. AVP-923 reduced agitation in AD and was well tolerated in a phase II RCT that included more than 200 patients. A phase III clinical development program of AVP-786 for AD agitation was recently initiated. This program is expected to start generating results in July 2018.
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Affiliation(s)
- Ricardo P Garay
- a Geriatric Psychiatry, Department of Psychiatry and Behavioural Neuroscience , Pharmacology and Therapeutics, Craven , Villemoisson-sur-Orge , France
| | - George T Grossberg
- b Department of Psychiatry and Behavioural Neuroscience , St Louis University School of Medicine , St Louis , MO , USA
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Zhang HF, Huang LB, Zhong YB, Zhou QH, Wang HL, Zheng GQ, Lin Y. An Overview of Systematic Reviews of Ginkgo biloba Extracts for Mild Cognitive Impairment and Dementia. Front Aging Neurosci 2016; 8:276. [PMID: 27999539 PMCID: PMC5138224 DOI: 10.3389/fnagi.2016.00276] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 11/04/2016] [Indexed: 12/21/2022] Open
Abstract
Ginkgo biloba extracts (GBEs) have been recommended to improve cognitive function and to prevent cognitive decline, but earlier evidence was inconclusive. Here, we evaluated all systematic reviews of GBEs for prevention of cognitive decline, and intervention of mild cognitive impairment (MCI) and dementia. Six databases from their inception to September 2015 were searched. Ten systematic reviews were identified, including reviews about Alzheimer's disease (n = 3), about vascular dementia (n = 1), about both Alzheimer's disease and vascular dementia (n = 2), about Alzheimer's disease, vascular dementia and mixed dementia (n = 3), and a review about MCI (n = 1). Based on the overview quality assessment questionnaire, eight studies were scored with at least 5 points, while the other two scored 4 points and 3 points, respectively. Medication with GBEs showed improvement in cognition, neuropsychiatric symptoms, and daily activities, and the effect was dose-dependent. Efficacy was convincingly demonstrated only when high daily dose (240 mg) was applied. Compared with placebo, overall adverse events and serious adverse events were at the same level as placebo, with less adverse events in favor of GBE in the subgroup of Alzheimer's disease patients, and fewer incidences in vertigo, tinnitus, angina pectoris, and headache. In conclusion, there is clear evidence to support the efficacy of GBEs for MCI and dementia, whereas the question on efficacy to prevent cognitive decline is still open. In addition, GBEs seem to be generally safe.
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Affiliation(s)
- Hong-Feng Zhang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China
| | - Li-Bo Huang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China
| | - Yan-Biao Zhong
- Department of Rehabilitation, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China
| | - Qi-Hui Zhou
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China
| | - Hui-Lin Wang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China
| | - Guo-Qing Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China
| | - Yan Lin
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University Wenzhou, China
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John SE, Gurnani AS, Bussell C, Saurman JL, Griffin JW, Gavett BE. The effectiveness and unique contribution of neuropsychological tests and the δ latent phenotype in the differential diagnosis of dementia in the uniform data set. Neuropsychology 2016; 30:946-960. [PMID: 27797542 PMCID: PMC5130291 DOI: 10.1037/neu0000315] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Two main approaches to the interpretation of cognitive test performance have been utilized for the characterization of disease: evaluating shared variance across tests, as with measures of severity, and evaluating the unique variance across tests, as with pattern and error analysis. Both methods provide necessary information, but the unique contributions of each are rarely considered. This study compares the 2 approaches on their ability to differentially diagnose with accuracy, while controlling for the influence of other relevant demographic and risk variables. METHOD Archival data requested from the NACC provided clinical diagnostic groups that were paired to 1 another through a genetic matching procedure. For each diagnostic pairing, 2 separate logistic regression models predicting clinical diagnosis were performed and compared on their predictive ability. The shared variance approach was represented through the latent phenotype δ, which served as the lone predictor in 1 set of models. The unique variance approach was represented through raw score values for the 12 neuropsychological test variables comprising δ, which served as the set of predictors in the second group of models. RESULTS Examining the unique patterns of neuropsychological test performance across a battery of tests was the superior method of differentiating between competing diagnoses, and it accounted for 16-30% of the variance in diagnostic decision making. CONCLUSION Implications for clinical practice are discussed, including test selection and interpretation. (PsycINFO Database Record
