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Relationship between cognitive impairment and postural stability in the elderly population. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00913-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Litak J, Mazurek M, Kulesza B, Szmygin P, Litak J, Kamieniak P, Grochowski C. Cerebral Small Vessel Disease. Int J Mol Sci 2020; 21:ijms21249729. [PMID: 33419271 PMCID: PMC7766314 DOI: 10.3390/ijms21249729] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 01/18/2023] Open
Abstract
Cerebral small vessel disease (CSVD) represents a cluster of various vascular disorders with different pathological backgrounds. The advanced vasculature net of cerebral vessels, including small arteries, capillaries, arterioles and venules, is usually affected. Processes of oxidation underlie the pathology of CSVD, promoting the degenerative status of the epithelial layer. There are several classifications of cerebral small vessel diseases; some of them include diseases such as Binswanger’s disease, leukoaraiosis, cerebral microbleeds (CMBs) and lacunar strokes. This paper presents the characteristics of CSVD and the impact of the current knowledge of this topic on the diagnosis and treatment of patients.
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Affiliation(s)
- Jakub Litak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland; (M.M.); (B.K.); (P.S.); (P.K.)
- Department of Immunology, Medical University of Lublin, 20-093 Lublin, Poland
- Correspondence:
| | - Marek Mazurek
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland; (M.M.); (B.K.); (P.S.); (P.K.)
| | - Bartłomiej Kulesza
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland; (M.M.); (B.K.); (P.S.); (P.K.)
| | - Paweł Szmygin
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland; (M.M.); (B.K.); (P.S.); (P.K.)
| | - Joanna Litak
- St. John’s Cancer Center in Lublin, 20-090 Lublin, Poland;
| | - Piotr Kamieniak
- Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, 20-954 Lublin, Poland; (M.M.); (B.K.); (P.S.); (P.K.)
| | - Cezary Grochowski
- Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland;
- Laboratory of Virtual Man, Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland
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Morley JE, Vellas B. Patient-Centered (P4) Medicine and the Older Person. J Am Med Dir Assoc 2019; 18:455-459. [PMID: 28549701 DOI: 10.1016/j.jamda.2017.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 12/25/2022]
Affiliation(s)
- John E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
| | - Bruno Vellas
- Gérontopôle, CHU Toulouse University Hospital and INSERM U1027, Toulouse, France
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Morley JE. The Future of Long-Term Care. J Am Med Dir Assoc 2017; 18:1-7. [DOI: 10.1016/j.jamda.2016.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 02/07/2023]
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Alzheimer Mythology: A Time to Think Out of the Box. J Am Med Dir Assoc 2016; 17:769-74. [DOI: 10.1016/j.jamda.2016.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022]
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Zenthöfer A, Baumgart D, Cabrera T, Rammelsberg P, Schröder J, Corcodel N, Hassel AJ. Poor dental hygiene and periodontal health in nursing home residents with dementia: an observational study. Odontology 2016; 105:208-213. [PMID: 27160268 DOI: 10.1007/s10266-016-0246-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
Poor oral health conditions are well documented in the institutionalized elderly, but the literature is lacking research on relationships between dementia and periodontal health in nursing home residents. The purpose of this cohort study, therefore, was to assess whether dementia is associated with poor oral health/denture hygiene and an increased risk of periodontal disease in the institutionalized elderly. A total of 219 participants were assessed using the Mini Mental State Examination (MMSE) to determine cognitive state. According to the MMSE outcome, participants scoring ≤20 were assigned to dementia group (D) and those scoring >20 to the non-dementia group (ND), respectively. For each of the groups D and ND, Gingival Bleeding Index (GBI) and Denture Hygiene Index (DHI) linear regression models were used with the confounders age, gender, dementia, number of comorbidities and number of permanent medications. To assess the risk factors for severe periodontitis as measured by the Community Index of Periodontal Treatment Needs, a logistic regression analysis was performed. Statistical analysis revealed no significant differences of GBI as well of DHI for demented and healthy subjects (p > 0.05). Severe periodontitis was detected in 66 % of participants with dementia. The logistic regression showed a 2.9 times increased risk among demented participants (p = 0.006). Oral hygiene, denture hygiene and periodontal health are poor in nursing home residents. The severity of oral problems, primarily periodontitis, seems to be enhanced in subjects suffering from dementia. Longitudinal observations are needed to clarify the cause-reaction relationship.
