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doi: 10.1002/gps.4524pmid: N/A
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doi: 10.1002/gps.4399pmid: 26679687
Objective The advent of second‐generation antipsychotics (SGAs) in the 1990s brought optimism that neuroleptic‐induced tardive dyskinesia (TD) may become relegated to history. Whether or not this is the case remains inconclusive, and this review aims to compare the risk of TD in older adults treated with first‐generation antipsychotics (FGAs) versus SGAs. Methods Relevant papers were sourced via a range of electronic databases, with a date range from 1957 to January 2015. Included studies used both a validated rating scale and research diagnostic criteria to report on the prevalence or incidence of TD in older adults exposed to antipsychotic medications. Results For FGAs, the prevalence estimate was 53% (95% confidence interval (CI) (39.0, 68.4)) for mild TD and 38% (95% CI (25.9, 50.3)) for probable TD. Incidence estimates for probable TD with FGAs were 23% (95% CI (15.3, 30.6)) at 1 year, 42% (95% CI (24.8, 58.4)) at 2 years and 57% (95% CI (45.3, 69.1)) at 3 years. For SGAs, the incidence estimates at 1 year were 7% (95% CI (4.4, 10.2)) for probable TD and 3% (95% CI (1.5, 4.2)) for persistent TD. Conclusions The risk of probable TD is more than three times lower in older adults receiving SGAs in comparison with FGAs after 1 year of treatment (23% vs 7%). The risk of persistent TD at 1 year with SGAs is particularly low. Evidence is lacking in regard to the longer‐term risk of TD with SGAs, although the rates associated with the prolonged use of FGAs are high. Caution is therefore still required, particularly with the protracted use of both FGAs and SGAs.
Foley, Kevin; Konetzka, R. Tamara; Bunin, Anthony; Yonan, Charles
doi: 10.1002/gps.4374pmid: 26526856
Objective Pseudobulbar affect (PBA) is a neurological disorder of emotional expression, characterized by uncontrollable episodes of crying or laughing in patients with certain neurological disorders affecting the brain. The purposes of this study were to estimate the prevalence of PBA in US nursing home residents and examine the relationship between PBA symptoms and other clinical correlates, including the use of psychopharmacological medications. Methods A retrospective study was conducted between 2013 and 2014 with a convenience sample of residents from nine Michigan nursing homes. Chronic‐care residents were included in the “predisposed population” if they had a neurological disorder affecting the brain and no evidence of psychosis, delirium, or disruptive behavior (per chart review). Residents were screened for PBA symptoms by a geropsychologist using the Center for Neurologic Study‐Lability Scale (CNS‐LS). Additional clinical information was collected using a diagnostic evaluation checklist and the most recent Minimum Data Set 3.0 assessment. Results Of 811 residents screened, complete data were available for 804, and 412 (51%) met the criteria for the “predisposed population.” PBA symptom prevalence, based on having a CNS‐LS score ≥13, was 17.5% in the predisposed population and 9.0% among all nursing home residents. Those with PBA symptoms were more likely to have a documented mood disorder and be using a psychopharmacological medication, including antipsychotics, than those without PBA symptoms. Conclusions Pseudobulbar affect symptoms were present in 17.5% of nursing home residents with neurological conditions, and 9.0% of residents overall. Increasing awareness and improving diagnostic accuracy of PBA may help optimize treatment. Copyright © 2015 John Wiley & Sons, Ltd.
Peisah, Carmelle; Bhatia, Sangita; Macnab, Jenna; Brodaty, Henry
doi: 10.1002/gps.4379pmid: 26559928
Objective Financial abuse is the most common form of elder abuse. Capacity Australia, established to promote education regarding capacity and abuse prevention across health, legal and financial sectors, was awarded a grant by the Dementia Collaborative Research Centre to educate the banking sector on financial abuse and dementia. We aimed to develop a knowledge translation tool for bank staff on this issue. Methods The banking sector across Australia was engaged and consulted to develop a tailored education tool based on Australian Banking Association's Guidelines on Financial Abuse Prevention, supplemented by information related to dementia, financial capacity and supported decision‐making. The tool was tested on 69 banking staff across Australia from two major banks. Results An online education tool using adaptive learning was developed, comprising a pretest of 15 multiple choice questions, followed by a learning module tailored to the individual's performance on the pretest, and a post‐test to assess knowledge translation. A significant increase in scores was demonstrated when baseline scores were compared with post‐course scores (mean difference in scores = 3.5; SD = 1.94; t = 15.1; df = 68; p < 0.001). The tool took approximately 10–20 min to complete depending on the knowledge of participant and continuity of completion. Conclusions The Australian banking industry was amenable to assist in the development of a tailored education tool on dementia, abuse and financial capacity. This online e‐tool provides an effective medium for knowledge translation. Copyright © 2015 John Wiley & Sons, Ltd.
