Health Technology Assessment, Journal Year: 2023, Volume and Issue: unknown, P. 1 - 108
Published: Oct. 1, 2023
Agitation is common and impacts negatively on people with dementia carers. Non-drug patient-centred care first-line treatment, but we need other treatment when this fails. Current evidence sparse safer effective alternatives to antipsychotics.
Language: Английский
JAMA Internal Medicine, Journal Year: 2024, Volume and Issue: 184(5), P. 563 - 563
Published: March 4, 2024
Importance Dementia affects 10% of those 65 years or older and 35% 90 older, often with profound cognitive, behavioral, functional consequences. As the baby boomers subsequent generations age, effective preventive treatment strategies will assume increasing importance. Observations Preventive measures are aimed at modifiable risk factors, many which have been identified. To date, no randomized clinical trial data conclusively confirm that interventions any kind can prevent dementia. Nevertheless, addressing factors may other health benefits should be considered. Alzheimer disease treated cholinesterase inhibitors, memantine, antiamyloid immunomodulators, last modestly slowing cognitive decline in people mild impairment dementia due to disease. Cholinesterase inhibitors memantine benefit persons types dementia, including Lewy bodies, Parkinson vascular traumatic brain injury. Behavioral psychological symptoms best nonpharmacologic management, identifying mitigating underlying causes individually tailored behavioral approaches. Psychotropic medications minimal evidence efficacy for treating these associated increased mortality clinically meaningful risks falls decline. Several emerging prevention hold promise improve care future. Conclusions Relevance Although current approaches less than optimally successful, substantial investments research undoubtedly provide new answers reducing burden worldwide.
Language: Английский
Citations
38
The Lancet Neurology, Journal Year: 2024, Volume and Issue: unknown
Published: Sept. 1, 2024
Language: Английский
Citations
8
The Lancet, Journal Year: 2021, Volume and Issue: 398(10310), P. 1487 - 1497
Published: Oct. 1, 2021
BackgroundAgitation is common in people with dementia and negatively affects the quality of life both carers. Non-drug patient-centred care first-line treatment, but there a need for other treatment when this not effective. Current evidence sparse on safer effective alternatives to antipsychotics. We assessed efficacy safety mirtazapine, an antidepressant prescribed agitation dementia.MethodsThis parallel-group, double-blind, placebo-controlled trial—the Study Mirtazapine Agitated Behaviours Dementia trial (SYMBAD)—was done 26 UK centres. Participants had probable or possible Alzheimer's disease, unresponsive non-drug Cohen-Mansfield Agitation Inventory (CMAI) score 45 more. They were randomly assigned (1:1) receive either mirtazapine (titrated mg) placebo. The primary outcome was reduction CMAI at 12 weeks. This registered ClinicalTrials.gov, NCT03031184, ISRCTN17411897.FindingsBetween Jan 26, 2017, March 6, 2020, 204 participants recruited randomised. Mean scores weeks significantly different between receiving placebo (adjusted mean difference –1·74, 95% CI –7·17 3·69; p=0·53). number controls adverse events (65 [64%] 102 controls) similar that group (67 [66%] mirtazapine). However, more deaths (n=7) by week 16 than control (n=1), post-hoc analysis suggesting marginal statistical significance (p=0·065).InterpretationThis found no benefit compared placebo, we observed potentially higher mortality use mirtazapine. data from study do support using as dementia.FundingUK National Institute Health Research Technology Assessment Programme.
Language: Английский
Citations
54
Journal of the American Geriatrics Society, Journal Year: 2021, Volume and Issue: 69(9), P. 2464 - 2475
Published: June 8, 2021
Abstract Background/objectives In older persons with dementia (PWD), extensive medication use is often unnecessary, discordant goals of care, and possibly harmful. The objective this study was to determine the prevalence constituents polypharmacy among PWD attending outpatient visits in United States. Design Cross‐sectional analysis. Setting participants without (PWOD) aged ≥65 years recorded nationally representative National Ambulatory Medical Care Survey (NAMCS), 2014–2016. Measurements were identified as those a diagnosis on NAMCS encounter form and/or receiving an anti‐dementia medication. Visits PWOD compared terms sociodemographic, practice/physician factors, comorbidities, prescribing outcomes. Regression analyses examined effect contributions by clinically relevant categories (defined being prescribed ≥5 prescription nonprescription medications). Results unweighted sample involved 918 for 26,543 PWOD, representing 29.0 780 million visits. had median age 81 average 2.8 comorbidities other than dementia; 63% female. number medications eight three ( p < 0.001). After adjustment, significantly higher odds (AOR 3.0; 95% CI: 2.1–4.3) or ≥10 2.8; 2.0–4.2) PWOD. largest sources cardiovascular central nervous system medications; usage from generally elevated at least one highly sedating anticholinergic 2.5; 1.6–3.9). Conclusion visits, extremely common PWD, driven wide array categories. Addressing will require cross‐cutting multidisciplinary approaches.