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Affiliation(s)
- Andreas Zenthöfer
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Dominik Baumgart
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tomas Cabrera
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes Schröder
- Institute of Gerontology, University of Heidelberg, Heidelberg, Germany.,Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Nicoleta Corcodel
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Jochen Hassel
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Jena A, Renjen PN, Taneja S, Gambhir A, Negi P. Integrated (18)F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging ((18)F-FDG PET/MRI), a multimodality approach for comprehensive evaluation of dementia patients: A pictorial essay. Indian J Radiol Imaging 2016; 25:342-52. [PMID: 26752814 PMCID: PMC4693381 DOI: 10.4103/0971-3026.169449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dementia, caused by irreversible neurodegenerative disorders such as Alzheimer's disease or reversible non-degenerative conditions, is rapidly becoming one of the most alarming health problems in our aging society. This cognitive disorder associated with a multitude of clinical differentials with overlapping clinical, pathological, and imaging features is difficult to diagnose and treat, as it often presents late after significant neuronal damage has already occurred. Novel disease-modifying treatments being developed will have to be corroborated with innovative imaging biomarkers so that earlier reliable diagnosis can be made and treatment initiated upon. Along with new specific PET radiotracers, integrated PET/MRI with combined methodological advantage and simultaneously acquired structural-cum-functional information may help achieve this goal. The present pictorial essay details our experiences with PET/MRI in dementing disorders, along with reviewing recent advances and future scope.
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Affiliation(s)
- Amarnath Jena
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Sangeeta Taneja
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Aashish Gambhir
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Pradeep Negi
- PET SUITE, Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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Seifaddini R, Tajadini H, Choopani R. Physiopathology of Dementia From the Perspective of Traditional Persian Medicine. J Evid Based Complementary Altern Med 2015; 20:224-7. [DOI: 10.1177/2156587214566275] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 12/06/2014] [Indexed: 11/16/2022] Open
Abstract
The most common cognitive disorder that is disabling is dementia. During the medieval period, traditional Persian medicine was an outstanding source of medicine that was used as standard references in medical schools of in the West and Middle East. In ancient manuscripts of traditional Persian medicine, a condition has been introduced similar to dementi ( raoonat and homgh). In this article, by collecting materials of traditional medicine texts on dementia, we aim to provide theories for further studies on this topics, as there is an obvious difference between traditional Persian medicine and modern medicine with regard to dementia; however, since modern medicine has not found a suitable response to treatment for all diseases, reviewing traditional Persian medicine for finding better treatment strategies is wise. Use of all medical potentials approved by the World Health Organization beside classic medicine like traditional medicine and considering the availability and acceptability among people is recommended.
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Affiliation(s)
- Rostam Seifaddini
- Neurology research center, Kerman University of Medical Sciences, Kerman, Iran
| | - Haleh Tajadini
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Choopani
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ampadu J, Morley JE. Heart failure and cognitive dysfunction. Int J Cardiol 2015; 178:12-23. [DOI: 10.1016/j.ijcard.2014.10.087] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
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Lazcano Z, Solis O, Bringas ME, Limón D, Diaz A, Espinosa B, García-Peláez I, Flores G, Guevara J. Unilateral injection of Aβ25-35in the hippocampus reduces the number of dendritic spines in hyperglycemic rats. Synapse 2014; 68:585-594. [DOI: 10.1002/syn.21770] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/15/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Zayda Lazcano
- Laboratorio de Neuropsiquiatría; Instituto de Fisiología Benemérita Universidad Autónoma de Puebla; Puebla México
| | - Oscar Solis
- Laboratorio de Neuropsiquiatría; Instituto de Fisiología Benemérita Universidad Autónoma de Puebla; Puebla México
| | - María Elena Bringas
- Laboratorio de Neuropsiquiatría; Instituto de Fisiología Benemérita Universidad Autónoma de Puebla; Puebla México
