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Thangwaritorn S, Lee C, Metchikoff E, Razdan V, Ghafary S, Rivera D, Pinto A, Pemminati S. A Review of Recent Advances in the Management of Alzheimer's Disease. Cureus 2024; 16:e58416. [PMID: 38756263 PMCID: PMC11098549 DOI: 10.7759/cureus.58416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative condition and a form of dementia encountered in medical practice. Despite many proposed and attempted treatments, this disease remains a major puzzle in the public health systems worldwide. The initial part of this article provides an overview and illustration of the primary mechanisms responsible for neuronal damage in AD. Subsequently, it offers a critical evaluation of the most noteworthy studies on pharmacological therapy for AD and outlines recent advancements and novel approaches to managing this condition. Main properties, categorization, Food and Drug Administration (FDA) status, mechanisms of action, benefits, and common side effects of the classical and the most recently proposed pharmacological treatments for AD are described. The conventional pharmacological agents revised comprise cholinesterase inhibitors, monoclonal antibodies, and other therapies, such as memantine, valproic acid, and rosiglitazone. The innovative reviewed pharmacological agents comprise the monoclonal antibodies: donanemab, gantenerumab, solanezumab, bapineuzumab, crenezumab, and semorinemab. Nutritional supplements such as alpha-tocopherol (vitamin E) and caprylidene are also revised. Tau and amyloid-targeting treatments include methylthioninium moiety (MT), leuco-methylthioninium bis (LMTM), an oxidized form of MT, and tramiprosate, which inhibits the beta-amyloid (Aβ) monomer aggregation into toxic oligomers. Antidiabetic and anti-neuroinflammation drugs recently proposed for AD treatment are discussed. The antidiabetic drugs include NE3107, an anti-inflammatory and insulin sensitizer, and the diabetes mainstream drug metformin. The anti-neuroinflammatory AD therapies include the use of sodium oligomannate (GV-971), infusions with intravenous immunoglobulin aiming to decrease plasma levels of the constituents of Aβ plaques, and masitinib, a tyrosine kinase inhibitor that impacts mast and microglia cells. Additional anti-inflammatory agents being currently tested in phase-2 clinical trials, such as atomoxetine (selective norepinephrine reuptake inhibitor), losartan (angiotensin 2 receptor agonist), genistein (anti-inflammatory isoflavone neuroprotective agent), trans-resveratrol (polyphenol antioxidant plant estrogen), and benfotiamine (synthetic thiamine precursor), were reviewed. Lastly, drugs targeting Alzheimer's-associated symptoms, such as brexpiprazole (serotonin dopamine activity modulator) and suvorexant (orexin receptor antagonist), respectively, used for agitation and insomnia in AD patients, are reviewed. As experimental investigations and clinical research progress, there is a possibility that a combination of newly tested medications and traditional ones may emerge as a promising treatment option for AD in the future.
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Affiliation(s)
- Skylynn Thangwaritorn
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Christopher Lee
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Elena Metchikoff
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Vidushi Razdan
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Suliman Ghafary
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Dominic Rivera
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Alvaro Pinto
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
| | - Sudhakar Pemminati
- Department of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA
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Hendrix MRS, Yasar M, Mohammad AK, Hugtenburg JG, Vanhommerig JW, Gündoğan-Yilmaz R, van den Bemt PMLA, Denig P, Karapinar-Carkıt F. Prescription Sequence Symmetry Analysis (PSSA) to assess prescribing cascades: a step-by-step guide. BMC Med Res Methodol 2024; 24:8. [PMID: 38212730 PMCID: PMC10782776 DOI: 10.1186/s12874-023-02108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
Prescribing cascades occur when patients are prescribed medication to treat the adverse drug reaction of previously prescribed medication. Prescription sequence symmetry analysis (PSSA) can be used to assess the association between two medications in prescription or dispensing databases and thus the potential occurrence of prescribing cascades. In this article, a step-by-step guide is presented for conducting PSSA to assess prescribing cascades. We describe considerations for medication data collection and setting time periods for relevant parameters, including washout window, exposure window, continued exposure interval and blackout period. With two examples, we illustrate the impact of changes in these parameters on the strengths of associations observed. Given the impact seen, we recommend that researchers clearly specify and explain all considerations regarding medication included and time windows set when studying prescribing cascades with PSSA, and conduct subgroup and sensitivity analyses.
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Affiliation(s)
- Mandy R S Hendrix
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Mustafa Yasar
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Atiya K Mohammad
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Fatma Karapinar-Carkıt
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center +, Maastricht, the Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
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Shahid F, Doherty A, Wallace E, Schmiedl S, Alexander GC, Dreischulte T. Prescribing cascades in ambulatory care: A structured synthesis of evidence. Pharmacotherapy 2024; 44:87-96. [PMID: 37743815 DOI: 10.1002/phar.2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/04/2023] [Accepted: 06/23/2023] [Indexed: 09/26/2023]
Abstract
The strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by an index drug, has not been well characterized. To perform a structured, systematic, and transparent review of the evidence supporting ambulatory care prescribing cascades. Ninety-four potential prescribing cascades identified through a previously published systematic review. Systematic search of the literature to further characterize prescribing cascades. (1) Grading of evidence based on observational studies investigating associations between index and marker drugs, including: Level I-strong evidence [i.e. multiple high-quality studies]; Level II-moderate evidence [i.e. single high-quality study]; Level III-fair evidence [no high-quality studies but one or more moderate-quality studies]; and Level IV-poor evidence [other]. (2) Listing of the adverse event associated with the index drug in the product's United States Food and Drug Administration (FDA) label. (3) Synthesis of the evidence supporting mechanisms linking index drugs and associated adverse events. Of 99 potential cascades, 94 were supported by one or more confirmatory observational studies and were therefore included in this review. The 94 cascades related to 30 types of adverse drug reactions affecting 10 different anatomic/physiologic systems and were investigated by a total of 88 confirmatory studies, including prescription sequential symmetry analysis (n = 51), cohort (n = 30), and case-control (n = 7) studies. Overall, the evidence from observational studies was strong for 18 (19.1%) prescribing cascades, moderate for 61 (64.9%), fair for 13 (13.8%), and poor for 2 (2.1%). Although the evidence supporting mechanisms that link index drugs and associated adverse events was variable, FDA labels included information about the adverse event associated with the index drug for most (n = 86) but not all of the 94 prescribing cascades. Although we identified 18 of 94 prescribing cascades supported by strong clinical evidence and most adverse events associated with index drugs are included in FDA label, the evidentiary basis for prescribing cascades varies, with many requiring further evidence of clinical relevance.