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Affiliation(s)
- Samantha E John
- Department of Psychology, University of Colorado Colorado Springs
| | - Ashita S Gurnani
- Department of Psychology, University of Colorado Colorado Springs
| | - Cara Bussell
- Department of Psychology, University of Colorado Colorado Springs
| | | | - Jason W Griffin
- Department of Psychology, University of Colorado Colorado Springs
| | - Brandon E Gavett
- Department of Psychology, University of Colorado Colorado Springs
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Garay RP, Citrome L, Grossberg GT, Cavero I, Llorca PM. Investigational drugs for treating agitation in persons with dementia. Expert Opin Investig Drugs 2016; 25:973-83. [PMID: 27232589 DOI: 10.1080/13543784.2016.1193155] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Agitation is common and distressing in persons with dementia, but safe, effective treatments remain elusive. In this review, the authors describe investigational compounds in ongoing or recently completed clinical trials for this indication and provide an opinion on how they may meet current therapeutic needs. AREAS COVERED Phase II and phase III clinical trials for agitation in persons with dementia were searched in US and EU clinical trial registries and in the medical literature for the period January 2013-February 2016 EXPERT OPINION: The authors searches identified 24 recent clinical trials investigating new treatments for agitation in persons with dementia. Candidate drugs in phase III development included the antipsychotic brexpiprazole, the antidepressant citalopram, the novel compound AVP-786 (deuterated-dextromethorphan/quinidine combination) and the cannabinoid nabilone. Of the compounds in phase II clinical trials, ELND005 (scyllo-inositol) is intended to progress into phase III development, based on evidence from a subgroup analysis and biomarker data. After many years without an FDA/EMA (Food and Drug Administration/European Medicines Agency) approved medication to treat agitation in persons with dementia, we may see the arrival of the first approved drug in the near future.
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Affiliation(s)
- Ricardo P Garay
- a Department of Pharmacology and Therapeutics , Craven , Villemoisson-sur-Orge , France
| | - Leslie Citrome
- b Department of Psychiatry and Behavioral Sciences , New York Medical College , Valhalla , NY , USA
| | - George T Grossberg
- c Department of Psychiatry , St Louis University School of Medicine , St Louis , MO , USA
| | - Icilio Cavero
- d Department of Safety Pharmacology , Craven , Villemoisson-sur-Orge , France
| | - Pierre-Michel Llorca
- e Centre Médico-Psychologique B, CHU, Clermont-Ferrand, EA U7280 , Université d'Auvergne , Clermont-Ferrand , France
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[Polarity of the freely formulated MMST sentence and state of health of people with dementia : Results of a cross-sectional study]. Z Gerontol Geriatr 2016; 50:45-51. [PMID: 27169955 DOI: 10.1007/s00391-016-1054-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/14/2016] [Accepted: 02/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The mini-mental status examination (MMSE) includes a task in which participants are asked to write a sentence of their own choice. The emotional tone of the sentence may be related to the emotions of the writer; therefore, it was investigated whether the emotional tone of the sentence in the MMSE written by people with dementia was associated with health-related quality of life and depressive symptoms. MATERIAL AND METHODS A secondary analysis was carried out based on the cross-sectional data of 107 people with dementia included in the "7th framework EU project RightTimePlaceCare". Two raters assessed the emotional tone of the sentence based on a standardized procedure as positive, neutral or negative. The association between the emotional tone of the sentence, health-related quality of life and depressive symptoms was investigated. Health-related quality of life was assessed by the quality of life in Alzheimer's disease questionnaire and depressive symptoms by the Cornell scale for depression in dementia questionnaire. RESULTS The sentences were rated as either positive or neutral in both cases with 42 % and 16 % were judged to have a negative emotional tone. The variance analysis by ANOVA indicated significant differences between the three groups of sentences regarding health-related quality of life of the writer (p = 0.04). The results of the Scheffé test confirmed a significant difference between sentences with a positive and negative tone and the health-related quality of life where people who wrote a sentence with a negative tone showed a lower health-related quality of life (p = 0.043). No significant association was revealed regarding depressive symptoms (p = 0.97). CONCLUSION It remains to be investigated in future studies whether the emotional tone is a reliable indicator of health-related quality of life and depressive symptoms of people with dementia, so that the written MMSE sentence can be used for diagnostic purposes.