| | - Daniel Limón
- Laboratorio de Neurofarmacología, Facultad de Ciencias Químicas; Benemérita Universidad Autónoma de Puebla; Puebla México
| | - Alfonso Diaz
- Departamento de Farmacia, Facultad de Ciencias Químicas; Benemérita Universidad Autónoma de Puebla; Puebla México
- Laboratorio Experimental de Enfermedades Neurodegenerativas; Instituto Nacional de Neurología y Neurocirugía; Ciudad de México Distrito Federal México
- Departamento de Bioquímica, Facultad de Medicina; Universidad Nacional Autónoma de México; Ciudad de México Distrito Federal México
| | - Blanca Espinosa
- Laboratorio de Bioquímica, Instituto Nacional de Enfermedades Respiratorias; Ciudad de México Distrito Federal México
| | - Isabel García-Peláez
- Departamento de Biología Celular y Tisular, Facultad de Medicina; Universidad Nacional Autónoma de México; Ciudad de México Distrito Federal México
| | - Gonzalo Flores
- Laboratorio de Neuropsiquiatría; Instituto de Fisiología Benemérita Universidad Autónoma de Puebla; Puebla México
| | - Jorge Guevara
- Departamento de Bioquímica, Facultad de Medicina; Universidad Nacional Autónoma de México; Ciudad de México Distrito Federal México
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Amyloid beta: multiple mechanisms of toxicity and only some protective effects? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:795375. [PMID: 24683437 PMCID: PMC3941171 DOI: 10.1155/2014/795375] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/21/2013] [Accepted: 12/22/2013] [Indexed: 12/22/2022]
Abstract
Amyloid beta (Aβ) is a peptide of 39–43 amino acids found in large amounts and forming deposits in the brain tissue of patients with Alzheimer's disease (AD). For this reason, it has been implicated in the pathophysiology of damage observed in this type of dementia. However, the role of Aβ in the pathophysiology of AD is not yet precisely understood. Aβ has been experimentally shown to have a wide range of toxic mechanisms in vivo and in vitro, such as excitotoxicity, mitochondrial alterations, synaptic dysfunction, altered calcium homeostasis, oxidative stress, and so forth. In contrast, Aβ has also shown some interesting neuroprotective and physiological properties under certain experimental conditions, suggesting that both physiological and pathological roles of Aβ may depend on several factors. In this paper, we reviewed both toxic and protective mechanisms of Aβ to further explore what their potential roles could be in the pathophysiology of AD. The complete understanding of such apparently opposed effects will also be an important guide for the therapeutic efforts coming in the future.
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Morley JE. Mild Cognitive Impairment—A Treatable Condition. J Am Med Dir Assoc 2014; 15:1-5. [DOI: 10.1016/j.jamda.2013.11.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 01/24/2023]
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Chen X, Clark JJ, Chen H, Naorungroj S. Cognitive impairment, oral self-care function and dental caries severity in community-dwelling older adults. Gerodontology 2013; 32:53-61. [PMID: 23758583 DOI: 10.1111/ger.12061] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate whether oral self-care function mediates the associations between cognitive impairment and caries severity in community-dwelling older adults. BACKGROUND Cognitive impairment affects activities of daily living and compromises oral health, systemic health and quality of life in older adults. However, the associations among cognitive impairment, oral self-care capacity and caries severity remain unclear. This increases difficulty in developing effective interventions for cognitively impaired patients. MATERIALS AND METHODS Medical, dental, cognitive and functional assessments were abstracted from the dental records of 600 community-dwelling elderly. 230 participants were selected using propensity score matching and categorised into normal, cognitive impairment but no dementia (CIND) and dementia groups based on their cognitive status and a diagnosis of dementia. Multivariable regressions were developed to examine the mediating effect of oral self-care function on the association between cognitive status and number of caries or retained roots. RESULTS Cognitive impairment, oral self-care function and dental caries severity were intercorrelated. Multivariable analysis showed that without adjusting for oral self-care capacity, cognition was significantly associated with the number of caries or retained roots (p = 0.003). However, the association was not significant when oral self-care capacity was adjusted (p = 0.125). In contrast, individuals with impaired oral self-care capacity had a greater risk of having a caries or retained root (RR = 1.67, 95% CI 1.15, 2.44). CONCLUSION Oral care capacity mediates the association between cognition and dental caries severity in community-dwelling older adults.
