Dementia Prevention and Treatment

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

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Prevalence of Central Nervous System–Active Polypharmacy Among Older Adults With Dementia in the US

JAMA, Journal Year: 2021, Volume and Issue: 325(10), P. 952 - 952

Published: March 9, 2021

Importance

Community-dwelling older adults with dementia have a high prevalence of psychotropic and opioid use. In these patients, central nervous system (CNS)–active polypharmacy may increase the risk for impaired cognition, fall-related injury, death.

Objective

To determine extent CNS-active among community-dwelling in US.

Design, Setting, Participants

Cross-sectional analysis all (identified byInternational Classification Diseases, Ninth Revision, Clinical Modification orInternational Statistical Diseases Related Health Problems, Tenth Revision diagnosis codes; N = 1 159 968) traditional Medicare coverage from 2015 to 2017. Medication exposure was estimated using prescription fills between October 1, 2017, December 31, 2018.

Exposures

Part D during observation year (January 1-December 2018).

Main Outcomes Measures

The primary outcome 2018, defined as 3 or more medications longer than 30 days consecutively following classes: antidepressants, antipsychotics, antiepileptics, benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids. Among those who met criterion polypharmacy, duration exposure, number distinct classes prescribed, common class combinations, most commonly used also were determined.

Results

study included 968 (median age, 83.0 years [interquartile range {IQR}, 77.0-88.6 years]; 65.2% female), whom 13.9% (n 161 412) (32 139 610 polypharmacy-days exposure). Those had median age 79.4 (IQR, 74.0-85.5 years) 71.2% female. 193 88-315 polypharmacy-days). Of 57.8% exposed 180 6.8% 365 days; 29.4% 5 5.2% medication classes. Ninety-two percent an antidepressant, 47.1% antipsychotic, 40.7% benzodiazepine. combination antiepileptic, antipsychotic (12.9% Gabapentin associated 33.0% polypharmacy-days.

Conclusions Relevance

this cross-sectional claims data, 2018 filled prescriptions consistent polypharmacy. lack information on prescribing indications limits judgments about clinical appropriateness combinations individual patients.

Language: Английский

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The global, regional, and national burdens of dementia in 204 countries and territories from 1990 to 2021: A trend analysis based on the Global Burden of Disease Study 2021

Medicine, Journal Year: 2025, Volume and Issue: 104(11), P. e41836 - e41836

Published: March 14, 2025

The global population is aging, and as a consequence, the prevalence of dementia increasing rapidly. This study aims to analyze trends in Global Burden Disease (GBD) health inequalities for over period 1990 2021. incidence, prevalence, disability-adjusted life year rates GBD 2021 database were analyzed at global, national, regional levels using Joinpoint 4.9.1.0 software. assessed combination age-standardized rates, average annual percentage changes (AAPCs), sociodemographic index. analysis revealed that, from 2021, AAPC years amounted 0.06 (95% confidence interval [CI]: 0.05–0.09), 0.09 CI: 0.08–0.10), 0.03 0.01–0.05), respectively. Conversely, mean mortality rate remained stable 0 −0.02 0.03). incidence exhibited positive association with index during period. 3 regions highest among 21 South Africa, Central Sub-Saharan Eastern Africa. findings indicate that burden increases age projected remain on an upward trend until 2040. has increased significantly prevention control represents long-term formidable challenge.

Language: Английский

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Pharmacist interventions to deprescribe opioids and benzodiazepines in older adults: A rapid review

Research in Social and Administrative Pharmacy, Journal Year: 2021, Volume and Issue: 18(6), P. 2913 - 2921

Published: July 16, 2021

Language: Английский

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Primary-Care Prescribers’ Perspectives on Deprescribing Opioids and Benzodiazepines in Older Adults

Drugs & Aging, Journal Year: 2022, Volume and Issue: 39(9), P. 739 - 748

Published: July 28, 2022

Language: Английский

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Patient Perceptions of Opioids and Benzodiazepines and Attitudes Toward Deprescribing

Drugs & Aging, Journal Year: 2023, Volume and Issue: 40(12), P. 1113 - 1122

Published: Oct. 4, 2023

Language: Английский

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Reducing Central Nervous System–Active Medications to Prevent Falls and Injuries Among Older Adults