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Ide K, Yamada H, Takuma N, Kawasaki Y, Harada S, Nakase J, Ukawa Y, Sagesaka YM. Effects of green tea consumption on cognitive dysfunction in an elderly population: a randomized placebo-controlled study. Nutr J 2016; 15:49. [PMID: 27142448 PMCID: PMC4855797 DOI: 10.1186/s12937-016-0168-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/25/2016] [Indexed: 02/06/2023] Open
Abstract
Background Green tea is a beverage with potential effects on cognitive dysfunction, as indicated by results of experimental studies. However, its effects in humans, especially at real-world (typical) consumption levels, are unclear. Methods A double-blind, randomized controlled study was conducted to assess the effects of green tea consumption on cognitive dysfunction (Mini-Mental State Examination Japanese version (MMSE-J) score <28) in Japan. Participants were randomly allocated to the green tea or placebo group, and consumed either 2 g/day of green tea powder (containing 220.2 mg of catechins) or placebo powder (containing 0.0 mg of catechins), respectively, for 12 months. Cognitive function assessments were performed every 3 months using the MMSE-J and laboratory tests. Results Thirty-three nursing home residents with cognitive dysfunction were enrolled (four men, 29 women; mean age ± SD, 84.8 ± 9.3; mean MMSE-J score ± SD, 15.8 ± 5.4), of whom 27 completed the study. Changes of MMSE-J score after 1 year of green tea consumption were not significantly different compared with that of the placebo group (−0.61 [−2.97, 1.74], least square mean (LSM) difference [95 % CI]; P = 0.59). However, levels of malondialdehyde-modified low-density lipoprotein (U/L), a marker of oxidative stress, was significantly lower in the green tea group (−22.93 [−44.13, −1.73], LSM difference [95 % CI]; P = 0.04). Conclusions Our results suggest that 12 months green tea consumption may not significantly affect cognitive function assessed by MMSE-J, but prevent an increase of oxidative stress in the elderly population. Additional long-term controlled studies are needed to clarify the effects. Trial registration UMIN000011668 Electronic supplementary material The online version of this article (doi:10.1186/s12937-016-0168-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kazuki Ide
- Department of Drug Evaluation & Informatics, Graduate school of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Hiroshi Yamada
- Department of Drug Evaluation & Informatics, Graduate school of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan.
| | - Norikata Takuma
- White Cross Nursing Home, 2-26-1 Suwa-cho, Higashimurayama, Tokyo, 189-0021, Japan
| | - Yohei Kawasaki
- Department of Drug Evaluation & Informatics, Graduate school of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Shohei Harada
- Department of Drug Evaluation & Informatics, Graduate school of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Junpei Nakase
- Central Research Institute, ITO EN, Ltd., 21 Mekami, Makinohara, Shizuoka, 421-0516, Japan
| | - Yuuichi Ukawa
- Central Research Institute, ITO EN, Ltd., 21 Mekami, Makinohara, Shizuoka, 421-0516, Japan
| | - Yuko M Sagesaka
- Central Research Institute, ITO EN, Ltd., 21 Mekami, Makinohara, Shizuoka, 421-0516, Japan
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Jones L, Candy B, Davis S, Elliott M, Gola A, Harrington J, Kupeli N, Lord K, Moore K, Scott S, Vickerstaff V, Omar RZ, King M, Leavey G, Nazareth I, Sampson EL. Development of a model for integrated care at the end of life in advanced dementia: A whole systems UK-wide approach. Palliat Med 2016; 30:279-95. [PMID: 26354388 PMCID: PMC4766969 DOI: 10.1177/0269216315605447] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prevalence of dementia is rising worldwide and many people will die with the disease. Symptoms towards the end of life may be inadequately managed and informal and professional carers poorly supported. There are few evidence-based interventions to improve end-of-life care in advanced dementia. AIM To develop an integrated, whole systems, evidence-based intervention that is pragmatic and feasible to improve end-of-life care for people with advanced dementia and support those close to them. DESIGN A realist-based approach in which qualitative and quantitative data assisted the development of statements. These were incorporated into the RAND/UCLA appropriateness method to achieve consensus on intervention components. Components were mapped to underlying theory of whole systems change and the intervention described in a detailed manual. SETTING/PARTICIPANTS Data were collected from people with dementia, carers and health and social care professionals in England, from expert opinion and existing literature. Professional stakeholders in all four countries of the United Kingdom contributed to the RAND/UCLA appropriateness method process. RESULTS A total of 29 statements were agreed and mapped to individual, group, organisational and economic/political levels of healthcare systems. The resulting main intervention components are as follows: (1) influencing local service organisation through facilitation of integrated multi-disciplinary care, (2) providing training and support for formal and informal carers and (3) influencing local healthcare commissioning and priorities of service providers. CONCLUSION Use of in-depth data, consensus methods and theoretical understanding of the intervention components produced an evidence-based intervention for further testing in end-of-life care in advanced dementia.