Lohman, Matthew C.; Raue, Patrick J.; Greenberg, Rebecca L.; Bruce, Martha L.
doi: 10.1002/gps.4381pmid: 26552852
Objectives The study evaluated the effectiveness of a depression care management intervention in reducing suicidal ideation (SI) among home health patients. Methods Data come from the cluster‐randomized effectiveness trial of the Depression Care for Patients at Home (Depression CAREPATH), an intervention that integrates depression care management into the routine nursing visits of Medicare home health patients screening positive for depression. Patients were interviewed at baseline, 3, 6, and 12‐month follow‐up. SI was measured using the Hamilton Rating Scale for Depression item. We compared likelihood of any level of SI between intervention and usual care patients using longitudinal logistic mixed‐effects models. Results A total of 306 eligible patients enrolled in the trial. Among them, 70 patients (22.9%) reported SI at baseline. Among patients with SI, patients under the care of nurses randomized to CAREPATH were less likely to report SI over the study period (odds ratio = 0.51, 95% CI; 0.24–1.07), with 63.6% of usual care versus 31.3% of CAREPATH participants continuing to report SI after one year. Baseline major depression, greater perceived burdensomeness, and greater functional disability were associated with greater likelihood of SI. Conclusion SI is reported in more than 10% of Medicare home health patients. The Depression CAREPATH intervention was associated with a reduction in patients reporting SI at one year, compared to enhanced usual care. Given relative low burden on nursing staff, depression care management may be an important component of routine home health practices producing long‐term reduction in SI among high‐risk patients. Copyright © 2015 John Wiley & Sons, Ltd.
Yeh, Yi‐Chun; Huang, Mei‐Feng; Hwang, Shang‐Jyh; Tsai, Jer‐Chia; Liu, Tai‐Ling; Hsiao, Shih‐Ming; Yang, Yi‐Hsin; Kuo, Mei‐Chuan; Chen, Cheng‐Sheng
doi: 10.1002/gps.4383pmid: 26553116
Choe, Young Min; Kim, Ki Woong; Jhoo, Jin Hyeong; Ryu, Seung Ho; Seo, Eun Hyun; Sohn, Bo Kyung; Byun, Min Soo; Bak, Jae‐Hwa; Lee, Jong‐Min; Yun, Hyuk Jin; Han, Myeong‐il; Woo, Jong Inn; Lee, Dong Young
Osone, Akira; Arai, Reiko; Hakamada, Rina; Shimoda, Kazutaka
doi: 10.1002/gps.4386pmid: 26593034
Objective The objective of the study is to investigate whether the lifestyle‐related disease (LSRD) hypertension, type II diabetes mellitus, and lipid abnormality are associated with conversion and reversion in patients with mild cognitive impairment (MCI) over 12 months of follow‐up. Methods One hundred and thirteen patients with MCI were prospectively enrolled and longitudinally assessed. Methods used include mini‐mental state examination, the Japanese version of the cognitive subscale of the Alzheimer's Disease Assessment Scale, the Clinical Dementia Rating, the Frontal Assessment Battery, the Neuropsychiatric Inventory, magnetic resonance imaging, and quantitative single‐photon emission computed tomography. In addition, laboratory examinations of glucose and lipids were also performed. All measurements were performed at first intake and again at the end of the 12‐month follow‐up. Conversion was identified as a change in Clinical Dementia Rating from 0.5 to 1 and reversion as a change from 0.5 to 0. Results Patients with MCI with reversion had lower comorbid lipid abnormality at baseline and higher cognitive and behaviour function across the 12‐month follow‐up compared with those with no change or conversion. Patients without comorbid LSRD had lower systolic pressure and lower glucose and triglyceride levels at baseline, as well as less cognitive decline compared with other groups across the follow‐up period. Conclusions The absence of lipid abnormality at baseline may contribute to reversion in patients with MCI. The presence of multiple LSRD was associated with cognitive decline. Our results highlight the contribution of multiple LSRD on increasing conversion and decreasing reversion in patients with MCI. Copyright © 2015 John Wiley & Sons, Ltd.