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Affiliation(s)
- Xi Chen
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Chen X, Clark JJJ, Naorungroj S. Oral health in nursing home residents with different cognitive statuses. Gerodontology 2012; 30:49-60. [PMID: 22364512 DOI: 10.1111/j.1741-2358.2012.00644.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To compare oral health in nursing home (NH) residents with different cognitive statuses. BACKGROUND Oral health is a significant issue for NH residents because of its relationships to quality of life, systemic health and well-being. It is known that oral health is poor in NH residents. However, how oral health differs in NH residents with different cognitive statuses remains unclear. MATERIALS AND METHODS Nine hundred and two NH residents were retrospectively recruited from a community-based geriatric dental clinic in Minnesota, USA. Comprehensive medical, dental, cognitive and functional assessments were completed for the participants. On the basis of medical history and cognitive status, participants were categorized into three groups: without cognitive impairment (non-impaired group), with cognitive impairment but no dementia (impaired group) and with dementia (demented group). ANOVA, Chi-square and Fisher's exact tests were used to compare medical, dental and functional statuses between groups. RESULTS Oral hygiene was poor in NH residents. Forty per cent of participants in the impaired group were edentulous, significantly higher than the edentulism rate in the demented group (29%, p = 0.01). More than 60% of the participants lost 16 or more teeth prior to examination. Depending on their cognitive status, 82-92% of the participants arrived with one or more caries or retained root. Dentate participants in the impaired and demented groups averaged about six caries or retained roots, significantly more than 4.7 caries or retained roots in the non-impaired group (p = 0.01). CONCLUSION Oral health was poor but slightly different in NH residents with different cognitive and functional statuses.
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Affiliation(s)
- Xi Chen
- Department of Dental Ecology, University of North Carolina, Chapel Hill, NC, USA.
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Härlein J, Halfens RJG, Dassen T, Lahmann NA. Falls in older hospital inpatients and the effect of cognitive impairment: a secondary analysis of prevalence studies. J Clin Nurs 2010; 20:175-83. [DOI: 10.1111/j.1365-2702.2010.03460.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Recovery of functional and structural age-related changes in the rat primary auditory cortex with operant training. Proc Natl Acad Sci U S A 2010; 107:13900-5. [PMID: 20643928 DOI: 10.1073/pnas.1007885107] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cognitive decline is a virtually universal aspect of the aging process. However, its neurophysiological basis remains poorly understood. We describe here more than 20 age-related cortical processing deficits in the primary auditory cortex of aging versus young rats that appear to be strongly contributed to by altered cortical inhibition. Consistent with these changes, we recorded in old rats a decrease in parvalbumin-labeled inhibitory cortical neurons. Furthermore, old rats were slower to master a simple behavior, with learning progressions marked by more false-positive responses. We then examined the effect of intensive auditory training on the primary auditory cortex in these aged rats by using an oddball discrimination task. Following training, we found a nearly complete reversal of the majority of previously observed functional and structural cortical impairments. These findings suggest that age-related cognitive decline is a tightly regulated plastic process, and demonstrate that most of these age-related changes are, by their fundamental nature, reversible.
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Carrillo-Mora P, Méndez-Cuesta LA, Pérez-De La Cruz V, Fortoul-van Der Goes TI, Santamaría A. Protective effect of systemic l-kynurenine and probenecid administration on behavioural and morphological alterations induced by toxic soluble amyloid beta (25–35) in rat hippocampus. Behav Brain Res 2010; 210:240-50. [DOI: 10.1016/j.bbr.2010.02.041] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 02/18/2010] [Accepted: 02/19/2010] [Indexed: 12/28/2022]
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Clemmer SJ, Ward-Griffin C, Forbes D. Family members providing home-based palliative care to older adults: the enactment of multiple roles. Can J Aging 2009; 27:267-83. [PMID: 19158043 DOI: 10.3138/cja.27.3.267] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Canadians are experiencing increased life expectancy and chronic illness requiring end-of-life care. There is limited research on the multiple roles for family members providing home-based palliative care. Based on a larger ethnographic study of client-family-provider relationships in home-based palliative care, this qualitative secondary analysis explores the enactment of multiple roles for family members providing home-based palliative care to seniors with advanced cancer. Family members had multiple expectations to provide care but felt their expectations of services were unmet. The process of enacting multiple roles was depicted by three interrelated themes: balancing, re-prioritizing, and evolving. Positive and negative health responses resulted from attempts to minimize personal health while simultaneously maintaining health. "True" family-centred care was found to be lacking, but should be a goal of health professionals involved in end-of-life care.