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Affiliation(s)
- Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Margaret Elliott
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Anna Gola
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Kathryn Lord
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Sharon Scott
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK St Christopher's Hospice, Sydenham, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK
| | - Rumana Z Omar
- Department of Statistical Science, University College London (UCL), London, UK
| | - Michael King
- Division of Psychiatry, University College London (UCL), London, UK
| | - Gerard Leavey
- The Bamford Centre for Mental Health and Well Being, University of Ulster, Londonderry, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London (UCL), London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London (UCL), London, UK Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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Associations between informal care, disease, and risk factors: A Spanish country-wide population-based study. J Public Health Policy 2016; 37:173-89. [PMID: 26865318 DOI: 10.1057/jphp.2016.3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This population-based study using 2011-2012 Spanish National Health Survey data aimed to measure the impact of disease, health-related habits, and risk factors associated with informal caregiving. We included and matched self-reported informal caregivers [ICs] with controls (1:4) from the same survey. For each outcome, we analyzed associations between ICs and controls using linear regression or logistic regression models. ICs had 3.4 per cent more depression (OR: 1.33, 95 per cent confidence intervals [CI]:1.06, 1.68). ICs had lower social support (95 per cent CI: 1.64, 3.28), they did more housework alone (OR:3.6, 95 per cent CI:2.65, 4.89), and had greater stress (95 per cent CI:0.13, 0.83). Women ICs caring alone had more anxiety than other groups. We found no statistical association between caregivers and worse health-related habits or increased risk factors (less physical activity, smoking, drinking, and cholesterol). Our results provide evidence that health-care professionals and organizations should recognize the importance of caring for those who care.
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91
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Candy B, Elliott M, Moore K, Vickerstaff V, Sampson E, Jones L. UK quality statements on end of life care in dementia: a systematic review of research evidence. BMC Palliat Care 2015; 14:51. [PMID: 26481400 PMCID: PMC4617713 DOI: 10.1186/s12904-015-0047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/08/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Globally, the number of people who die with dementia is increasing. The importance of a palliative approach in the care of people with dementia is recognised and there are national polices to enhance current care. In the UK implementation of these polices is promoted by the National Institute for Health and Care Excellence (NICE) Dementia Quality Standards (QS). Since publication of the QS new care interventions have been developed. AIM To explore critically the current international research evidence on effect available to inform NICE Dementia QS relevant to end of life (EOL) care. DESIGN We used systematic review methods to seek the research evidence for three statements within the Dementia QS. These are those that recommend: (1) a case management approach, (2) discussing and consideration of making a statement about future care (SFC) and (3) a palliative care assessment (PCA). We included evaluative studies of relevant interventions that used a comparative design, such as trials and cohort studies, and measured EOL care outcomes for persons dying with moderate to severe dementia. Our primary outcome of interest was whether the intervention led to a measurable impact on wellbeing for the person with dementia and their family. We assessed included studies for quality using a scale by Higginson and colleagues (2002) for assessment of quality of studies in palliative care, and two authors undertook key review processes. Data sources included Cinahl, Embase, and PsychINFO from 2001 to August 2014. Our search strategy included free text and medical subject headings relevant to population and recommended care. RESULTS We found seven studies evaluating a care intervention; four assessed SFC, three PCA. None assessed case management. Studies were of weak design; all used retrospective data and relied on others for precise record keeping and for accurate recall of events. There was limited overlap in outcome measurements. Overall reported benefits were mixed. CONCLUSIONS Quality statements relevant to EOL care are useful to advance practice however they have a limited evidence base. High quality empirical work is needed to establish that the recommendations in these statements are best practice.