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Affiliation(s)
- Faiza Shahid
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Ann Doherty
- Department of General Practice, University College Cork, Cork, Ireland
| | - Emma Wallace
- Department of General Practice, University College Cork, Cork, Ireland
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - G Caleb Alexander
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
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Adrien O, Mohammad AK, Hugtenburg JG, McCarthy LM, Priester-Vink S, Visscher R, van den Bemt PMLA, Denig P, Karapinar-Carkıt F. Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review. Drugs Aging 2023; 40:1085-1100. [PMID: 37863868 PMCID: PMC10682291 DOI: 10.1007/s40266-023-01072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND To reduce prescribing cascades occurring in clinical practice, healthcare providers require information on the prescribing cascades they can recognize and prevent. OBJECTIVE This systematic review aims to provide an overview of prescribing cascades, including dose-dependency information and recommendations that healthcare providers can use to prevent or reverse them. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Relevant literature was identified through searches in OVID MEDLINE, OVID Embase, OVID CINAHL, and Cochrane. Additionally, Web of Science and Scopus were consulted to analyze reference lists and citations. Publications in English were included if they analyzed the occurrence of prescribing cascades. Prescribing cascades were included if at least one study demonstrated a significant association and were excluded when the adverse drug reaction could not be confirmed in the Summary of Product Characteristics. Two reviewers independently extracted and grouped similar prescribing cascades. Descriptive summaries were provided regarding dose-dependency analyses and recommendations to prevent or reverse these prescribing cascades. RESULTS A total of 95 publications were included, resulting in 115 prescribing cascades with confirmed adverse drug reactions for which at least one significant association was found. For 52 of these prescribing cascades, information regarding dose dependency or recommendations to prevent or reverse prescribing cascades was found. Dose dependency was analyzed and confirmed for 12 prescribing cascades. For example, antipsychotics that may cause extrapyramidal syndrome followed by anti-parkinson drugs. Recommendations focused on dosage lowering, discontinuing medication, and medication switching. Explicit recommendations regarding alternative options were given for three prescribing cascades. One example was switching to ondansetron or granisetron when extrapyramidal syndrome is experienced using metoclopramide. CONCLUSIONS In total, 115 prescribing cascades were identified and an overview of 52 of them was generated for which recommendations to prevent or reverse them were provided. Nonetheless, information regarding alternative options for managing prescribing cascades was scarce.
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Affiliation(s)
- Oriane Adrien
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Atiya K Mohammad
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | - Lisa M McCarthy
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Leslie Dan Faculty of Pharmacy and Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Robbert Visscher
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fatma Karapinar-Carkıt
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands.
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Saraf U, Batla A, Sakakibara R, Panicker JN. The Impact of Polypharmacy on Management of Lower Urinary Tract Symptoms in Parkinson's Disease. Drugs Aging 2023; 40:909-917. [PMID: 37651023 DOI: 10.1007/s40266-023-01060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
Lower urinary tract (LUT) symptoms are a common presentation of autonomic dysfunction in Parkinson's disease (PD). Symptoms significantly impact quality of life and are associated with worsening of motor symptoms and increased risk for falls. Different medical co-morbidities can often contribute to LUT symptoms, and a thorough evaluation therefore becomes essential. The effects of medications used for Parkinson's disease and other co-existing medical co-morbidities on LUT symptoms is often underestimated. Treatment options include behavioural therapy, oral agents such as antimuscarinic and beta-3 receptor agonist agents, botulinum toxin and neuromodulation. The first-line oral agents cause adverse effects that may exacerbate pre-existing Parkinson's disease-related symptoms. Furthermore, these oral agents can interact with other medications used in Parkinson's disease, and the challenges posed by interactions on pharmacological effects and metabolism are discussed. Knowledge about drug interactions can help in effective management of such patients and mitigate the risks for developing adverse effects.
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Affiliation(s)
- Udit Saraf
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India.
| | - Amit Batla
- Department of Clinical and Movement Neuroscience, Faculty of Brain Science, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
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Doherty AS, Shahid F, Moriarty F, Boland F, Clyne B, Dreischulte T, Fahey T, Kennelly SP, Wallace E. Prescribing cascades in community-dwelling adults: A systematic review. Pharmacol Res Perspect 2022; 10:e01008. [PMID: 36123967 PMCID: PMC9485823 DOI: 10.1002/prp2.1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022] Open
Abstract
The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community-dwelling adults. A systematic review was reported in line with the PRISMA guidelines and pre-registered with PROSPERO. Electronic databases (Medline [Ovid], EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: community-dwelling adults; risk-prescription medication; outcomes-initiation of new medicine to "treat" or reduce ADR risk; study type-cohort, cross-sectional, case-control, and case-series studies. Title/abstract screening, full-text screening, data extraction, and methodological quality assessment were conducted independently in duplicate. A narrative synthesis was conducted. A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11 593 989 participants and 15 studies examined older adults specifically (≥60 years). Seventy-eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic (n = 5), amiodarone to levothyroxine (n = 5), inhaled corticosteroid to topical antifungal (n = 4), antipsychotic to anti-Parkinson drug (n = 4), and acetylcholinesterase inhibitor to urinary incontinence drugs (n = 4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months.