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(7), P. e2424234 - e2424234

Published: July 25, 2024

Importance High-risk medications that contribute to adverse health outcomes are frequently prescribed older adults. Deprescribing interventions reduce their use, but studies often not designed examine effects on patient-relevant outcomes. Objective To test the effect of a system–embedded deprescribing intervention targeting adults and primary care clinicians for reducing use central nervous system–active drugs preventing medically treated falls. Design, Setting, Participants In this cluster randomized, parallel-group, clinical trial, 18 practices from an integrated delivery system in Washington state were recruited April 1, 2021, June 16, 2022, participate, along with eligible patients. Randomization occurred at clinic level. Patients community-dwelling aged 60 years or older, least 1 medication any 5 targeted classes (opioids, sedative-hypnotics, skeletal muscle relaxants, tricyclic antidepressants, first-generation antihistamines) 3 consecutive months. Intervention Patient education clinician decision support. Control arm participants received usual care. Main Outcomes Measures The outcome was Secondary included discontinuation, sustained dose reduction each target medication. Serious drug withdrawal events involving opioids sedative-hypnotics main safety outcome. Analyses conducted using intent-to-treat analysis. Results Among 2367 patient (mean [SD] age, 70.6 [7.6] years; 1488 women [63%]), adjusted cumulative incidence rate first fall months 0.33 (95% CI, 0.29-0.37) group 0.30 0.27-0.34) (estimated hazard ratio, 1.11 0.94-1.31) ( P = .11). There significant differences favoring antidepressants 6 (discontinuation rate: group, 0.23 [95% 0.18-0.28] vs 0.13 0.09-0.17]; relative risk, 1.79 1.29-2.50]; .001) secondary time points (9, 12, 15 months). Conclusions Relevance randomized trial clinicians, no more effective than For systems attend as part routine practice, additional may confer modest benefits prescribing without measurable Trial Registration ClinicalTrials.gov Identifier: NCT05689554

Language: Английский

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A deprescribing medication program to evaluate falls in older adults: methods for a randomized pragmatic clinical trial

Trials, Journal Year: 2022, Volume and Issue: 23(1)

Published: April 4, 2022

Opioids and benzodiazepines (BZDs) are some of the most commonly prescribed medications that contribute to falls in older adults. These challenging appropriately prescribe monitor, with little guidance on safe prescribing these for patients. Only a handful small studies have evaluated whether reducing opioid BZD use through deprescribing has positive impact outcomes. Leveraging strengths large health system, we targeted consultant pharmacist intervention deprescribe opioids BZDs adults seen primary care practices North Carolina.We developed toolkit process based literature review from an interprofessional team pharmacists, geriatricians, investigators. A total fifteen been randomized receive service (n = 8) or usual 7). The consists several components: (1) weekly automated reports identify chronic users BZDs, (2) clinical medication review, (3) recommendations and/or alternate therapies routed prescribers electronic record. We will collect data all patients presenting one clinics who meet criteria their prescription order history. year prior evaluate baseline exposures using morphine milligram equivalents (MMEs) diazepam (DMEs). In following intervention, changes discontinuations between control clinics. Incident be as secondary outcome. To date, study enrolled 914 1048 users. anticipate 80% power detect 30% reduction MMEs DMEs.This clinic pragmatic trial valuable evidence regarding interventions reduce settings.Clinicaltrials.gov NCT04272671 . Registered February 17, 2020.

Language: Английский

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Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study

BMC Geriatrics, Journal Year: 2022, Volume and Issue: 22(1)

Published: Oct. 26, 2022

Abstract Background Benzodiazepines (BZD) are widely prescribed to older adults despite their association with increased fall injury. Our aim is better characterize risk-elevating factors among those BZD. Methods A retrospective cohort study using a 20% sample of Medicare beneficiaries Part D prescription drug coverage. Patients BZD (“index”) between 1 April 2016 and 31 December 2017 contributed incident ( n =379,273) continuing =509,634) cohorts based on prescriptions during 6-month pre-index baseline. Exposures were index average daily dose days prescribed; baseline medication possession ratio (MPR) (for the cohort); co-prescribed central nervous system-active medications. Outcome was treated fall-related injury within 30 post-index BZD, examined Cox proportional hazards adjusting for demographic clinical covariates prescribed. Results Among cohorts, 0.9% 0.7% experienced of index. In both risk elevated immediately lowest quantity: e.g., <14-day fill (ref: 14-30 days) in cohort, 37% higher 10 post-fill (adjusted hazard [HR] 1.37 [95% confidence interval [CI] 1.19-1.59]). Risk users low exposure (e.g., MPR <0.5 [ref: 0.5-1], HR 1-10 1.23 [CI 1.08-1.39]). Concurrent antipsychotics opioids associated HRs 1.21 1.03-1.40] 1.22 1.07-1.40], respectively; [1.10-1.37] [1.11-1.33]). Conclusions Low small after fill. short-term cohorts.

Language: Английский

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Impact of Hearing Loss on Patient Falls in the Inpatient Setting

American Journal of Preventive Medicine, Journal Year: 2020, Volume and Issue: 58(6), P. 839 - 844

Published: May 19, 2020

Language: Английский

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