Showing 1 to 10 of 20 Articles
Objective Smoking is a well‐established public health issue, which has not been examined previously among the elderly in Singapore. This paper describes and identifies the current prevalence and predictors of tobacco use among the older resident population. Methods Data were derived from the Well‐being of the Singapore Elderly study, a cross‐sectional epidemiological study of the elderly in Singapore. Sociodemographic data from 2565 Singapore residents aged 60 years and above were collected through face‐to‐face interviews. Multinomial logistic regression analyses identified predictors of tobacco use. Results A total of 236 respondents were current tobacco users (9.5%). The majority of older tobacco users were men (88.1%). Significant predictors of tobacco use were gender, marital status, and education level. Younger age (60–74 years old) was associated with more tobacco use, and the completion of tertiary education with lower rates of use. Conclusions Smoking prevalence among the elderly was lower than that of the Singapore general adult population (16%). However, the rate is still high and is of concern given the likelihood of a higher rate of physical disorders, which could be worsened with tobacco use. The identification of those at risk enables them to be targeted for smoking cessation programs and other interventions. Copyright © 2015 John Wiley & Sons, Ltd.
Objectives Patients with chronic kidney disease (CKD) have been found to have cognitive impairment. However, the core features and clinical correlates of cognitive impairment are still unclear. Elevated homocysteine levels are present in CKD, and this is a risk factor for cognitive impairment and vascular diseases in the general population. Thus, this study investigated the core domains of cognitive impairment and investigated the associations of homocysteine level and vascular burden with cognitive function in patients with CKD. Methods Patients with CKD aged ≥ 50 years and age‐ and sex‐matched normal comparisons were enrolled. The total fasting serum homocysteine level was measured. Vascular burden was assessed using the Framingham Cardiovascular Risk Scale. Cognitive function was evaluated using comprehensive neuropsychological tests. Results A total of 230 patients with CKD and 92 comparisons completed the study. Memory impairment and executive dysfunction were identified as core features of cognitive impairment in the CKD patients. Among the patients with CKD, higher serum homocysteine levels (β = −0.17, p = 0.035) and higher Framingham Cardiovascular Risk Scale scores (β = −0.18, p = 0.013) were correlated with poor executive function independently. However, an association with memory function was not noted. Our results showed that an elevated homocysteine level and an increased vascular burden were independently associated with executive function, but not memory, in CKD patients. Conclusions This findings suggested the co‐existence of vascular and non‐vascular hypotheses regarding executive dysfunction in CKD patients. Meanwhile, other risk factors related to CKD itself should be investigated in the future. Copyright © 2015 John Wiley & Sons, Ltd.
doi: 10.1002/gps.4384pmid: 26553313
Objectives A series of preclinical studies have suggested that selective serotonin reuptake inhibitor antidepressants not only stimulate neurogenesis but also have neuroprotective effects. The present study primarily aimed to investigate whether escitalopram would decelerate the brain atrophy of patients with mild‐to‐moderate Alzheimer's disease (AD). We also assessed the effects of escitalopram on the cognitive function and neuropsychiatric symptoms of these participants. Methods Seventy‐four probable AD patients without major depression were recruited from four dementia clinics of university hospitals and randomly assigned in a 1:1 ratio. Each group received 20 mg/day of escitalopram or placebo for 52 weeks. The primary outcome measures were the change rates of hippocampal and whole brain volume on magnetic resonance imaging for 52 weeks. The Alzheimer's Disease Assessment Scale—cognitive subscale, Mini‐Mental State Examination, Neuropsychiatric Inventory, and Cornell Scale for Depression in Dementia (CSDD) were also applied. Results We did not find any significant differences in the changes of hippocampal or whole brain volume between the groups. Escitalopram showed significant beneficial effects on the CSDD score at 28 weeks compared with placebo (t = −2.17, df = 50.42, p = 0.035), but this finding did not persist throughout the study. Conclusion The findings of the present study do not support the role of escitalopram as a progression‐delaying treatment for AD. However, the negative results of the present trial should be interpreted cautiously because of the relatively small sample size. Further large‐scale escitalopram trials targeting the earlier stages of AD, even prodromal AD, are still needed. Copyright © 2015 John Wiley & Sons, Ltd.