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Affiliation(s)
- Bridget Candy
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Margaret Elliott
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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van den Dungen P, Moll van Charante EP, van de Ven PM, Foppes G, van Campen JPCM, van Marwijk HWJ, van der Horst HE, van Hout HPJ. Dutch family physicians' awareness of cognitive impairment among the elderly. BMC Geriatr 2015; 15:105. [PMID: 26310787 PMCID: PMC4549900 DOI: 10.1186/s12877-015-0105-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dementia is often not formally diagnosed in primary care. To what extent this is due to family physicians' (FPs) watchful waiting, reluctance to diagnose or to their unawareness of the presence of cognitive impairment is unclear. The objective of this study was to assess FPs' awareness of cognitive impairment by comparing their evaluation of the absence or presence of cognitive impairment in older patients without an established diagnosis of dementia, with a reference test of cognitive functioning. In addition, we assessed which patient characteristics were associated with con- and discordance between FPs' evaluation of cognition and results of the reference test. METHODS The design was a nested diagnostic study. FPs (n = 29) of 15 primary care practices classified the cognitive status of all their patients ≥ 65 years of age (n = 7865) into four categories, based on recollection and medical records. All patients categorized as 'possible cognitive impairment or dementia' and a sample of patients categorized as 'no signs of cognitive impairment' randomly selected to match age and gender were offered to receive a reference test of cognitive function (the CAMCOG) to verify the FPs' label. This reference test could yield three outcomes: no cognitive impairment, amnestic mild cognitive impairment (aMCI) or dementia. Reference test results were weighted back to the original samples to provide estimates for the correct categorization of elderly as 'possible cognitive impairment or dementia' (positive predictive value [PPV]) and 'no signs of cognitive impairment' (negative predictive value [NPV]). Cognitive functioning was not assessed for patients evaluated by FPs as 'probable dementia' and 'unknown or no recent contact'. Characteristics associated with the con- or discordance of the FPs' classification and the reference test were assessed using logistic regression. RESULTS Complete reference test results were obtained from 318 elderly. FPs labeled 8.3 % of elderly 'possible cognitive impairment or dementia'. The PPV of this label for a CAMCOG score suggestive of dementia or aMCI was 47.1 % (95 %-confidence interval: 43.5 - 62.4 %). FPs labeled 83.7 % 'no signs of cognitive impairment'. The 1-NPV of this label for a CAMCOG score suggestive of dementia or aMCI was 12.5 % (95 %-CI 8.2 - 16.8 %). FPs labeled 3.6 % as 'probable dementia' and 4.5 % as 'unknown or no recent contact'. The odds that FPs' suspicion of cognitive impairment were confirmed by the CAMCOG were higher if persons were ADL dependent (OR 2.24 [95 %-CI 1.16 - 4.35]). The odds of FPs being unaware of the presence of cognitive impairment were higher in the older elderly (OR 1.15 [95 %-CI 1.09 - 1.23] per year). CONCLUSION Evaluation of FPs' classification of the global cognitive function of elderly without a firm diagnosis of dementia showed both over- and unawareness of the presence of cognitive impairment. FPs were more often unaware of cognitive impairment in the older elderly.
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Affiliation(s)
- Pim van den Dungen
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Eric P Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
| | - Gerbrand Foppes
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Jos P C M van Campen
- Department of Geriatric Medicine, Slotervaart Hospital, Amsterdam, The Netherlands.
| | - Harm W J van Marwijk
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
- Primary Care Research Centre, Institute of Population Health, University of Manchester, Manchester, UK.
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Hein P J van Hout
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
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