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Affiliation(s)
- Ann S. Doherty
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Faiza Shahid
- Institute of General Practice and Family MedicineUniversity Hospital of Ludwig‐Maximilians‐University MunichMunichGermany
| | - Frank Moriarty
- School of Pharmacy and Biomolecular SciencesRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Fiona Boland
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
- Data Science CentreRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Barbara Clyne
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Tobias Dreischulte
- Institute of General Practice and Family MedicineUniversity Hospital of Ludwig‐Maximilians‐University MunichMunichGermany
| | - Tom Fahey
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Seán P. Kennelly
- Department of Medical GerontologyTrinity College DublinDublin 2Ireland
- Department of Age‐related HealthcareTallaght University HospitalDublin 24Ireland
| | - Emma Wallace
- Department of General PracticeUniversity College CorkCorkIreland
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Siddique YH, Naz F, Rahul, Varshney H. Comparative study of rivastigmine and galantamine on the transgenic Drosophila model of Alzheimer's disease. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2022; 3:100120. [PMID: 35992376 PMCID: PMC9389239 DOI: 10.1016/j.crphar.2022.100120] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/13/2022] Open
Abstract
Alzheimer's Disease (AD) is characterized as a progressive neurodegenerative disease most commonly associated with memory deficits and cognitive decline. The formation of amyloid plaques and neurofibrillary tangles are important pathological markers of AD. The accumulation of amyloid plaques and neurofibrillary tangles leads to the loss of neurons including the cholinergic neurons thus decreasing the levels of acetylcholine (a neurotransmitter). To reduce the AD symptoms cholinesterase inhibitors are widely used to decrease the hydrolysis of acetylcholine released from presynaptic neurons. In the present study we have studied the effect of rivastigmine and galantamine (commonly used cholinesterase inhibitors) on the transgenic Drosophila model of AD expressing human Aβ-42 in the neurons. The effect of similar doses of rivastigmine and galantamine (i.e. 0.1,1 and 10 mM) was studied on the climbing ability, lifespan, oxidative stress markers, caspase 9 and 3, acetylcholinesterase activity and on the formation of Aβ-42 aggregates. The results suggest that the rivastigmine is more potent in reducing the oxidative stress and improving climbing ability of AD flies. Both the drugs were found to be effective in increasing the lifespan of AD flies. Galantamine was found to be a more potent inhibitor of acetylcholinesterase compared to rivastigmine. Galantamine prevents the formation of Aβ-42 aggregates more effectively compared to rivastigmine.
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Affiliation(s)
- Yasir Hasan Siddique
- Drosophila Transgenic Laboratory, Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh-202002, Uttar Pradesh, India
| | - Falaq Naz
- Drosophila Transgenic Laboratory, Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh-202002, Uttar Pradesh, India
| | - Rahul
- Drosophila Transgenic Laboratory, Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh-202002, Uttar Pradesh, India
| | - Himanshi Varshney
- Drosophila Transgenic Laboratory, Section of Genetics, Department of Zoology, Faculty of Life Sciences, Aligarh Muslim University, Aligarh-202002, Uttar Pradesh, India
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Ruangritchankul S, Chantharit P, Srisuma S, Gray LC. Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review. Ther Clin Risk Manag 2021; 17:927-949. [PMID: 34511919 PMCID: PMC8427072 DOI: 10.2147/tcrm.s323387] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022] Open
Abstract
The rising of global geriatric population has contributed to increased prevalence of dementia. Dementia is a neurodegenerative disease, which is characterized by progressive deterioration of cognitive functions, such as judgment, language, memory, attention and visuospatial ability. Dementia not only has profoundly devastating physical and psychological health outcomes, but it also poses a considerable healthcare expenditure and burdens. Acetylcholinesterase inhibitors (AChEIs), or so-called anti-dementia medications, have been developed to delay the progression of neurocognitive disorders and to decrease healthcare needs. AChEIs have been widely prescribed in clinical practice for the treatment of Alzheimer's disease, which account for 70% of dementia. The rising use of AChEIs results in increased adverse drug reactions (ADRs) such as cardiovascular and gastrointestinal adverse effects, resulting from overstimulation of peripheral cholinergic activity and muscarinic receptor activation. Changes in pharmacokinetics (PK), pharmacodynamics (PD) and pharmacogenetics (PGx), and occurrence of drug interactions are said to be major risk factors of ADRs of AChEIs in this population. To date, comprehensive reviews in ADRs of AChEIs have so far been scarcely studied. Therefore, we aimed to recapitulate and update the diverse aspects of AChEIs, including the mechanisms of action, characteristics and risk factors of ADRs, and preventive strategies of their ADRs. The collation of this knowledge is essential to facilitate efforts to reduce ADRs of AChEIs.
