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Odenigbo N, Nkemjika S, Atolagbe A, Nwabueze C, Olwit C, Lawrence J, Olupona T. Donepezil-induced bradycardia in a schizophrenic patient with comorbid neurocognitive disorder: a case report and review of the literature. J Med Case Rep 2024; 18:129. [PMID: 38532522 PMCID: PMC10967060 DOI: 10.1186/s13256-024-04454-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Trials of cholinergic and glutamatergic agents have improved cognition and memory for the geriatric schizophrenic population. Donepezil is an acetylcholinesterase inhibitor that improves cognition by preventing postsynaptic degradation of hippocampal acetylcholine in patients with mild-to-moderate dementia. Donepezil has been attributed to some adverse effects, especially gastrointestinal symptoms. However, cardiovascular adverse effects are not common as there remains a dearth of literature regarding donepezil-induced bradycardia. CASE REPORT Hence, we present the case of a 70-year-old Hispanic female with past psychiatry history of schizophrenia who developed bradycardia and syncope following the commencement of low-dose donepezil in the inpatient unit and subsequent resolution with cessation. She had no prior cardiovascular symptoms or diagnosis. DISCUSSION Considering there is no baseline cardiac monitoring requirement guideline for patients on Donepezil treatment, pre-assessment electrocardiogram is advised before the commencement of acetylcholinesterase inhibitors. Finally, routine monitoring of vital signs for at least the first 72 hours following the start of donepezil might be good proactive practice for all psychiatrists. Extending this practice to inpatient and outpatient service settings will be worthwhile.
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Affiliation(s)
- Nkolika Odenigbo
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Ayodele Atolagbe
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | | | - Connie Olwit
- Department of Nursing, Makere University, Kampala, Uganda.
| | - Jeffery Lawrence
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Tolulope Olupona
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
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2
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Ahuja M, Siddhpuria S, Karimi A, Lewis K, Wong E, Lee J, Reppas-Rindlisbacher C, Sood E, Gabor C, Patterson C. Cholinesterase inhibitors and falls, syncope and injuries in patients with cognitive impairment: a systematic review and meta-analysis. Age Ageing 2023; 52:afad205. [PMID: 37993407 DOI: 10.1093/ageing/afad205] [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: 05/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Cholinesterase inhibitors are commonly used to treat patients with neurocognitive disorders, who often have an elevated risk of falling. Effective use of these medications requires a thoughtful assessment of risks and benefits. OBJECTIVE To provide an update on previous reviews and determine the association between cholinesterase inhibitors and falls, syncope, fracture and accidental injuries in patients with neurocognitive disorders. METHODS Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature and AgeLine were systematically searched through March 2023 to identify all randomised controlled trials of cholinesterase inhibitors (donepezil, galantamine, rivastigmine) in patients with cognitive impairment. Corresponding authors were contacted for additional data necessary for meta-analysis. Inclusion criteria consisted of adults ≥19 years, with a diagnosis of dementia, Parkinson's disease, mild cognitive impairment or traumatic brain injury. Data were extracted in duplicate for the aforementioned primary outcomes and all outcomes were analysed using random-effects meta-analysis. RESULTS Fifty three studies (30 donepezil, 14 galantamine, 9 rivastigmine) were included providing data on 25, 399 patients. Cholinesterase inhibitors, compared to placebo, were associated with reduced risk of falls (risk ratio [RR] 0.84 [95% confidence interval [CI] = 0.73-0.96, P = 0.009]) and increased risk of syncope (RR 1.50 [95% CI = 1.02-2.21, P = 0.04]). There was no association with accidental injuries or fractures. CONCLUSION In patients with neurocognitive disorders, cholinesterase inhibitors were associated with decreased risk of falls, increased risk of syncope and no association with accidental trauma or fractures. These findings will help clinicians better evaluate risks and benefits of cholinesterase inhibitors.
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Affiliation(s)
- Manan Ahuja
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shailee Siddhpuria
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arian Karimi
- Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Kaitlin Lewis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eric Wong
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Justin Lee
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
| | | | - Emma Sood
- Faculty of Science, Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | | | - Christopher Patterson
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Canada
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3
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Santiago Martinez P, Lord SR, Close JCT, Taylor ME. Associations between psychotropic and anti-dementia medication use and falls in community-dwelling older adults with cognitive impairment. Arch Gerontol Geriatr 2023; 114:105105. [PMID: 37364485 DOI: 10.1016/j.archger.2023.105105] [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: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Evidence for effective fall prevention strategies is limited for people with cognitive impairment. Understanding what factors contribute to fall risk identifies potential intervention strategies. We aimed to determine if psychotropic and anti-dementia medication use are associated with falls in community-dwelling older people with mild-moderate cognitive impairment and dementia. DESIGN Secondary analysis of an RCT (i-FOCIS). PARTICIPANTS AND SETTING 309 community-dwelling people with mild to moderate cognitive impairment or dementia from Sydney, Australia. METHODS Demographic information, medical history, and medication use were collected at baseline and participants were followed up for 1-year for falls using monthly calendars and ancillary telephone falls. RESULTS Psychotropic medication use was associated with an increased rate of falls (IRR 1.41, 95%CI 1.03, 1.93) and slower gait speed, poor balance and reduced lower limb function when adjusting for age, sex, education and cognition, as well as RCT group allocation when examining prospective falls. Antidepressants use increased the rate of falls in a similarly adjusted model (IRR 1.54, 95%CI 1.10, 2.15), but when additionally adjusting for depressive symptoms, antidepressant use was no longer significantly associated with falls while depressive symptoms was. Anti-dementia medication use was not associated with rate of falls. CONCLUSIONS Psychotropic medication use increases fall risk, and anti-dementia medication does not reduce fall risk in older adults with cognitive impairment. Effective management of depressive symptoms, potentially with non-pharmacological approaches, is needed to prevent falls in this population. Research is also required to ascertain the risks/benefits of withdrawing psychotropic medications, particularly in relation to depressive symptoms.
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Affiliation(s)
| | - Stephen R Lord
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Morag E Taylor
- Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia.