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Morley JE, Thomas DR. Cachexia: new advances in the management of wasting diseases. J Am Med Dir Assoc 2008; 9:205-10. [PMID: 18457793 DOI: 10.1016/j.jamda.2008.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Accepted: 02/20/2008] [Indexed: 10/22/2022]
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Vasudevaraju P, Bharathi, Garruto R, Sambamurti K, Rao K. Role of DNA dynamics in Alzheimer's disease. ACTA ACUST UNITED AC 2008; 58:136-48. [DOI: 10.1016/j.brainresrev.2008.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
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Morley JE. Managing Persons with Dementia in the Nursing Home: High Touch Trumps High Tech. J Am Med Dir Assoc 2008; 9:139-46. [DOI: 10.1016/j.jamda.2007.12.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Levenson SA, Morley JE. Evidence rocks in long-term care, but does it roll? J Am Med Dir Assoc 2007; 8:493-501. [PMID: 17931572 DOI: 10.1016/j.jamda.2007.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Indexed: 01/10/2023]
Abstract
This article reviews the problems with the implementation of evidence-based care in long-term care. It highlights the fact that many common practices are incompatible with evidence and that available evidence, including evidence about inadvisable and ineffective treatments, is often not followed. Often, there is a tendency to follow recommendations for younger persons (for example, the management of hypertension and elevated cholesterol), or to use questionable interventions (for example, choices for treating constipation). In many cases, the treatments used have only marginal efficacy and increased potential for side effects. This article makes recommendations for improving the approach to evidence-based care in long-term care and strongly urges the FDA to require drug studies in nursing homes.
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Affiliation(s)
- Steven A Levenson
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St Louis, MO 63104, USA
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Howard G, Safford MM, Meschia JF, Moy CS, Howard VJ, Pulley L, Gomez CR, Crowther M. Stroke Symptoms in Individuals Reporting No Prior Stroke or Transient Ischemic Attack Are Associated With a Decrease in Indices of Mental and Physical Functioning. Stroke 2007; 38:2446-52. [PMID: 17673720 DOI: 10.1161/strokeaha.106.478032] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke symptoms in the absence of recognized stroke are common, but potential associated dysfunctions have not been described. METHODS We assessed quality-of-life measures using the Physical and Mental Component Summary scores of the Short Form 12 (PCS-12 and MCS-12) in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Differences in mean PCS-12 and MCS-12 scores were assessed among participant groups symptoms-free (n=16 090); history of stroke symptoms but free of stroke/transient ischemic attack (n=3404); history of stroke (n=1491); and history of transient ischemic attack (n=818). RESULTS Participants with symptoms (but no diagnosis) had average PCS-12 scores 5.5 (95% CI: 5.2 to 5.9) points lower than those without symptoms, a difference similar to transient ischemic attack (6.0; 95% CI: 5.3 to 6.7) and over one half the effect of stroke (8.4; 95% CI: 8.0 to 9.0). MCS-12 scores were 2.7 (95% CI: 2.4 to 3.0) points lower for those with symptoms, -0.5 for transient ischemic attack (95% CI: 0.0 to -1.1), and -1.6 for stroke (95% CI: -1.2 to -2.0). Differences in demographic and vascular risk factors, health behaviors, physiological measures, and indices of socioeconomic status did not fully explain these differences. Those reporting history of weakness or numbness had larger current decrements in physical functioning, and those reporting history of inability to express themselves or understand language had larger current decrements in mental functioning. CONCLUSIONS Individuals with clinically consistent symptoms but no stroke diagnosis have a lower quality of life than those without symptoms. The difference in physical functioning is substantial with a smaller decline in mental functioning. Apart from so-called "silent stroke," there appear to be many individuals with possibly symptomatic cerebrovascular disease-either stroke or transient ischemic attack-who are not being diagnosed. Furthermore, these symptomatic but undiagnosed strokes may not be benign.
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Affiliation(s)
- George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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