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Affiliation(s)
- Sirasa Ruangritchankul
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prawat Chantharit
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sahaphume Srisuma
- Ramathibodi Poison Center and Division of Clinical Pharmacology and Toxicology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Trenaman SC, Bowles SK, Kirkland S, Andrew MK. An examination of three prescribing cascades in a cohort of older adults with dementia. BMC Geriatr 2021; 21:297. [PMID: 33964882 PMCID: PMC8106136 DOI: 10.1186/s12877-021-02246-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prescribing cascades are a source of inappropriate prescribing for older adults with dementia. We aimed to study three prescribing cascades in older Nova Scotians with dementia using administrative databases. METHODS Cohort entry for Nova Scotia Seniors' Pharmacare Program beneficiaries was the date of dementia diagnosis. Prescription drug dispensing data was extracted for inciting medication and second treatment (cholinesterase inhibitor and bladder anticholinergic, metoclopramide and Parkinson's disease medication, or calcium channel blocker (CCB) and diuretic) over the six-year period April 1, 2009 to March 31, 2015. In three separate analyses, dispensing an inciting medication signaled a look back of 365 days from the date of first dispensing to confirm that the second treatment was started after the inciting medication. The prescribing cascade was considered when the second treatment was started within 180 days of the inciting treatment. Sex differences in the prescribing cascade were tested using t-tests or chi square tests as appropriate. Both univariate (unadjusted) and multivariate (adjusted) logistic regression (adjusted for age, rurality, and sex) and Cox proportional hazards regression was used to identify risk factors for the prescribing cascade. RESULTS From March 1, 2005 to March 31, 2015, 28,953 Nova Scotia Seniors' Pharmacare beneficiaries with dementia (NSSPBD) were identified. There were 60 cases of bladder anticholinergics following cholinesterase inhibitors, 11 cases of Parkinson's disease medication following metoclopramide, and 289 cases of a diuretic following CCB in the cohort. Regression analysis demonstrated that risk of bladder anticholinergics following cholinesterase inhibitors and diuretics following CCBs were associated with female sex. Cox regression suggested that bladder anticholinergics were less often used by those on cholinesterase inhibitors and did not identify CCB use as leading more frequently to diuretic use. CONCLUSIONS The combination of diuretics following CCB was the most common prescribing cascade and bladder anticholinergics following cholinesterase inhibitors the second most common. However, exposure to the inciting medications did not increase risk of exposure to the second treatments. Combinations of bladder anticholinergics following cholinesterase inhibitors and diuretics following CCBs were more common for women raising concern that women may be at increased risk of these prescribing cascades.
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Affiliation(s)
- Shanna C Trenaman
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Susan K Bowles
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health, Halifax, Nova Scotia, Canada
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health, Halifax, Nova Scotia, Canada
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Chang CW, Juan YS, Yang YH, Lee HY. The Relationship Between Lower Urinary Tract Symptoms and Severity of Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2021; 36:1533317521992657. [PMID: 33635087 PMCID: PMC10623918 DOI: 10.1177/1533317521992657] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Urinary incontinence (UI) is more prevalent in elderly populations with dementia than those without dementia. Alzheimer's disease (AD) is the most common cause of dementia. Urge UI, the most common type of UI in AD patients, causes more morbidity and mortality. However, it is inconvenient to obtain the report of urodynamic study from AD patient to diagnose urinary incontinence. Nevertheless, it is easier to obtain subjective or objective questionnaires from the patients or the caregivers. The data collected from the questionnaires are used to evaluate if severity of dementia is associated with urge UI and other lower urinary tract symptoms (LUTs). PATIENTS AND METHODS A total of 43 AD patients were enrolled in this study, all of whom were checked post-void residual (PVR) urine amount by sonography after voiding. The severity of dementia was evaluated by questionnaire including Cognitive Abilities Screening Instrument (CASI), Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR), and Clinical Dementia Rating Sub-of-Box (CDR-SB). The LUTs were assessed with International Consultation of Incontinence Questionnaire (ICIQ) and Overactive bladder symptom scores (OABSS) questionnaire. Independent t test and Pearson's correlation analysis were calculated. RESULTS The average age in both AD with/without urge UI patients is 78 years old. The scores of CDR-SB, OABSS and ICIQ are significantly different in these 2 groups (p = 0.023, p = 0.003, p = 0.001; respectively). However, the neurophysiological scores of CASI, MMSE, CDR, CDR-SB is not correlated with OABSS (r = 0.047, p = 0.382; r = 0.074, p = 0.317; r = 0.087, p = 0.288; r = 0.112, p = 0.237; respectively). Interestingly, if we separate each individual symptom of OAB, there is a significant correlation between CDR-SB and urge UI score (r = 0.314, p = 0.023). CONCLUSIONS Higher lower urinary tract symptom scores are noted in AD patients with urge UI. The CDR-SB score is highly correlated with urge UI in AD patients.
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Affiliation(s)
- Che-Wei Chang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yung-Shun Juan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung
| | - Hsiang-Ying Lee
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Mahmoodi BK, Tragante V, Kleber ME, Holmes MV, Schmidt AF, McCubrey RO, Howe LJ, Direk K, Allayee H, Baranova EV, Braund PS, Delgado GE, Eriksson N, Gijsberts CM, Gong Y, Hartiala J, Heydarpour M, Pasterkamp G, Kotti S, Kuukasjärvi P, Lenzini PA, Levin D, Lyytikäinen LP, Muehlschlegel JD, Nelson CP, Nikus K, Pilbrow AP, Tang W, van der Laan SW, van Setten J, Vilmundarson RO, Deanfield J, Deloukas P, Dudbridge F, James S, Mordi IR, Teren A, Bergmeijer TO, Body SC, Bots M, Burkhardt R, Cooper-DeHoff RM, Cresci S, Danchin N, Doughty RN, Grobbee DE, Hagström E, Hazen SL, Held C, Hoefer IE, Hovingh GK, Johnson JA, Kaczor MP, Kähönen M, Klungel OH, Laurikka JO, Lehtimäki T, Maitland-van der Zee AH, McPherson R, Palmer CN, Kraaijeveld AO, Pepine CJ, Sanak M, Sattar N, Scholz M, Simon T, Spertus JA, Stewart AFR, Szczeklik W, Thiery J, Visseren FL, Waltenberger J, Richards AM, Lang CC, Cameron VA, Åkerblom A, Pare G, März W, Samani NJ, Hingorani AD, ten Berg JM, Wallentin L, Asselbergs FW, Patel R. Association of Factor V Leiden With Subsequent Atherothrombotic Events: A GENIUS-CHD Study of Individual Participant Data. Circulation 2020; 142:546-555. [PMID: 32654539 PMCID: PMC7493828 DOI: 10.1161/circulationaha.119.045526] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies examining the role of factor V Leiden among patients at higher risk of atherothrombotic events, such as those with established coronary heart disease (CHD), are lacking. Given that coagulation