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Tuena C, Maestri S, Serino S, Pedroli E, Stramba-Badiale M, Riva G. Prognostic relevance of gait-related cognitive functions for dementia conversion in amnestic mild cognitive impairment. BMC Geriatr 2023; 23:462. [PMID: 37525134 PMCID: PMC10388514 DOI: 10.1186/s12877-023-04175-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/15/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Increasing research suggests that gait abnormalities can be a risk factor for Alzheimer's Disease (AD). Notably, there is growing evidence highlighting this risk factor in individuals with amnestic Mild Cognitive Impairment (aMCI), however further studies are needed. The aim of this study is to analyze cognitive tests results and brain-related measures over time in aMCI and examine how the presence of gait abnormalities (neurological or orthopedic) or normal gait affects these trends. Additionally, we sought to assess the significance of gait and gait-related measures as prognostic indicators for the progression from aMCI to AD dementia, comparing those who converted to AD with those who remained with a stable aMCI diagnosis during the follow-up. METHODS Four hundred two individuals with aMCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database were included. Robust linear mixed-effects models were used to study the impact of gait abnormalities on a comprehensive neuropsychological battery over 36 months while controlling for relevant medical variables at baseline. The impact of gait on brain measures was also investigated. Lastly, the Cox proportional-hazards model was used to explore the prognostic relevance of abnormal gait and neuropsychological associated tests. RESULTS While controlling for relevant covariates, we found that gait abnormalities led to a greater decline over time in attention (DSST) and global cognition (MMSE). Intriguingly, psychomotor speed (TMT-A) and divided attention (TMT-B) declined uniquely in the abnormal gait group. Conversely, specific AD global cognition tests (ADAS-13) and auditory-verbal memory (RAVLT immediate recall) declined over time independently of gait profile. All the other cognitive tests were not significantly affected by time or by gait profile. In addition, we found that ventricles size increased faster in the abnormal gait group compared to the normal gait group. In terms of prognosis, abnormal gait (HR = 1.7), MMSE (HR = 1.09), and DSST (HR = 1.03) covariates showed a higher impact on AD dementia conversion. CONCLUSIONS The importance of the link between gait and related cognitive functions in terms of diagnosis, prognosis, and rehabilitation in aMCI is critical. We showed that in aMCI gait abnormalities lead to executive functions/attention deterioration and conversion to AD dementia.
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Affiliation(s)
- Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Sara Maestri
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Serino
- Department of Psychology, Università degli Studi Milano-Bicocca, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, Università eCampus, Novedrate, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
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Minta K, Colombo G, Taylor WR, Schinazi VR. Differences in fall-related characteristics across cognitive disorders. Front Aging Neurosci 2023; 15:1171306. [PMID: 37358956 PMCID: PMC10289027 DOI: 10.3389/fnagi.2023.1171306] [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] [Received: 02/23/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Approximately 40-60% of falls in the elderly lead to injuries, resulting in disability and loss of independence. Despite the higher prevalence of falls and morbidity rates in cognitively impaired individuals, most fall risk assessments fail to account for mental status. In addition, successful fall prevention programmes in cognitively normal adults have generally failed in patients with cognitive impairment. Identifying the role of pathological aging on fall characteristics can improve the sensitivity and specificity of fall prevention approaches. This literature review provides a thorough investigation into fall prevalence and fall risk factors, the accuracy of fall risk assessments, and the efficacy of fall prevention strategies in individuals with diverse cognitive profiles. We show that fall-related characteristics differ between cognitive disorders and fall risk assessment tools as well as fall prevention strategies should critically consider each patient's cognitive status to facilitate the identification of fallers at an earlier stage and support clinical decision-making.
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Affiliation(s)
- Karolina Minta
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Giorgio Colombo
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - William R. Taylor
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Health Sciences and Technology, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Victor R. Schinazi
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
- Department of Psychology, Bond University, Gold Coast, QLD, Australia
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Zawadzki RS, Grill JD, Gillen DL. Frameworks for estimating causal effects in observational settings: comparing confounder adjustment and instrumental variables. BMC Med Res Methodol 2023; 23:122. [PMID: 37217854 PMCID: PMC10201752 DOI: 10.1186/s12874-023-01936-2] [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: 10/24/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
To estimate causal effects, analysts performing observational studies in health settings utilize several strategies to mitigate bias due to confounding by indication. There are two broad classes of approaches for these purposes: use of confounders and instrumental variables (IVs). Because such approaches are largely characterized by untestable assumptions, analysts must operate under an indefinite paradigm that these methods will work imperfectly. In this tutorial, we formalize a set of general principles and heuristics for estimating causal effects in the two approaches when the assumptions are potentially violated. This crucially requires reframing the process of observational studies as hypothesizing potential scenarios where the estimates from one approach are less inconsistent than the other. While most of our discussion of methodology centers around the linear setting, we touch upon complexities in non-linear settings and flexible procedures such as target minimum loss-based estimation and double machine learning. To demonstrate the application of our principles, we investigate the use of donepezil off-label for mild cognitive impairment. We compare and contrast results from confounder and IV methods, traditional and flexible, within our analysis and to a similar observational study and clinical trial.
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Affiliation(s)
- Roy S Zawadzki
- Department of Statistics, University of California, Irvine, Irvine, USA.
| | - Joshua D Grill
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, USA
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, USA
| | - Daniel L Gillen
- Department of Statistics, University of California, Irvine, Irvine, USA
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Bizpinar O, Onder H. Investigation of the gait parameters after donepezil treatment in patients with alzheimer' s disease. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-5. [PMID: 36745707 DOI: 10.1080/23279095.2023.2172681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Clinical studies remark that gait disturbance is common in patients with Alzheimer's disease (AD). However, the treatment response of gait disturbance in those patients may constitute a more interesting issue that is rarely addressed. METHODS In this prospective, interventional study, we included 14 consecutive patients with a new diagnosis of AD. Basal gait analysis was performed using a 'Gait Analyzer' program that was uploaded to a mobile phone. The gait parameters including Step time (ST), step length (SL), step number (SN), gait velocity (GV), and cadence were measured. Afterward, donepezil 5 mg daily was initiated, and the re-assessments were re-performed 8 weeks after the treatment. RESULTS The mean age was 71.78 ± 5.02 (F/M = 8/6). The evaluations after the donepezil treatment showed that there was a significant improvement in the SN (p = 0.021) and SL (p = 0.001) in comparison to the basal evaluations. The repeated analysis in the subgroup of early-stage AD subjects (n = 10) yielded that there were significant improvements in SN (p = 0.003), SL (p = 0.005), and cadence (p = 0.026) after treatment. CONCLUSIONS Our results support the efficiency of cholinergic treatment in gait functions in AD subjects.
