"iDoctor – Medical Blog"

Publication year: 2012
Source:The American Journal of Geriatric Pharmacotherapy

Robert D. Nebes, Bruce G. Pollock, Subashan Perera, Edythe M. Halligan, Judith A. Saxton

Recent studies found use of anticholinergic medications to be associated with greater performance decrements in older persons who carry an ε4 allele of the apolipoprotein E (APOE) gene than in those carrying only ε2 or ε3 alleles.

The present study examined whether the apparently greater behavioral toxicity of anticholinergic drugs in ε4 carriers may result from an increased risk of cerebrovascular disease, which is more common in ε4 carriers.

Cross-sectional data were available from 240 elderly community volunteers who had participated in 2 different studies of the cognitive and motor effects of normal aging. As part of these studies, information was gathered on subjects’ use of anticholinergic medications (based on an inventory of medications taken within 24 hours of testing), risk of cerebrovascular disease (Framingham Stroke Risk Profile), and APOE genotype. Performance data were also available from measures of general cognitive status (Mini-Mental State Examination), executive function (Trail Making Test), mood (Geriatric Depression Scale), sleep (Pittsburgh Sleep Quality Index), and walking speed. Logistic and linear regression models were used to examine how outcomes differed between genotypes and drug use, independent of the risk of cerebrovascular disease.

In persons with a non-ε4 genotype, anticholinergic medication use did not significantly affect any of the behavioral measures. By contrast, among ε4 carriers, those taking anticholinergic drugs performed significantly worse than did those not taking such drugs on tests of general cognitive status, executive function, mood, and sleep. Adjusting for participants’ stroke risk had a minimal effect on these results.

Anticholinergic medication use was associated with poorer performance on measures of cognition, sleep, and mood only in older persons who carried 1 or more ε4 alleles of the APOE gene; this effect did not appear to be the result of an increased risk of cerebrovascular disease.

Publication year: 2012
Source:The American Journal of Geriatric Pharmacotherapy

Scott Martin Vouri, Carlos A. Alvarez, Amie Taggart Blaszczyk

Limited data exist on the use of bisphosphonates in patients with poor kidney function due to a contraindication derived from inadequate experience among patients with kidney failure, accounting for as much as 25% of nonprescribing when otherwise appropriate.

To determine whether bisphosphonate use in patients with decreased renal function, as outlined in the package insert (estimated creatinine clearance [eCrCl] <35 mL/min), would result in higher rates of hypocalcemia, as suggested in previous studies.

This was a retrospective cohort study of elderly veterans 65 years of age and older at the Veterans Affairs North Texas Health Care System in Dallas, Texas. We identified 3089 patients who started oral bisphosphonate therapy between August 1, 2003 and July 12, 2010. Of the 252 patients meeting the inclusion criteria, 25 and 227 patients had an eCrCl <35 mL/min and eCrCl ≥35 mL/min, respectively. Analyses of changes in serum calcium from baseline to the 1-year study end point were performed within and between each renal function group.

Among the veterans with an eCrCl <35 mL/min and eCrCl ≥35 mL/min, there were decreases in median serum calcium levels from baseline to study end point from 9.8 mg/dL (interquartile range [IQR], 9.4–10.2 mg/dL) to 9.3 mg/dL (IQR, 9.0–10.0 mg/dL; P = 0.028) and 9.6 mg/dL (IQR, 9.3–9.9 mg/dL) to 9.4 mg/dL (IQR, 9.1–9.8 mg/dL; P < 0.001), respectively. However, there was no difference in Δcalcium: −0.2 mg/dL (IQR, 0–0.6 mg/dL) and 0.2 mg/dL (IQR, −0.2 to 0.5 mg/dL; P = 0.547), respectively.

This exploratory assessment may suggest that, in elderly veterans, the initiation of oral bisphosphonate therapy contributed to a statistically significant decrease in serum calcium levels regardless of baseline renal function; however, the clinical impact of this change does not appear to be significant. Future studies should assess serum calcium in a larger population of patients to confirm the safety of oral bisphosphonates in poor kidney function.

• Content Type Journal Article
• Pages 1-21
• DOI 10.1007/s10465-012-9131-0
• Authors
  • Jennifer Frank Tantia, Pratt Institute, 90 St. Mark’s Avenue, #3, Brooklyn, NY 11217, USA

• Journal American Journal of Dance Therapy
• Online ISSN 1573-3262
• Print ISSN 0146-3721

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