"iDoctor – Medical Blog"

Publication year: 2011
Source: The American Journal of Geriatric Pharmacotherapy, In Press, Corrected Proof, Available online 30 July 2011

Jo-Anne, Clarke , Murray, Cutler , Inna, Gong , Ute I., Schwarz , David, Freeman , …

 Background: The cytochrome P450 (CYP) 2D6 enzyme is involved in the metabolism of many drugs used by the elderly population. Variations in its activity can lead to altered drug response. However, few studies on the activity of this enzyme system have enrolled the elderly population. Objective: The goal of this pilot study was to assess the feasibility of in vivo phenotyping of CYP2D6 in an elderly population with dementia and to determine if part of the variability in response to treatment with galantamine is attributable to CYP2D6 phenotype. Methods: Patients with dementia attending geriatric clinics and receiving galantamine treatment for at least 6 months were…

Publication year: 2011
Source: The American Journal of Geriatric Pharmacotherapy, In Press, Corrected Proof, Available online 16 July 2011

Irving H., Gomolin , Candace, Smith , Thomas M., Jeitner

 Background: Cholinesterase inhibitors are indicated for the treatment of Alzheimer-type dementia. There are few direct comparative studies of adverse effects or studies to suggest clinical superiority of one inhibitor over the others. Objective: The objective of this study was to relate pharmacokinetic differences among the agents to potential clinical considerations. Methods: Population pharmacokinetics were obtained from US Food and Drug Administration–approved label information and published literature. Plasma concentration–time profiles were derived from these parameters using noncompartmental pharmacokinetic modeling. Results: Plasma concentration profiles differed significantly among different agents and between different formulations of the same agent. Conclusions: The initial choice among the various cholinesterase inhibitors requires consideration to adherence and…

Publication year: 2011
Source: The American Journal of Geriatric Pharmacotherapy, In Press, Corrected Proof, Available online 16 July 2011

Danielle M., Stitt , David P., Elliott , Stephanie N., Thompson

Background: It has been reported that 14.1% of geriatric patients experience ≥1 medication discrepancies after hospitalization. Objective: The goal of this study was to identify and characterize discharge medication list discrepancies among geriatric patients and to describe characteristics associated with discrepancies. Methods: An institutional review board–approved retrospective review was conducted of patients aged ≥65 years discharged from hospitalist and internal medicine services at a large tertiary care hospital from August 2008 to December 2009. A random cohort of 200 patients was selected and categorized by age, gender, attending medical service, and the absence or presence of a pharmacist on the service. Medication lists were…

We examined whether errorless learning (EL) and learning by modeling (LM) were more advantageous than trial and error learning (TEL) in the acquisition of instrumental activities of daily living (IADL) in Alzheimer’s dementia (AD) patients (n = 14). Using a counterbalanced within-subject design, participants performed 3 learning conditions. EL consisted of straightforward prompts before any action, LM focused on the modeling of each step of the tasks and standard TEL without cues was used as a control condition. The participants had to (re)learn 3 IADL. Repeated-measure analyses during learning and follow-up assessments were performed 1 and 3 weeks after learning. The LM and the EL procedures resulted in significantly better learning compared to TEL, with effect sizes (partial eta squared) of 0.42 and 0.35, respectively. This is the first controlled study to show that (re)learning of IADL is possible in patients with AD using an error-reduction approach.

Involving institutionalized people with dementia in their routines may be challenging, particularly in advanced stages of the disease. Motor and multisensory stimulation may help to maintain or improve residents’ remaining abilities such as communication and self-care. This study examines the effects of a motor and multisensory-based approach on the behavior of 6 residents with moderate-to-severe dementia. A single-group, pre- and post test design was conducted. Motor and multisensory stimulation strategies were implemented in residents’ morning care routines by staff, after the provision of training and assistance. Twelve video recordings of morning care (6 pre- and 6 post interventions) were coded for the type of residents’ behavior. Results showed a tendency toward improvements in residents’ levels of caregiver-direct gaze, laughing and engagement, and a reduction of closed eyes, during morning care. The introduction of a motor and multisensory-based approach in care routines may improve residents’ engagement and attention to the environment.

Dementia incidence rates are rapidly increasing among culturally and linguistically diverse (CALD) Australians, and there is very little local research to inform practice. In response, a qualitative study employing focus group methods was undertaken with carers from 4 CALD communities—Arabic-speaking, Chinese-speaking, Italian-speaking and, Spanish-speaking. The study examined the experiences and perceptions of these family carers with regard to their caregiving for a person living with dementia (PLWD). Analysis revealed that while considerable similarities exist across the experiences and perceptions of carers from all 4 CALD communities, there were nevertheless some important distinctions across the different groups. These study findings have significant implications for those working with CALD communities.

Background/Rationale: To determine the suitability of published estimates of the US cost of Alzheimer’s disease (AD) for use in cost-effectiveness models for new AD treatments. Methods: A systematic literature review of published information on direct medical, direct nonmedical, indirect, and informal care costs for different levels of disease severity. Results: Nineteen studies were included in the review. In studies presenting mean costs by disease severity, the change in different types of costs with increasing disease severity varied, depending on the data sources and characteristics of patients with AD. In studies presenting the results of regression analyses, costs were shown to be independently associated with cognition, functional status, behavioral symptoms, and dependence. Conclusions: Published US studies (1) did not include all the types of costs and AD populations, and (2) generally did not include all the measures of disease severity that are needed for cost-effectiveness models.

Previous research on female caregivers of elderly relatives with dementia has demonstrated that caregiving self-efficacy (SE) is associated with reduced cumulative health risk. The overarching aim of the current study was to expand on that research by exploring whether depressive symptoms mediate the relationship between 3 domains of caregiving SE and cumulative health risk associated with health behavior patterns. Data from 256 female family caregivers of patients with dementia are presented. Path analysis revealed a significant mediated effect for depressive symptoms as both SE for obtaining respite and SE for controlling upsetting Thoughts had a significant, indirect effect on cumulative health risk. There were no direct effects between caregiver SE and cumulative health risk. The current study sheds light on the complex pathway between caregiver SE and health and speaks to the importance of skills-based interventions designed to enhance efficacy beliefs and minimize depression in dementia caregivers.

Background: Cognitive and functional decline in dementia generally impairs performance of basic care activities. Staff assistance during these activities frequently results in confusion, anxiety, and distress, expressed through resistance to care (RTC). Methods: A single-system ABA withdrawal design (n = 1) evaluated the effect of video-simulated presence (VSP) for decreasing RTC and increasing participation. A family member pre-recorded videos for use during episodes of RTC, in which the family member spoke directly to the participant to encourage participation. Results: Introduction of the VSP significantly reduced RTC during the basic care tasks of feeding and talking medication. This effect was reversed when the intervention was withdrawn. Participation increased following VSP, demonstrating clear trends toward clinical significance. Conclusions: This person-centered intervention, based on VSP of a family member, provides encouraging results for reducing RTC and increasing participation of adults with dementia in basic care tasks.