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Affiliation(s)
- Ozlem Bizpinar
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Halil Onder
- Neurology Clinic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Hopkins J, Hill K, Jacques A, Burton E. Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis. Clin Rehabil 2022; 37:215-243. [PMID: 36189497 DOI: 10.1177/02692155221129832] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify falls prevalence, falls risk factors and evaluate the effectiveness of falls prevention interventions for community-dwelling people with Mild Cognitive Impairment. DATA SOURCES Peer-reviewed articles (inception to 4 August 2022) from PubMed, CINAHL, PsycInfo, EMBASE, Scopus, SportDiscus and the Cochrane library. REVIEW METHODS All types of methodological approaches were considered. Inclusion criteria were community-dwelling; diagnosis of Mild Cognitive Impairment; aged 50+ years. Interventions needed to include falls prevention programs aiming to reduce falls and/or risk of falls. Outcomes of interest included number and/or rate of falls, falls prevalence and falls risk factors. For controlled trials, any control group was included. Quality assessment was completed using Cochrane's Risk of Bias Tool for randomized controlled trials and the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields for all other studies. Where statistical data pooling was not possible, narrative synthesis was used to present data in tables and figures. RESULTS Forty-seven studies were included. Prevalence of falls was 43% when data were gathered prospectively for 12 months. Confirmed falls risk factors included slow gait, dual-tasking, postural control and non-amnesic Mild Cognitive Impairment. Few studies evaluated interventions to reduce falls. Six meta-analyses were conducted, no significant reduction in falls was found. CONCLUSIONS Until further high-quality, adequately powered studies are available to guide practice, best practice guidelines recommend balance training as a core component of falls prevention programs for older people generally, as well as people with Mild Cognitive Impairment.
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Affiliation(s)
- Jane Hopkins
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Angela Jacques
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,Institute for Health Research, 3431University of Notre Dame Australia, Fremantle, WA, Australia
| | - Elissa Burton
- Curtin School of Allied Health, 1649Curtin University, Perth, WA, Australia.,enAble Institute, 1649Curtin University, Perth, WA, Australia
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Tseng PT, Zeng BY, Chen YW, Yang CP, Su KP, Chen TY, Wu YC, Tu YK, Lin PY, Carvalho AF, Stubbs B, Matsuoka YJ, Li DJ, Liang CS, Hsu CW, Sun CK, Cheng YS, Yeh PY, Shiue YL. The Dose and Duration-dependent Association between Melatonin Treatment and Overall Cognition in Alzheimer's Dementia: A Network Meta- Analysis of Randomized Placebo-Controlled Trials. Curr Neuropharmacol 2022; 20:1816-1833. [PMID: 35450525 PMCID: PMC9886806 DOI: 10.2174/1570159x20666220420122322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/18/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND While Alzheimer's dementia (AD) has a prevalence as high as 3-32% and is associated with cognitive dysfunction and the risk of institutionalization, no efficacious and acceptable treatments can modify the course of cognitive decline in AD. Potential benefits of exogenous melatonin for cognition have been divergent across trials. OBJECTIVE The current network meta-analysis (NMA) was conducted under the frequentist model to evaluate the potential beneficial effects of exogenous melatonin supplementation on overall cognitive function in participants with AD in comparison to other FDA-approved medications (donepezil, galantamine, rivastigmine, memantine, and Namzaric). METHODS The primary outcome was the changes in the cognitive function [measured by mini-mental state examination (MMSE)] after treatment in patients with Alzheimer's dementia. The secondary outcomes were changes in the quality of life, behavioral disturbance, and acceptability (i.e., drop-out due to any reason and rate of any adverse event reported). RESULTS The current NMA of 50 randomized placebo-controlled trials (RCTs) revealed the medium-term lowdose melatonin to be associated with the highest post-treatment MMSE (mean difference = 1.48 in MMSE score, 95% confidence intervals [95% CIs] = 0.51 to 2.46) and quality of life (standardized mean difference = -0.64, 95% CIs = -1.13 to -0.15) among all of the investigated medications in the participants with AD. Finally, all of the investigated exogenous melatonin supplements were associated with similar acceptability as was the placebo. CONCLUSION The current NMA provides evidence for the potential benefits of exogenous melatonin supplementation, especially medium-term low-dose melatonin, in participants with AD.
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Affiliation(s)
- Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan;,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan;,Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan;,These authors contributed equally as first authors
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan;,These authors contributed equally as first authors
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan;,These authors contributed equally as first authors
| | - Chun-Pai Yang
- Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan;,Department of Nutrition, Huangkuang University, Taichung, Taiwan
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan;,College of Medicine, China Medical University, Taichung, Taiwan;,An-Nan Hospital, China Medical University, Tainan, Taiwan;,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan;,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei112, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan;,Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan;,Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Andre F. Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK;,Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Yutaka J. Matsuoka
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan;,Former Division Chief of Health Care Research, National Cancer Center, Japan
| | - Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan;,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University School of Medicine for International Students
| | - Yu-Shian Cheng
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan;,Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai’s Home, Taiwan
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Clinical Psychology Center, Asia University Hospital, Taichung, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan;,Address correspondence to this author at the Institute of Biomedical Sciences, National Sun Yat-sen University, Address: 70 Lienhai Rd. 80424 Kaohsiung, Taiwan; Tel: +886-7-525-2000 ext. 5818; +886-915-515-971; Fax: +886-7-525-0197; E-mail:
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Burton E, Hill K, Ellis KA, Hill AM, Lowry M, Moorin R, McVeigh JA, Jacques A, Erickson KI, Tate J, Bernard S, Orr CF, Bongiascia L, Clarnette R, Clark ML, Williams S, Lautenschlager N. Balance on the Brain: a randomised controlled trial evaluating the effect of a multimodal exercise programme on physical performance, falls, quality of life and cognition for people with mild cognitive impairment-study protocol. BMJ Open 2022; 12:e054725. [PMID: 35437246 PMCID: PMC9016395 DOI: 10.1136/bmjopen-2021-054725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Exercise and physical activity have been shown to improve cognition for people living with mild cognitive impairment (MCI). There is strong evidence for the benefits of aerobic exercise and medium evidence for participating in regular strength training for people with MCI. However, people living with MCI fall two times as often as those without cognitive impairment and the evidence is currently unknown as to whether balance training for people with MCI is beneficial, as has been demonstrated for older people without cognitive impairment. The aim of this study is to determine whether a balance-focused multimodal exercise intervention improves balance and reduces falls for people with MCI, compared with a control group receiving usual care. METHODS AND ANALYSIS This single blind randomised controlled trial (Balance on the Brain) will be offered to 396 people with MCI living in the community. The multimodal exercise intervention consists of two balance programmes and a walking programme to be delivered by physiotherapists over a 6-month intervention period. All participants will be followed up over 12 months (for the intervention group, this involves 6-month intervention and 6-month maintenance). The primary outcomes are (1) balance performance and (2) rate of falls. Physical performance, levels of physical activity and sedentary behaviour, quality of life and cognition are secondary outcomes. A health economic analysis will be undertaken to evaluate the cost-effectiveness of the intervention compared with usual care. ETHICS AND DISSEMINATION Ethics approval has been received from the South Metropolitan Health Service Human Research Ethics Committee (HREC), Curtin University HREC and the Western Australia Department of Health HREC; and approval has been received to obtain data for health costings from Services Australia. The results will be disseminated through peer-review publications, conference presentations and online platforms. TRIAL REGISTRATION NUMBER ACTRN12620001037998; Australian New Zealand Clinical Trials Registry (ANZCTR).