is involved in the thrombus formation stage on atherosclerotic plaque rupture, we hypothesized that factor V Leiden may be a stronger risk factor for atherothrombotic events in patients with established CHD. METHODS We performed an individual-level meta-analysis including 25 prospective studies (18 cohorts, 3 case-cohorts, 4 randomized trials) from the GENIUS-CHD (Genetics of Subsequent Coronary Heart Disease) consortium involving patients with established CHD at baseline. Participating studies genotyped factor V Leiden status and shared risk estimates for the outcomes of interest using a centrally developed statistical code with harmonized definitions across studies. Cox proportional hazards regression models were used to obtain age- and sex-adjusted estimates. The obtained estimates were pooled using fixed-effect meta-analysis. The primary outcome was composite of myocardial infarction and CHD death. Secondary outcomes included any stroke, ischemic stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality. RESULTS The studies included 69 681 individuals of whom 3190 (4.6%) were either heterozygous or homozygous (n=47) carriers of factor V Leiden. Median follow-up per study ranged from 1.0 to 10.6 years. A total of 20 studies with 61 147 participants and 6849 events contributed to analyses of the primary outcome. Factor V Leiden was not associated with the combined outcome of myocardial infarction and CHD death (hazard ratio, 1.03 [95% CI, 0.92-1.16]; I2=28%; P-heterogeneity=0.12). Subgroup analysis according to baseline characteristics or strata of traditional cardiovascular risk factors did not show relevant differences. Similarly, risk estimates for the secondary outcomes including stroke, coronary revascularization, cardiovascular mortality, and all-cause mortality were also close to identity. CONCLUSIONS Factor V Leiden was not associated with increased risk of subsequent atherothrombotic events and mortality in high-risk participants with established and treated CHD. Routine assessment of factor V Leiden status is unlikely to improve atherothrombotic events risk stratification in this population.
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Affiliation(s)
- Bakhtawar K. Mahmoodi
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
- Division of Hemostasis and Thrombosis, Department of Hematology, UMC Groningen, University of Groningen, Groningen, the Netherlands
| | - Vinicius Tragante
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marcus E. Kleber
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael V. Holmes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, UK
| | - Amand F. Schmidt
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Raymond O. McCubrey
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Laurence J. Howe
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Kenan Direk
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Hooman Allayee
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Ekaterina V. Baranova
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Peter S. Braund
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Graciela E. Delgado
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | | | | | - Yan Gong
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
| | - Jaana Hartiala
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
- Institute for Genetic Medicine, Keck School of Medicine of USC, Los Angeles, CA 90033, USA
| | - Mahyar Heydarpour
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Gerard Pasterkamp
- Department of Clinical Chemistry, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Salma Kotti
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), Paris, France
| | - Pekka Kuukasjärvi
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Arvo Ylpön katu 34, Tampere 33014, Finland
| | - Petra A. Lenzini
- Washington University School of Medicine, Department of Genetics, Statistical Genomics Division, Saint Louis, Missouri, USA
| | - Daniel Levin
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Arvo Ylpön katu 34, Tampere 33014, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Jochen D. Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Christopher P. Nelson
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Kjell Nikus
- Department of Cardiology, Heart Center, Tampere University Hospital, Ensitie 4, 33520 Tampere, Finland
- Department of Cardiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere 33014, Finland
| | - Anna P. Pilbrow
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - W.H.Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institue, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Sander W. van der Laan
- Central Diagnostics Laboratory, Division Laboratories, Pharmacy, and Biomedical Genetics, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jessica van Setten
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ragnar O. Vilmundarson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - John Deanfield
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Panos Deloukas
- William Harvey Research Institute, Barts and the London Medical School, Queen Mary University of London, London, UK
- Centre for Genomic Health, Queen Mary University of London, London, UK
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Stefan James
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Ify R Mordi
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Andrej Teren
- Heart Center Leipzig, Leipzig, Germany
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Thomas O. Bergmeijer
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Simon C. Body
- Department of Anaesthesiology, Boston University School of Medicine, 750 Albany St, Boston, MA 02118, USA
| | - Michiel Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Ralph Burkhardt
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Rhonda M. Cooper-DeHoff
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Sharon Cresci
- Washington University School of Medicine, Department of Genetics, Statistical Genomics Division, Saint Louis, Missouri, USA
- Washington University School of Medicine, Department of Medicine, Cardiovascular Division, Saint Louis, Missouri, USA
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Cardiology, Hôpital Européen Georges Pompidou, 75015 Paris, France; FACT (french Alliance for cardiovascular trials); Université Paris Descartes, Paris, France
- Université Paris-Descartes, Paris, France
| | - Robert N. Doughty
- Heart Health Research Group, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- Uppsala University, Dept of Cardiology, Uppsala, Sweden and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institue, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, and Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Claes Held
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Imo E. Hoefer
- Department of Clinical Chemistry and Hematology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - G. Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Julie A. Johnson
- University of Florida, Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics, 1333 Center Drive, Gainesville, FL 32608, USA
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Marcin P. Kaczor
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, FM1 3rd floor, Tampere 33521, Finland
- Department of Clinical Physiology, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Jari O. Laurikka
- Department of Cardio-Thoracic Surgery, Heart Center, Tampere University Hospital, Arvo Ylpön katu 6, Tampere 33521, Finland