Language: Английский
Citations
49
The Permanente Journal, Journal Year: 2022, Volume and Issue: 27(1), P. 122 - 132
Published: Dec. 12, 2022
Sleep disorders in older adults increase with aging, likely due to increased sleep latency, decreased efficiency, and total time. Common issues include chronic insomnia, circadian rhythm sleep-wake disorders, sleep-related movement sleep-disordered breathing. Diagnostic tools, such as a comprehensive history questionnaires, or log for more specific complaints, are commonly used. Polysomnography is not recommended routine test; however, it can be used abnormal behaviors during if treatment fails. disorder management based on the etiology may nonpharmacological pharmacological alternative treatments. For example, insomnia some consist of cognitive behavioral therapy, hygiene education, relaxation restriction, light stimulus control therapy. Because quality evidence poor, medication choice should shared decision-making between practitioner patient, limited prescription.
Language: Английский
Citations
24
Journal of the American Geriatrics Society, Journal Year: 2022, Volume and Issue: 70(9), P. 2592 - 2601
Published: May 18, 2022
Abstract Background Over 6 million Americans have Alzheimer's Disease or Related Dementia (ADRD) but whether spikes in spending surrounding a new diagnosis reflect pre‐diagnosis morbidity, diagnostic testing, treatments for comorbidities is unknown. Methods We used the 1998–2018 Health and Retirement Study linked Medicare claims from older (≥65) adults to assess incremental quarterly changes just before versus after clinical (diagnosis cohort, n = 2779) and, comparative purposes, cohort screened as impaired based on validated Telephone Interview Cognitive Status (TICS) (impairment 2318). Models were adjusted sociodemographic health characteristics. Spending patterns examined separately by sex, race, education, dual eligibility, geography. Results Among mean (SD) overall was $4773 ($9774) per quarter – 43% of which hospital care ($2048). In analyses, increased $8400 ( p < 0.001), 156%, $5394 prior $13,794 including diagnosis. impairment incidentally detected using TICS, did not change detection impairment, $2986 $2962 0.90). Incremental differ Conclusion Large, transient increases accompany an ADRD that may be attributed functional status due dementia. Further study help reveal how treatment associated with dementia, potential implications spending.
Language: Английский
Citations
23
Multiple Sclerosis Journal, Journal Year: 2022, Volume and Issue: 29(1), P. 107 - 118
Published: Oct. 27, 2022
Background: Little is known about polypharmacy and multiple sclerosis (MS). Objectives: To estimate prevalence in a population-based MS cohort compare persons with/without polypharmacy. Methods: Using administrative pharmacy data from Canada, we estimated (⩾5 concurrent medications for >30 consecutive days) individuals 2017. We compared the characteristics of described number days, most common medication classes contributing to hyper-polypharmacy (⩾10 medications). Results: Of 14,227 included (75% women), mean age = 55.4 (standard deviation (SD): 13.2) years; 28% ( n 3995) met criteria (median days 273 (interquartile range (IQR): 120–345)). Odds were higher women (adjusted odds ratio (aOR) 1.14; 95% confidence intervals (CI):1.04–1.25), older (aORs 50–64 years 2.04; CI:1.84–2.26; ⩾65 3.26; CI: 2.92–3.63 vs. <50 years), those with more comorbidities (e.g. ⩾3 none, aOR 6.03; 5.05–7.22) lower socioeconomic status (SES) (SES-Q1) least deprived (SES-Q5) 1.64; 1.44–1.86). Medication commonly as follows: antidepressants (66% days), antiepileptics (47%), peptic ulcer drugs (41%). Antidepressants frequently co-prescribed (34% (27%). Five percent (716/14,227) experienced hyper-polypharmacy. Conclusion: More than one four The women, persons, comorbidities, but SES.