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Affiliation(s)
- Elissa Burton
- Curtin School of Allied Health, Curtin University-Perth City Campus, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Keith Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
| | - Kathryn A Ellis
- The Academic Unit for Psychiatry of Old Age, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne-Marie Hill
- School of Allied Health, Western Australian Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia
| | - Meggen Lowry
- Next Step Health, Brisbane, Queensland, Australia
| | - Rachael Moorin
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Joanne A McVeigh
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Angela Jacques
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Kirk I Erickson
- Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- College of Science, Health, Engineering, and Education, Murdoch University, Perth, Western Australia, Australia
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Joel Tate
- Department of Rehabilitation and Aged Care, Armadale Health Service, Armadale, Western Australia, Australia
| | - Sarah Bernard
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Geriatric Acute and Rehabilitation Medicine, Sir Charles Gairdner Hospital Group, Perth, Western Australia, Australia
| | - Carolyn F Orr
- Cognitive Clinic, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Luke Bongiascia
- Physiotherapy Department, Adult Community and Allied Health Directorate, Rockingham Peel Group, Rockingham, Western Australia, Australia
| | - Roger Clarnette
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Melanie L Clark
- Neurosciences Unit, North Metropolitan Health Service Mental Health, Public Health and Dental Services, Perth, Western Australia, Australia
| | - Shannon Williams
- Neurogenetic Clinic and Physiotherapy Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nicola Lautenschlager
- Academic Unit of Psychiatry of Old Age, University of Melbourne, Melbourne, Victoria, Australia
- NorthWestern Mental Health, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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11
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Xiang K, Liu Y, Sun L. Motoric Cognitive Risk Syndrome: Symptoms, Pathology, Diagnosis, and Recovery. Front Aging Neurosci 2022; 13:728799. [PMID: 35185512 PMCID: PMC8847709 DOI: 10.3389/fnagi.2021.728799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/14/2021] [Indexed: 12/20/2022] Open
Abstract
The motoric cognitive risk (MCR) syndrome is a pre-dementia condition, marked by the enhanced risk for Alzheimer's disease (AD) and vascular dementia, together with falls, disability, and abnormal movements. The research studies revealed the distinct neurological and non-neurological clinical gait irregularities during dementia and accelerated functional decline, such as postural and balance impairments, memory loss, cognitive failure, and metabolic dysfunctions. The disabling characteristics of MCR comprise altered afferent sensory and efferent motor responses, together with disrupted visual, vestibular, and proprioceptive components. The pathological basis of MCR relates with the frontal lacunar infarcts, white matter hyperintensity (WMH), gray matter atrophy in the pre-motor and pre-frontal cortex, abnormal cholinergic functioning, inflammatory responses, and genetic factors. Further, cerebrovascular lesions and cardiovascular disorders exacerbate the disease pathology. The diagnosis of MCR is carried out through neuropsychological tests, biomarker assays, imaging studies, questionnaire-based evaluation, and motor function tests, including walking speed, dual-task gait tests, and ambulation ability. Recovery from MCR may include cognitive, physical, and social activities, exercise, diet, nutritional supplements, symptomatic drug treatment, and lifestyle habits that restrict the disease progression. Psychotherapeutic counseling, anti-depressants, and vitamins may support motor and cognitive improvement, primarily through the restorative pathways. However, an in-depth understanding of the association of immobility, dementia, and cognitive stress with MCR requires additional clinical and pre-clinical studies. They may have a significant contribution in reducing MCR syndrome and the risk for dementia. Overall, the current review informs the vital connection between gait performance and cognition in MCR and highlights the usefulness of future research in the discernment and treatment of dementiating illness.
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12
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Efficacy and safety of donepezil for mild cognitive impairment: A systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 213:107134. [DOI: 10.1016/j.clineuro.2022.107134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/18/2022]
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13
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Racey M, Markle-Reid M, Fitzpatrick-Lewis D, Ali MU, Gagne H, Hunter S, Ploeg J, Sztramko R, Harrison L, Lewis R, Jovkovic M, Sherifali D. Fall prevention in community-dwelling adults with mild to moderate cognitive impairment: a systematic review and meta-analysis. BMC Geriatr 2021; 21:689. [PMID: 34893027 PMCID: PMC8665555 DOI: 10.1186/s12877-021-02641-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive impairment (CI) increases an individual's risk of falls due to the role cognition plays in gait control. Older adults with dementia fall 2-3 times more than cognitively healthy older adults and 60-80% of people with dementia fall annually. Practitioners require evidence-based fall prevention best practices to reduce the risk of falls in cognitively impaired adults living in the community. METHODS We conducted a systematic review and meta-analysis to identify the effectiveness of primary and secondary fall prevention interventions in reducing falls and fear of falling, and improving gait, balance, and functional mobility. We searched 7 databases for fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations, extracted data, and assessed risk of bias and certainty of evidence (GRADE). We assessed statistical and methodological heterogeneity and performed a meta-analysis of studies including subgroup analysis based on intervention and risk of bias groupings. RESULTS Five hundred nine community-dwelling adults (mean age 67.5 to 84.0 years) with mild to moderate CI from 12 randomized or clinical controlled trials (RCTs/CCTs) were included in this review. Eight studies were exercise interventions, 3 were multifactorial, and 1 provided medication treatment. Fall prevention interventions had significant effects of medium magnitude on fear of falling (standardized mean difference (SMD) -0.73 [- 1.10, - 0.36]), balance (SMD 0.66 [0.19, 1.12]), and functional mobility measured as Timed Up and Go test (SMD -0.56 [- 0.94, - 0.17]) and significant effects of small magnitude on gait control (SMD 0.26 [0.08, 0.43]) all with moderate certainty of evidence. The meta-analysis showed no significant effects for falls (number of events or falls incidence). Sub-analysis showed that exercise and low risk of bias studies remained significant for balance and perceived risk of falls. CONCLUSION The effect of fall prevention interventions on direct outcomes, such as falls, remains unclear in cognitively impaired individuals. Exercise interventions are effective at improving fall risk factors, however, high quality studies with longer follow-up and adequate sample sizes are needed to determine their effectiveness on falls directly. There remains a gap in terms of effective fall prevention interventions for older adults with CI.