- Department of Cardio-Thoracic Surgery, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Arvo Ylpön katu 34, Tampere 33014, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere 33014, Finland
| | - Anke H. Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Departments of Medicine and Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - Colin N. Palmer
- Pat Macpherson Centre for Pharmacogenetics and Pharmacogenomics, Division of Molecular and Clinical Medicine, Level 5, Mailbox 12, Ninewells Hospital and Medical School, Dundee, UK
| | - Adriaan O. Kraaijeveld
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carl J. Pepine
- College of Medicine, Division of Cardiovascular Medicine, University of Florida, 1600 SW Archer Road/Box 100277, Gainesville, FL 32610, USA
| | - Marek Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Markus Scholz
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (APHP), Department of Clinical Pharmacology, Platform of Clinical Research of East Paris (URCEST-CRCEST-CRB HUEP-UPMC), FACT (French Alliance for Cardiovascular trials); Sorbonne Université, Paris-06, France
- Paris-Sorbonne University, UPMC-Site St Antoine, 27 Rue Chaligny, 75012, Paris, France
| | - John A. Spertus
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, 9th Floor, Kansas City, MO 64111, USA
| | - Alexandre F. R. Stewart
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ontario, Canada
| | - Wojciech Szczeklik
- Department of Internal Medicine, Jagiellonian University Medical College, 8 Skawinska Str, 31-066 Kraków, Poland
| | - Joachim Thiery
- LIFE Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital, Leipzig, Germany
| | - Frank L.J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | | | - A. Mark Richards
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
- Cardiovascular Research Institute, National University of Singapore, 1 E Kent Ridge Road, Singapore
| | - Chim C. Lang
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee DD1 9SY, Scotland, UK
| | - Vicky A. Cameron
- The Christchurch Heart Institute, University of Otago Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Axel Åkerblom
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Guillaume Pare
- McMaster University, Department of Pathology and Molecular Medicine, Hamilton, Canada
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Aroon D. Hingorani
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
| | - Jurriën M. ten Berg
- St. Antonius Hospital, department of Cardiology, Koekoekslaan 1, 3435CM, Nieuwegein, the Netherlands
| | - Lars Wallentin
- Uppsala Clinical Research Center, Uppsala, Sweden
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Folkert W. Asselbergs
- Department of Cardiology, Division Heart and Lungs, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Riyaz Patel
- Institute of Cardiovascular Science and UCL BHF Research Accelerator, Faculty of Population Health Science, University College London, London, UK
- Bart’s Heart Centre, St Bartholomew’s Hospital, London, EC1A2DA, UK
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Tulbă D, Cozma L, Popescu BO, Davidescu EI. Dysautonomia in Alzheimer's Disease. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E337. [PMID: 32650427 PMCID: PMC7404689 DOI: 10.3390/medicina56070337] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/27/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022]
Abstract
Alzheimer's disease is the most common neurodegenerative disorder, and its prevalence increases with age. Although there is a large amount of scientific literature focusing on Alzheimer's disease cardinal cognitive features, autonomic nervous system dysfunction remains understudied despite being common in the elderly. In this article, we reviewed the evidence for autonomic nervous system involvement in Alzheimer's disease. We identified four major potential causes for dysautonomia in Alzheimer's disease, out of which two are well-studied (comorbidities and medication) and two are rather hypothetical (Alzheimer's pathology and brain co-pathology). Although there appears to be some evidence linking Alzheimer's disease pathology to autonomic nervous system dysfunction, there is an important gap between two types of studies; histopathologic studies do not address dysautonomia manifestations, whereas clinical studies do not employ histopathologic diagnostic confirmation. Moreover, brain co-pathology is emerging as an important confounding factor. Therefore, we consider the correlation between dysautonomia and Alzheimer's disease to be an open question that needs further study. Nevertheless, given its impact on morbidity and mortality, we emphasize the importance of assessing autonomic dysfunction in patients with Alzheimer clinical syndrome.
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Affiliation(s)
- Delia Tulbă
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Colentina—Research and Development Center, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
| | - Liviu Cozma
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
- Laboratory of Cell Biology, Neurosciences and Experimental Myology, Victor Babeș National Institute of Pathology, Splaiul Independenței 99–101, 050096 Bucharest, Romania
| | - Eugenia Irene Davidescu
- Department of Neurology, Colentina Clinical Hospital, Șoseaua Ștefan cel Mare 19–21, 020125 Bucharest, Romania; (D.T.); (L.C.); (E.I.D.)
- Department of Clinical Neurosciences, School of Medicine, Carol Davila University of Medicine and Pharmacy, Bulevardul Eroii Sanitari 8, 050474 Bucharest, Romania
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Yoo D, Kim N, Hwang DW, Song KB, Lee JH, Lee W, Kwon J, Park Y, Hong S, Lee JW, Hwang K, Shin D, Tak E, Kim SC. Association between Metformin Use and Clinical Outcomes Following Pancreaticoduodenectomy in Patients with Type 2 Diabetes and Pancreatic Ductal Adenocarcinoma. J Clin Med 2020; 9:jcm9061953. [PMID: 32580502 PMCID: PMC7356590 DOI: 10.3390/jcm9061953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022] Open
Abstract
Retrospective studies on the association between metformin and clinical outcomes have mainly been performed on patients with non-resectable pancreatic ductal adenocarcinoma and may have been affected by time-related bias. To avoid this bias, recent studies have used time-varying analysis; however, they have only considered the start date of metformin use and not the stop date. We studied 283 patients with type 2 diabetes and pancreatic ductal adenocarcinoma following pancreaticoduodenectomy, and performed analysis using a Cox model with time-varying covariates, while considering both start and stop dates of metformin use. When start and stop dates were not considered, the metformin group showed significantly better survival. Compared with previous studies, adjusted analysis based on Cox models with time-varying covariates only considering the start date of postoperative metformin use showed no significant differences in survival. However, although adjusted analysis considering both start and stop dates showed no significant difference in recurrence-free survival, the overall survival was significantly better in the metformin group (Hazard ratio (HR), 0.747; 95% confidence interval (CI), 0.562–0.993; p = 0.045). Time-varying analysis incorporating both start and stop dates thus revealed that metformin use is associated with a higher overall survival following pancreaticoduodenectomy in patients with type 2 diabetes and pancreatic ductal adenocarcinoma.