Language: Английский
Citations
22
Journal of the American Geriatrics Society, Journal Year: 2022, Volume and Issue: 70(11), P. 3250 - 3259
Published: Oct. 6, 2022
Abstract Background Non‐Hispanic Black individuals may be less likely to receive a diagnosis of dementia compared non‐Hispanic White individuals. These findings raise important questions regarding which factors explain this observed association and any differences in the time disparities emerge following onset. Methods We conducted retrospective cohort study using survey data from 1995 2016 Health Retirement Study linked with Medicare fee‐for‐service claims. Using Hurd algorithm (a regression‐based approach), we identified onset among older adult respondents (age ≥65 years) Telephone Interview for Cognitive Status proxy respondents. determined date up 3 years list established codes. Cox Proportional Hazards modeling was used examine between an individual's reported race likelihood after accounting sociodemographic characteristics, income, education, functional status, healthcare use. Results 3435 adults who experienced new dementia. Among them, 30.1% received within 36 months In unadjusted analyses, difference cumulative proportion diagnosed by continued increase across onset, p ‐value <0.001. 23.8% versus 31.4% participants were Hazard Ratio = 0.73 (95% CI: 0.61, 0.88). The persisted adjustment status use; however, these had impact on strength than income level education. Conclusion Lower rates persists Further understanding barriers that related social determinants health is needed improve dementia‐related outcomes Americans.
Language: Английский
Citations
21
Pharmacoepidemiology, Journal Year: 2025, Volume and Issue: 4(1), P. 4 - 4
Published: Jan. 8, 2025
Background/Objectives: This systematic review aimed to identify a comprehensive list of potential opioid-related indicators from the published literature assess prescribing safety in any setting. Methods: Studies that reported 1990 2019 were retrieved previously review. A subsequent search was conducted seven electronic databases additional studies June 2024. Potential opioid extracted non-injectable opioids prescribed adults with concerns about risk harm. The split by each opioid, and duplicates removed. identified categorized type problem, medication, patient condition/disease, indicators. Results: total 99 unique opioid-specific 53 included articles. Overall, 42 (42%) focused on specific class opioids. Pethidine, tramadol, fentanyl most frequently drugs (n = 22, 22%). account for six types problems: medication inappropriate population 20), omission 8), duration 10), inadequate monitoring 2), drug–disease interaction 26), drug–drug 33). Of all indicators, older age (over 65) is common factor 38, 39%). Central nervous system-related adverse effects are concern 28 (29%) associated interactions. Furthermore, five ’omission’ related ’without using laxatives’. Conclusions: set flagging patients at high harm, thereby supporting informed decision-making optimizing utilization. However, further research essential validate these evaluate their feasibility across diverse healthcare settings.
Language: Английский
Citations
0
Drugs & Aging, Journal Year: 2025, Volume and Issue: unknown
Published: Jan. 21, 2025
Despite their limited benefits and serious adverse effects, psychotropics remain frequently prescribed for neuropsychiatric symptoms (NPS) of dementia. Psychotropic polypharmacy, the use two or more concomitant psychotropic medications, is therefore not recommended people with The objectives this study were to investigate prevalence polypharmacy in Australians living dementia whose caregivers sought external NPS support from Dementia Support Australia (DSA; national provider support) association demographics characteristics. A retrospective cross-sectional a subset DSA referrals at baseline (i.e., yet receive psychosocial intervention(s)) between 2016 2020 was conducted. Referrals without compared on basis demographic characteristics (e.g., sex, subtype), type agitation), severity associated caregiver distress as measured by Neuropsychiatric Inventory (NPI), using Pearson's chi-square test Welch's t-test categorical continuous data, respectively. Logistic regression models used examine relationship individual NPI domains exposure polypharmacy. total 421 (mean age 81.5 (standard deviation 8.5) years, 52.3% males, 46.8% Alzheimer's disease) analysed. Of those, over 90% (n = 383) least one psychotropic, 214 (50.8%) medication types most antipsychotics 162, 75.7%), opioids 104, 48.6%), anxiolytics 93, 43.5%), sedative/hypnotics 52, 24.3%) antidepressants 47, 22.0%). No any variable tested identified, including age, subtype severity. highly prevalent referred dementia-specific behaviour programs, but no factors its presence cohort.
Language: Английский
Citations
0