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Affiliation(s)
- M Racey
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
| | - M Markle-Reid
- School of Nursing, Faculty of Health Sciences, McMaster University; and Scientific Director, Aging, Community and Health Research Unit, McMaster University, Hamilton, Canada
| | - D Fitzpatrick-Lewis
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - M U Ali
- McMaster Evidence Review and Synthesis Team and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - H Gagne
- Injury Prevention, Ontario Neurotrauma Foundation, Toronto, Canada
| | - S Hunter
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - J Ploeg
- School of Nursing, McMaster University and Aging, Community and Health Research Unit, McMaster University, Hamilton, Canada
| | - R Sztramko
- Geriatric Medicine, McMaster University, Hamilton, Canada
| | | | - R Lewis
- McMaster Evidence Review and Synthesis Team, Hamilton, Canada
| | - M Jovkovic
- McMaster Evidence Review and Synthesis Team, Hamilton, Canada
| | - D Sherifali
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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14
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Racey M, Markle-Reid M, Fitzpatrick-Lewis D, Ali MU, Gagné H, Hunter S, Ploeg J, Sztramko R, Harrison L, Lewis R, Jovkovic M, Sherifali D. Applying the RE-AIM implementation framework to evaluate fall prevention interventions in community dwelling adults with cognitive impairment: a review and secondary analysis. BMC Geriatr 2021; 21:441. [PMID: 34311700 PMCID: PMC8314446 DOI: 10.1186/s12877-021-02376-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cognitive impairment (CI) is a risk factor for falls due to environmental or living settings, balance, gait and vision impairments, as well as medications. While previous systematic reviews have focused on the effectiveness of fall prevention programs in adults with cognitive impairment, very limited information is available on their implementation. This review examines what aspects of fall prevention interventions for community-dwelling adults with CI have been reported using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to support successful implementation. METHODS We examined the included studies from our systematic review, which searched 7 databases for primary and secondary fall prevention interventions involving community-dwelling adults ≥50 years with mild to moderate CI. Reviewers screened citations and extracted data for study characteristics and the 5 dimensions (62 criteria) of the RE-AIM framework. RESULTS Twelve randomized or clinical controlled trials (RCTs/CCTs) consisting of 8 exercise interventions, 3 multifactorial interventions, and 1 medication treatment were included in the review. Only 4 of 62 criteria were reported by all 12 included studies and 29 criteria were not reported by any of the studies. Five of the included studies reported on 20 or more of the 62 possible RE-AIM criteria and 3 of these studies self-identified as "feasibility" studies. While Reach was the best-reported construct by the included studies, followed by Effectiveness and Implementation, the criteria within the Adoption and Maintenance constructs were rarely mentioned by these studies. In general, there was also wide variation in how each of the criteria were reported on by study authors. CONCLUSION Based on the reporting of RE-AIM components in this review, we are unable to make connections to successful intervention components and thus practice-based recommendations for fall prevention in those with CI. The lack of detail regarding implementation approaches greatly limits the interpretation and comparisons across studies to fully inform future research efforts.
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Affiliation(s)
- M Racey
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - M Markle-Reid
- School of Nursing, Faculty of Health Sciences, McMaster University; and Scientific Director, Aging, Community and Health Research Unit, McMaster University, Hamilton, Canada
| | - D Fitzpatrick-Lewis
- McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - M U Ali
- McMaster Evidence Review and Synthesis Team; and Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - H Gagné
- Prevention, Ontario Neurotrauma Foundation, Toronto, Canada
| | - S Hunter
- School of Physical Therapy, University of Western Ontario, London, Canada
| | - J Ploeg
- School of Nursing, Faculty of Health Sciences, McMaster University; and Aging, Community and Health Research Unit, McMaster University, Hamilton, Canada
| | - R Sztramko
- Geriatric Medicine, McMaster University, Hamilton, Canada
| | | | - R Lewis
- McMaster Evidence Review and Synthesis Team, Hamilton, Canada
| | - M Jovkovic
- McMaster Evidence Review and Synthesis Team, Hamilton, Canada
| | - D Sherifali
- Director, McMaster Evidence Review and Synthesis Team; and School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
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15
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Smith L, Jacob L, Kostev K, Butler L, Barnett Y, Pfeifer B, Soysal P, Grabovac I, López-Sánchez GF, Veronese N, Yang L, Oh H, Koyanagi A. Mild cognitive impairment is associated with fall-related injury among adults aged ≥65 years in low- and middle-income countries. Exp Gerontol 2020; 146:111222. [PMID: 33385480 DOI: 10.1016/j.exger.2020.111222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES There is a scarcity of data on the association between mild cognitive impairment (MCI) and falls, especially from low- and middle-income countries (LMICs) where 70% of all older adults reside. Thus, we investigated the association between MCI and fall-related injury among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa). DESIGN Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. METHODS The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria, and information on past 12-month fall-related injury was also collected. Multivariable logistic regression analysis was conducted to assess associations. RESULTS The analytical sample consisted of 13,623 individuals aged ≥65 years [mean (SD) age 72.3 (10.9) years; 45.6% males]. The prevalence of fall-related injury was higher among those with MCI (6.3%) vs. no MCI (4.1%). After adjustment for potential confounders, MCI was associated with a 1.53 (95%CI = 1.12-2.07) times higher odds for fall-related injury. CONCLUSIONS MCI was associated with higher odds for fall-related injury among older adults in LMICs. Future studies are warranted to investigate the mechanisms underlying this association and to elucidate whether targeting those with MCI can lead to reduced risk for falls among older adults.
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Affiliation(s)
- Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux 78180, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain
| | | | - Laurie Butler
- Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | | | - Briona Pfeifer
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Guillermo F López-Sánchez
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada; Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Hans Oh
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, 08830 Barcelona, Spain; ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
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16
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Physical Therapy for Gait, Balance, and Cognition in Individuals with Cognitive Impairment: A Retrospective Analysis. Rehabil Res Pract 2020; 2020:8861004. [PMID: 33204533 PMCID: PMC7655244 DOI: 10.1155/2020/8861004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives The purpose of this study was to determine if a pragmatic physical therapy (PT) program was associated with improved cognition, gait, and balance in individuals with cognitive impairment. This study investigated these associations for individuals with Alzheimer disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and mild cognitive impairment (MCI) in order to better characterize outcomes to PT for each diagnostic group. Methods Data before and after one month of physical therapy were extracted from patient records (67 with AD, 34 with VaD, 35 with DLB, and 37 with MCI). The mean number of PT sessions over a month was 3.4 (±1.8). Outcomes covered the domains of gait, balance, and cognition with multiple outcomes used to measure different constructs within the balance and gait domains. Results All groups showed improvements in balance and at least one gait outcome measure. Those with MCI improved in every measure of gait and balance performance. Lastly, cognition as measured by Montreal Cognitive Assessment improved in individuals in the AD, VaD, and MCI groups. Conclusion While this retrospective analysis is not appropriate for causal inference, results of one month of physical therapy were associated with decreases in gait, balance, and cognitive impairment in individuals with AD, VaD, DLB<, and MCI. Clinical Implications. While physical therapy is not typically a primary treatment strategy for individuals with cognitive impairment, the results of this study are consistent with the literature that demonstrates improvement from physical therapy for other neurodegenerative diseases. Further clinical and research exploration for physical therapy as a primary treatment strategy in these populations is warranted.