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Affiliation(s)
- Daegwang Yoo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Jaewoo Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Sarang Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Jong Woo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Kyungyeon Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Dakyum Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (D.Y.); (D.W.H.); (K.B.S.); (J.H.L.); (W.L.); (J.K.); (Y.P.); (S.H.); (J.W.L.); (K.H.); (D.S.)
| | - Eunyoung Tak
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology (AMIST), Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Correspondence: (E.T.); (S.C.K.); Tel.: +82-2-3010-4634 (E.T.); +82-2-3010-3936 (S.C.K.)
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Institute of Convergence Science and Technology (AMIST), Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea
- Correspondence: (E.T.); (S.C.K.); Tel.: +82-2-3010-4634 (E.T.); +82-2-3010-3936 (S.C.K.)
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15
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Kushner DS, Johnson-Greene D. Association of Urinary Incontinence with Cognition, Transfers and Discharge Destination in Acute Stroke Inpatient Rehabilitation. J Stroke Cerebrovasc Dis 2018; 27:2677-2682. [PMID: 29941393 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Acute-stroke prognostic indicators remain controversial including relationship of urinary incontinence with outcomes in cognition, transfers, and discharge destination. OBJECTIVE To examine if urinary incontinence is associated with inpatient-rehabilitation (IR) outcomes in cognition, transfers, and discharge destinations. DESIGN Retrospective observational study of 303 of 579(52%) acute-stroke patients admitted to IR 2012-2015 with complete urinary incontinence (total assistance for bladder management). Discharge Functional Independence Measure (FIM) scores were correlated for continence, cognition, transfers-(bed/chair/wheelchair), and discharge destination. RESULTS Patients were admitted to IR on average 7.4 days after acute stroke. Average length-of-stay in IR was 14 days. At discharge 118 of 303(39%) remained urinary incontinent (total assistance). Continence/bladder-management FIM scores at discharge were associated with cognition FIM scores at discharge (chi square =105.8; P < .0001), and associated with transfer FIM scores at discharge (chi square = 153.1; P < .0001). Patients total to moderate assistance for continence at discharge included greater percentage that were dependent to moderate assistance for cognition and transfers than those minimal assistance to independent for continence. Continence/bladder-management FIM scores at discharge were associated with discharge disposition destinations (chi square = 29.98; P < .002). Patients total to moderate assistance for continence at discharge included greater percentage of acute care transfers, and skilled-nursing-facility dispositions, than patients that recovered to minimal assist to independent for continence. Urinary-incontinence recovery to minimal assistance to independent was associated with a home/community disposition rate of 82%. CONCLUSIONS 52% stroke patients were total assistance with bladder management for urinary incontinence on IR admission. Partial to complete continence recovery occurred in 61%. Continence/bladder-management FIM scores at discharge were associated with cognition and transfer FIM scores, and discharge destinations.
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Affiliation(s)
- David S Kushner
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.
| | - Doug Johnson-Greene
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida.
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16
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Corcos J, Przydacz M, Campeau L, Witten J, Hickling D, Honeine C, Radomski SB, Stothers L, Wagg A. CUA guideline on adult overactive bladder. Can Urol Assoc J 2017; 11:E142-E173. [PMID: 28503229 PMCID: PMC5426936 DOI: 10.5489/cuaj.4586] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christiane Honeine
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sidney B. Radomski
- Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Lynn Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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17
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Ishola IO, Adamson FM, Adeyemi OO. Ameliorative effect of kolaviron, a biflavonoid complex from Garcinia kola seeds against scopolamine-induced memory impairment in rats: role of antioxidant defense system. Metab Brain Dis 2017; 32:235-245. [PMID: 27631100 DOI: 10.1007/s11011-016-9902-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/01/2016] [Indexed: 02/07/2023]
Abstract
In Alzheimer's disease (AD) basal forebrain cholinergic neurons appear to be targeted primarily in early stages of the disease. Scopolamine (muscarinic receptor antagonist) has been used for decades to induce working and reference memory impairment in rodents. In this study, we evaluated the protective effect of kolaviron, a biflavonoid complex isolated from Garcinia kola seeds extract against scopolamine-induced memory impairment/oxidative stress. Rats were pretreated with kolaviron (25, 50 or 100 mg/kg p.o.) for 3 consecutive days, scopolamine (3 mg/kg, i.p.) was administered 1 h post-treatment on day 3. Five minutes post-scopolamine injection, memory function was assessed using the Y-maze or Morris water maze tests (MWM) in rats. The rats were sacrificed and brains isolated on the 8th day after the MWM test for estimation of acetylcholinesterase activity and nitrosative/oxidative stress status. Scopolamine injection induced deficit (P < 0.05) in percentage alternation behaviour in the Y-maze test indicating memory impairment which was ameliorated by kolaviron in a dose-dependent manner. Also, pre-training treatment with kolaviron significantly improved spatial learning evidenced in the session-dependent and more efficient localization of the hidden platform in the MWM test. Moreover, scopolamine injection induced significant increase in lipid peroxidation (prefrontal cortex), nitrite generation (striatum and hippocampus) and a decrease in glutathione (prefrontal cortex, striatum and hippocampus) and superoxide dismutase (striatum and hippocampus) level which was attenuated by kolaviron pre-treatment. These findings showed that kolaviron possesses cognition enhancing effect through enhancement of antioxidant defense and cholinergic systems.