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17
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Mancioppi G, Fiorini L, Rovini E, Cavallo F. The use of Motor and Cognitive Dual-Task quantitative assessment on subjects with mild cognitive impairment: A systematic review. Mech Ageing Dev 2020; 193:111393. [PMID: 33188785 DOI: 10.1016/j.mad.2020.111393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
Dementia and Alzheimer's Disease (AD) represent a health emergency. The identification of valid and noninvasive markers to identify people with Mild Cognitive Impairment (MCI) is profoundly advocated. This review outlines the use of quantitative Motor and Cognitive Dual-Task (MCDT) on MCI, by technologies aid. We describe the framework and the most valuable researches, displaying the adopted protocols, and the available technologies. PubMed Central, Web of Science, and Scopus were inspected between January 2010 and May 2020. 1939 articles were found in the initial quest. Exclusion criteria allowed the selection of the most relevant papers; 38 papers were included. The articles, regarding four technological solutions "wearable sensors", "personal devices", "optokinetic systems", and "electronic walkways", are organized into three categories: "Quantitative MCDT", "MCDT Inspired by Neuropsychological Test", and "MCDT for MCI Stimulation". MCDT might furnish clinical landmarks, supplying aid for disease stratication, risk prediction, and intervention optimization. Such protocols could foster the use of data mining and machine learning techniques. Notwithstanding, there is still a need to standardize and harmonize such protocols.
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Affiliation(s)
- Gianmaria Mancioppi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Laura Fiorini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Erika Rovini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Filippo Cavallo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (PI), 56025 Pisa, Italy; Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy; Department of Industrial Engineering, University of Florence, Via Santa Marta 3, 50139 Florence, Italy.
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18
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Chebotareva AD, Levin OS. [Practical aspects of using donepezil in the treatment of dementia]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:137-143. [PMID: 33081459 DOI: 10.17116/jnevro2020120091137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Donepezil is the most commonly used drug of the group of cholinesterase inhibitors. It is recommended for tretament of Alzheimer's disease. Donepezil is also used to treat dementia in Lewy body disease, Parkinson's disease with dementia, and vascular dementia. In Russia, donepezil is not used as often, which is facilitated by the concern of doctors about the possibility of serious side-effects. Clinical studies demonstrate the safety and good tolerability of donepezil. Our study included 62 patients with dementia due to various neurodegenerative diseases (Alzheimer's disease, Lewy body disease, Parkinson's disease with dementia). Thirty-seven patients (59.7%) started to receive donepezil. Side-effects, including bradycardia, hypertension, aggressive behavior, increased tremor, were observed in 7 patients (18.9%). There was no correlation between the development of side-effects and polymorphisms of the CYP2D6 and MDR1 genes.
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Affiliation(s)
- A D Chebotareva
- Russian Medicl Academy of Continuing Professional Education, Moscow, Russia
| | - O S Levin
- Russian Medicl Academy of Continuing Professional Education, Moscow, Russia
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Lin YY, Guo SJ, Quan H, Zhao YX, Huang DY. Donepezil Improves Gait Performance in Patients with an Acute Cerebral Infarction: A Prospective Observational Cohort Study. Curr Neurovasc Res 2020; 17:304-311. [PMID: 32282302 DOI: 10.2174/1567202617666200413130101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022]
Abstract
Background:
Hemiplegia is a common symptom after acute cerebral infarction.
Objective:
This study aimed to explore the influence factors of gait performance and investigate
whether donepezil could improve gait performance in patients with an acute cerebral infarction.
Methods:
A total of 107 patients who experienced unilateral paresis after an acute cerebral infarction
incident were enrolled in this prospectively observational study. Participants underwent a 3-
month assessment. At the study's conclusion, patients were divided into 2 groups-those who received
donepezil daily (observation Group) and those who did not (Control Group).
Results:
There was a significant difference (t=3.269, P=0.001) of Wisconsin Gait Scale (WGS)
score between single site infarction (27.11±6.65) and multiple sites infarction (31.54±6.42). For
gender, smoking, drinking, hypertension, hyperlipidemia and diabetes, there was no difference in
WGS scores between subgroups (P>0.05), respectively. The patient's admission National Institute
of Health Stroke Scale(NIHSS) score had a strongly positive correlation with WGS score (r=0.850,
P<0.001). Besides, age (r=0.218, P=0.024), glycosylated hemoglobin (r=0.274, P=0.004), MMSE
(r=-0.261, P=0.007) and Montreal Cognitive Assessment (MoCA) (r=-0.272, P=0.005) had a weak
correlation with WGS scores. Multivariate analysis showed age (95% CI: 0.042~0.188, P=0.002),
admission NIHSS score (95% CI: 2.405~3.137, P<0.001) and multiple sites infarction (95% CI:
0.044~2.983, P=0.044) were independent risk factors of WGS scores. WGS scores of both observation
and control groups gradually decreased after admission (P<0.001). At 3 months after admission,
WGS score of the observation group was significantly lower than the control group
(t=2.468, P=0.015). There were no significant differences between observation and control group
at admission and 1 month after admission (P>0.05) and WGS scores of both single site and multiple
sites infarction gradually decreased at one month and three months after admission (P<0.001),
while there was no significant difference between two groups (P>0.05).
Conclusion:
Admission NIHSS score, age and multiple sites infarction were independent risk factors
of WGS score. Donepezil could improve gait performance in patients with acute cerebral infarction.