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Affiliation(s)
- Ismail O Ishola
- Department of Pharmacology, Therapeutics and Toxicology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-araba, Lagos, Nigeria.
| | - Folasade M Adamson
- Department of Pharmacology, Therapeutics and Toxicology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-araba, Lagos, Nigeria
| | - Olufunmilayo O Adeyemi
- Department of Pharmacology, Therapeutics and Toxicology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, PMB 12003, Idi-araba, Lagos, Nigeria
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18
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Lee HY, Li CC, Juan YS, Chang YH, Yeh HC, Tsai CC, Chueh KS, Wu WJ, Yang YH. Urinary Incontinence in Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2017; 32:51-55. [PMID: 28100075 PMCID: PMC10852810 DOI: 10.1177/1533317516680900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES Urinary incontinence (UI) is more prevalent in the elderly populations with dementia than without dementia, and Alzheimer's disease (AD) is the most common cause of dementia. Urinary incontinence may complicate AD morbidity and mortality. Therefore, this study aimed to evaluate the prevalence and annual incidence and determine the risk possibility of UI, which is the main type of incontinence in patients with AD in Taiwan. METHODS A total of 933 patients with AD were included in the study cohort, and a total of 2799 patients without AD by 1:3 proportion compared to the study cohort were used as a matched cohort. All participants were selected from the National Health Insurance Research Database in 2000 sample population. We utilize Cox proportional hazard regression to evaluate the risk of UI and cumulative incidence ratio curve to analyze the cumulative incidence function. Prevalence and annual incidence rate are calculated in individual medication including rivastigmine, donepezil, galantamine, and memantine only being initiated in patients with AD. RESULTS The risk of UI is higher in AD cohort (hazard ratio: 1.54, 95% confidence interval: 1.13-2.09). The cumulative incidence ratio of UI event between AD cohort and matched cohort presents statistical significance ( P < .001). Annual incidence and prevalence of UI in patients with AD are 6.2% and 4.2%, respectively. CONCLUSION The present results suggest that the risk of UI is higher in patients with AD than in the general population.
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Affiliation(s)
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yu-Han Chang
- Management Office, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chun Tsai
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Kuang-Shun Chueh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
- Department of and Master’s Program in Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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19
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Sugimoto T, Yoshida M, Ono R, Murata S, Saji N, Niida S, Toba K, Sakurai T. Frontal Lobe Function Correlates with One-Year Incidence of Urinary Incontinence in Elderly with Alzheimer Disease. J Alzheimers Dis 2017; 56:567-574. [DOI: 10.3233/jad-160923] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Taiki Sugimoto
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
- Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences, Kobe, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Rei Ono
- Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences, Kobe, Japan
| | - Shunsuke Murata
- Department of Community Health Sciences, Kobe University, Graduate School of Health Sciences, Kobe, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shumpei Niida
- Medical Genome Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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20
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Kröger E, Mouls M, Wilchesky M, Berkers M, Carmichael PH, van Marum R, Souverein P, Egberts T, Laroche ML. Adverse Drug Reactions Reported With Cholinesterase Inhibitors. Ann Pharmacother 2015; 49:1197-206. [DOI: 10.1177/1060028015602274] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: No worldwide pharmacovigilance study evaluating the spectrum of adverse drug reactions (ADRs) induced by cholinesterase inhibitors (ChEI) in Alzheimer’s disease has been conducted since their emergence on the market. Objective: To describe ChEI related ADRs in Alzheimer’s disease (donepezil, rivastigmine, and galantamine) and characterize their seriousness as reported by national pharmacovigilance systems to VigiBase, a World Health Organization International Drug Monitoring Program database, between 1998 and 2013. Methods: All ChEI related reports, submitted to VigiBase between 1998 and 2013 from the five continents were extracted. Analyses were carried out for general, serious, and nonserious ADRs. Results: A total of 18 955 reports (43 753 ADRs) from 58 countries were reported: 60.1% in women; mean age 77.4 ± 9.1 years. Most reports originated from Europe (47.6%) and North America (40.4%). Rivastigmine and donepezil were involved in most reports (41.4% each). The most frequently reported ADRs were neuropsychiatric (31.4%), gastrointestinal (15.9%), general (11.9%), and cardiovascular (11.7%) disorders. During the 2006-2013 period, serious ADRs remained more often reported than nonserious ones; the most serious were neuropsychiatric (34.0%), general (14.0%), cardiovascular (12.1%), and gastrointestinal (11.6%) disorders. Medication errors were reported in 2.0% of serious cases. Death occurred in 2.3% of the reports. Conclusions: This international pharmacovigilance study highlights the ADR pattern induced by ChEIs. Neuropsychiatric events were the most frequently reported ADRs. Serious cardiovascular events were frequently reported, suggesting that their significance has probably been previously underestimated. Given the frailty of the patients and the frequent comedications, caution is advised before introducing a ChEI.
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Affiliation(s)
- Edeltraut Kröger
- Centre de Recherche du CHU de Québec, Canada
- Université Laval, Québec, Canada
| | - Marie Mouls
- Service de Pharmacologie-Toxicologie-Pharmacovigilance, Limoges, France
| | - Machelle Wilchesky
- McGill University, Montréal, Canada
- Centre for Clinical Epidemiology Jewish General Hospital–Lady Davis Research Institute, Montréal, Canada
- Donald Berman Maimonides Geriatric Centre, Montréal, Canada
| | | | | | - Rob van Marum
- Jeroen-Bosch Ziekenhuis, ‘s-Hertogenbosch, Netherlands
- EMGO Institute for Health and Care Research VU University Medical Center Amsterdam, Netherlands
| | | | - Toine Egberts
- Utrecht University, Netherlands
- University Medical Centre, Utrecht, Netherlands
| | - Marie-Laure Laroche
- Service de Pharmacologie-Toxicologie-Pharmacovigilance, Limoges, France
- Université de Limoges, Limoges, France
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