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Affiliation(s)
- Ying-Ying Lin
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Shi-Jie Guo
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Hui Quan
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Yan-Xin Zhao
- Department of Neurology, Tongji University School of Medicine, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai 200072, China
| | - Dong-Ya Huang
- Department of Neurology, Tongji University School of Medicine, East Hospital, 150 Jimo Road, Shanghai 200120, China
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20
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Matsunaga S, Fujishiro H, Takechi H. Efficacy and Safety of Cholinesterase Inhibitors for Mild Cognitive Impairment:A Systematic Review and Meta-Analysis. J Alzheimers Dis 2020; 71:513-523. [PMID: 31424411 DOI: 10.3233/jad-190546] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The clinical benefit of cholinesterase inhibitors (ChEIs) for mild cognitive impairment (MCI) remains inconclusive. OBJECTIVE We performed a systematic review and meta-analysis of the efficacy/safety of ChEIs on subjects with MCI. METHODS We included randomized controlled trials (RCTs) of ChEIs in subjects with MCI, using cognitive function scores as a primary outcome measure. RESULTS Fourteen RCTs (six using donepezil, four using galantamine, and four using rivastigmine) with 5,278 subjects were included. We found no significant difference in cognitive function scores between the ChEIs and placebo groups [standardized mean difference (SMD) = -0.06, p = 0.38, I2 = 76% ]. However, in the secondary outcomes, ChEIs were associated with a lower incidence of progression to dementia compared with placebo (risk ratio = 0.76, the number needed to treat = 20). For safety outcomes, ChEIs were associated with a lower prevalence of fall than placebo. On the other hand, compared with placebo, ChEIs were associated with a higher incidence of discontinuation due to all causes, discontinuation due to adverse events, at least one adverse event, abnormal dreams, diarrhea, dizziness, headache, insomnia, loose stools, muscle cramps, nausea, vomiting, and weight loss. CONCLUSIONS Although ChEIs have a slight efficacy in the treatment of MCI, there are many safety issues. Therefore, ChEIs are difficult to recommend for MCI. However, the efficacy and safety of ChEIs on MCI with a biomarker-based diagnosis is unclear. Further RCTs are needed to confirm the efficacy and safety of ChEIs when used for individual neuropathological classifications of MCI.
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Affiliation(s)
- Shinji Matsunaga
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Kutsukake, Toyoake, Aichi, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Kawasaki Memorial Hospital, Miyamae, Kawasaki, Kanagawa, Japan
| | - Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Kutsukake, Toyoake, Aichi, Japan
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Lord S, Moyes S, Teh R, Port W, Muru-Lanning M, Bacon CJ, Wilkinson T, Kerse N. Gait, cognition and falls over 5 years, and motoric cognitive risk in New Zealand octogenarians: Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ. BMC Geriatr 2020; 20:43. [PMID: 32024482 PMCID: PMC7003444 DOI: 10.1186/s12877-020-1420-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/08/2020] [Indexed: 01/08/2023] Open
Abstract
Background Understanding falls risk in advanced age is critical with people over 80 a rapidly growing demographic. Slow gait and cognitive complaint are established risk factors and together comprise the Motoric Cognitive Risk Syndrome (MCR). This study examined trajectories of gait and cognition and their association with falls over 5 years, and documented MCR in Māori and non-Māori of advanced age living in New Zealand. Method Falls frequency was ascertained retrospectively at annual assessments. 3 m gait speed was measured and cognition was assessed using the Modified Mini-Mental Status Examination (3MS). Frequency of MCR was reported. Gait and cognition trajectories were modelled and clusters identified from Latent Class Analysis. Generalised linear models examined association between changes in gait, cognition, MCR and falls. Results At baseline, 138 of 408 Māori (34%) and 205 of 512 non-Māori (40%) had fallen. Mean (SD) gait speed (m/s) for Māori was 0.66 (0.29) and 0.82 (0.26) for non-Māori. Respective 3MS scores were 86.2 (15.6) and 91.6 (10.4). Ten (4.3%) Maori participants met MCR criteria, compared with 7 (1.9%) non-Māori participants. Māori men were more likely to fall (OR 1.56; 95% CI 1.0–2.43 (P = 0.04) whilst for non-Māori slow gait increased falls risk (OR 0.40; 95% CI 0.24–0.68(P < 0.001). Non-Māori with MCR were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06–5.68 (P = 0.03). Conclusions Māori and non-Māori of advanced age show a mostly stable pattern of gait and cognition over time. Risk factors for falls differ for Māori, and do not include gait and cognition.
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Affiliation(s)
- Sue Lord
- Health & Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, 1142, New Zealand.
| | - Simon Moyes
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Tamaki Campus, Auckland, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Tamaki Campus, Auckland, New Zealand
| | - Waiora Port
- James Henare Māori Research Centre, University of Auckland, Auckland, New Zealand
| | - Marama Muru-Lanning
- James Henare Māori Research Centre, University of Auckland, Auckland, New Zealand
| | - Catherine J Bacon
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Tamaki Campus, Auckland, New Zealand
| | | | - Ngaire Kerse
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Sciences, University of Auckland, Tamaki Campus, Auckland, New Zealand
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22
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Pieruccini‐Faria F, Sarquis‐Adamson Y, Anton‐Rodrigo I, Noguerón‐García A, Bray NW, Camicioli R, Muir‐Hunter SW, Speechley M, McIlroy B, Montero‐Odasso M. Mapping Associations Between Gait Decline and Fall Risk in Mild Cognitive Impairment. J Am Geriatr Soc 2019; 68:576-584. [DOI: 10.1111/jgs.16265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Frederico Pieruccini‐Faria
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and DentistryUniversity of Western Ontario London Ontario Canada
| | - Yanina Sarquis‐Adamson
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
| | - Ivan Anton‐Rodrigo
- Department of Geriatric MedicineMatia Fundazioa, Hospital Ricardo Bermingham San Sebastian Spain
| | | | - Nick W. Bray
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Faculty of Health SciencesSchool of Kinesiology, University of Western Ontario London Ontario, Canada
| | - Richard Camicioli
- Faculty of Health Sciences, School of Physical TherapyUniversity of Western Ontario London Ontario Canada
| | - Susan W. Muir‐Hunter
- Faculty of Health Sciences, School of Physical TherapyUniversity of Western Ontario London Ontario Canada
| | - Mark Speechley
- Department of Epidemiology and BiostatisticsUniversity of Western Ontario London Ontario Canada
| | - Bill McIlroy
- Department of KinesiologyUniversity of Waterloo Waterloo Ontario Canada
| | - Manuel Montero‐Odasso
- Gait and Brain LaboratoryParkwood Institute and Lawson Health Research InstituteUniversity of Western Ontario London Ontario Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and DentistryUniversity of Western Ontario London Ontario Canada
- Faculty of Health SciencesSchool of Kinesiology, University of Western Ontario London Ontario, Canada
- Division of Neurology, Department of MedicineUniversity of Alberta Edmonton Alberta Canada
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23
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Chebotareva AD, Dudchenko NG. [The use of donepezil in gait disorders in eldery patients with dementia]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:56-59. [PMID: 31825391 DOI: 10.17116/jnevro201911909256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Donepezil is the most commonly used cholinesterase inhibitor. The indication for its use is Alzheimer's disease. A number of clinical studies have shown its effectiveness in vascular dementia, dementia with Lewy bodies, Parkinson's disease with dementia, dementia due to traumatic brain injury. It is shown that dementia is a risk factor for falls, and standard measures to prevent falls in the elderly are ineffective in patients with cognitive impairment. This article provides a review of publications on the influence of donepezil on gait and balance. Most authors agree that donepezil is able to improve some parameters of gait, such as gait velocity and stride time variability, which can increase stability and reduce the risk of falls. The effect of donepezil on motor function is small, but its use may be particularly valuable if other approaches to treatment of gait disorders in patients with cognitive impairment are ineffective.
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Affiliation(s)
- A D Chebotareva
- Russian Academy for Continuing Professional Education, Moscow, Russia
| | - N G Dudchenko
- Russian Academy for Continuing Professional Education, Moscow, Russia
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24
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Marino FR, Lessard DM, Saczynski JS, McManus DD, Silverman-Lloyd LG, Benson CM, Blaha MJ, Waring ME. Gait Speed and Mood, Cognition, and Quality of Life in Older Adults With Atrial Fibrillation. J Am Heart Assoc 2019; 8:e013212. [PMID: 31735113 PMCID: PMC6915300 DOI: 10.1161/jaha.119.013212] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Low gait speed has been linked with impaired mood, cognition, and quality of life (QOL) in older adults. We examined whether low gait speed was associated with impaired mood, cognition, and QOL among older adults with atrial fibrillation (AF). Methods and Results Participants (n=1185) had a diagnosis of AF, aged ≥65 years, CHA2DS2VASc ≥2 and had no contraindications to anticoagulation. Participants completed a 15‐foot walk test, and low gait speed was categorized using cutoffs from the Fried Frailty Index. Participants self‐reported measures of depressive symptoms (Patient Health Questionnaire 9 ≥10), anxiety symptoms (Generalized Anxiety Disorder 7 ≥10), cognitive impairment (Montreal Cognitive Assessment ≤23), and potentially impaired Atrial Fibrillation Effect Quality‐of‐Life Questionnaire <80. Participants were on average aged 75.3 (SD: 7.0) years, 48.0% were women, and 85.5% were non‐Hispanic white; 85.6% were taking an oral anticoagulant, 26.1% had low gait speed, 8.4% had elevated depressive symptoms, 5.7% had elevated anxiety symptoms, 41.1% were cognitively impaired, and 41.6% had potentially impaired AF‐related QOL. Participants with low gait speed were significantly more likely to have elevated depressive symptoms (adjusted odds ratio: 2.1, 95% CI: 1.3–3.4), elevated anxiety symptoms (adjusted odds ratio: 2.2, 95% CI: 1.2–3.9), and cognitive impairment (adjusted odds ratio: 1.5, 95% CI: 1.1–2.1). Impaired AF‐related QOL did not differ by gait speed after adjustment for clinical characteristics (adjusted odds ratio: 1.1, 95% CI: 0.8–1.5). Conclusions Twenty‐six percent of older adults with AF had low gait speed, and low gait speed was associated with impaired mood and cognition. Further research is needed to determine whether declines in gait speed lead to impaired mood and cognition or whether these conditions develop concurrently.
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Affiliation(s)
- Francesca R Marino
- Division of Cardiology Department of Medicine University of Massachusetts Medical School Worcester MA
| | - Darleen M Lessard
- Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Jane S Saczynski
- Department of Pharmacy and Health System Sciences Northeastern University Boston MA
| | - David D McManus
- Division of Cardiology Department of Medicine University of Massachusetts Medical School Worcester MA.,Department of Population and Quantitative Health Sciences University of Massachusetts Medical School Worcester MA
| | - Luke G Silverman-Lloyd
- University of California, Berkeley - University of California, San Francisco Joint Medical Program UC Berkeley School of Public Health Berkeley CA.,Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | | | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
| | - Molly E Waring
- Department of Allied Health Sciences University of Connecticut Storrs CT
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25
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Yang GJ, Liu H, Ma DL, Leung CH. Rebalancing metal dyshomeostasis for Alzheimer's disease therapy. J Biol Inorg Chem 2019; 24:1159-1170. [PMID: 31486954 DOI: 10.1007/s00775-019-01712-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
Abstract
Alzheimer's disease (AD) is a type of neurodegenerative malady that is associated with the accumulation of amyloid plaques. Metal ions are critical for the development and upkeep of brain activity, but metal dyshomeostasis can contribute to the development of neurodegenerative diseases, including AD. This review highlights the association between metal dyshomeostasis and AD pathology, the feasibility of rebalancing metal homeostasis as a therapeutic strategy for AD, and a survey of current drugs that action via rebalancing metal homeostasis. Finally, we discuss the challenges that should be overcome by researchers in the future to enable the practical use of metal homeostasis rebalancing agents for clinical application.
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Affiliation(s)
- Guan-Jun Yang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, 999078, Macau SAR, China
| | - Hao Liu
- Department of Chemistry, Hong Kong Baptist University, Kowloon, 999077, Hong Kong SAR, China
| | - Dik-Lung Ma
- Department of Chemistry, Hong Kong Baptist University, Kowloon, 999077, Hong Kong SAR, China.
| | - Chung-Hang Leung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, 999078, Macau SAR, China.
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26
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Grande G, Triolo F, Nuara A, Welmer AK, Fratiglioni L, Vetrano DL. Measuring gait speed to better identify prodromal dementia. Exp Gerontol 2019; 124:110625. [PMID: 31173841 DOI: 10.1016/j.exger.2019.05.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/25/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
Slow gait speed has been shown to predict incident dementia and cognitive decline in older individuals. We aimed to summarize the evidence concerning the association of slow gait speed with cognitive decline and dementia, and discuss the possible shared pathways leading to cognitive and motor impairments, under the unifying hypothesis that body and mind are intimately connected. This is a scoping review supported by a systematic search of the literature, performed on PubMed and Web of Science. Longitudinal studies providing information on the role of gait speed in the prediction of cognitive decline and dementia in cognitively intact people and in those with initial cognitive impairment were eligible. Of 39 studies selected, including overall 57,456 participants, 33 reported a significant association between gait speed and cognitive outcomes, including dementia. Neurodegenerative pathology and cerebrovascular burden may damage cerebral areas involved in both cognitive functions and motor control. At the same time, systemic conditions, characterized by higher cardiorespiratory, and metabolic and inflammatory burden, can affect a number of organs and systems involved in motor functions, including the brain, having ultimately an impact on cognition. The interplay of body and mind seems relevant during the development of cognitive decline and dementia. The measurement of gait speed may improve the detection of prodromal dementia and cognitive impairment in individuals with and without initial cognitive deficits. The potential applicability of such a measure in both clinical and research settings points at the importance of expanding our knowledge about the common underlying mechanisms of cognitive and motor decline.
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Affiliation(s)
- Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Arturo Nuara
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy; Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, Parma, Italy
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Allied Health Professionals, Function Area Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy.
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