Current and Future Treatments in Alzheimer Disease: An Update

Journal of Central Nervous System Disease, Год журнала: 2020, Номер 12, С. 117957352090739 - 117957352090739

Опубликована: Янв. 1, 2020

Disease-modifying treatment strategies for Alzheimer disease (AD) are still under extensive research. Nowadays, only symptomatic treatments exist this disease, all trying to counterbalance the neurotransmitter disturbance: 3 cholinesterase inhibitors and memantine. To block progression of therapeutic agents supposed interfere with pathogenic steps responsible clinical symptoms, classically including deposition extracellular amyloid β plaques intracellular neurofibrillary tangle formation. Other underlying mechanisms targeted by neuroprotective, anti-inflammatory, growth factor promotive, metabolic efficacious stem cell therapies. Recent therapies have integrated multiple new features such as novel biomarkers, neuropsychological outcomes, enrollment earlier populations in course innovative trial designs. In near future different specific every patient might be used a “precision medicine” context, where aberrant biomarkers accompanied particular pattern neuroimaging findings could determine regimen within customized framework. review, we discuss potential disease-modifying that currently being studied individualized frameworks can proved beneficial patients AD.

Язык: Английский

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Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions

Frontiers in Pharmacology, Год журнала: 2021, Номер 12

Опубликована: Ноя. 26, 2021

Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in older adults, there an urgent need introducing effective strategies to prevent manage problem this age group.

Язык: Английский

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Amyloid-beta aggregation implicates multiple pathways in Alzheimer’s disease: Understanding the mechanisms

Frontiers in Neuroscience, Год журнала: 2023, Номер 17

Опубликована: Апрель 11, 2023

Alzheimer’s disease (AD) is a progressive neurodegenerative condition characterized by tau pathology and accumulations of neurofibrillary tangles (NFTs) along with amyloid-beta (Aβ). It has been associated neuronal damage, synaptic dysfunction, cognitive deficits. The current review explained the molecular mechanisms behind implications Aβ aggregation in AD via multiple events. Beta (β) gamma (γ) secretases hydrolyzed amyloid precursor protein (APP) to produce Aβ, which then clumps together form fibrils. fibrils increase oxidative stress, inflammatory cascade, caspase activation cause hyperphosphorylation into (NFTs), ultimately lead damage. Acetylcholine (Ach) degradation accelerated upstream regulation acetylcholinesterase (AChE) enzyme, leads deficiency neurotransmitters impairment. There are presently no efficient or disease-modifying medications for AD. necessary advance research suggest novel compounds treatment prevention. Prospectively, it might be reasonable conduct clinical trials unclean medicines that have range effects, including anti-amyloid anti-tau, neurotransmitter modulation, anti-neuroinflammatory, neuroprotective, enhancement.

Язык: Английский

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Potentially inappropriate medications prescribing according to Beers criteria among elderly outpatients in Jordan: a cross sectional study

Pharmacy Practice, Год журнала: 2019, Номер 17(2), С. 1439 - 1439

Опубликована: Июнь 5, 2019

Due to aging, along with its associated physiological changes, older adults are extremely vulnerable be afflicted multiple chronic conditions (multimorbidity). Accordingly, prescribing a large number of drugs would inevitable. Resulted complex drug regimens can lead Potentially Inappropriate Medications (PIMs) subsequent negative health and economic outcomes.The main objective this study is investigate the prevalence predictors PIMs among Jordanian elderly outpatients, using last updated version American Geriatrics Society (AGS) Beers Criteria (2015 version).A Unicenter, cross-sectional were data was assessed medical records included subjects conducted over three months period from beginning October end December 2016 at King Abdullah University Hospital, Al Ramtha, Jordan. Our patients aged 65 years or above who visited outpatient clinics hospital (KAUH) prescribed least one oral medication during period. identified for these further classified according 2015 AGS Criteria. We measured outpatients in Jordan.A total 4622 eligible evaluated study, whom 62.5% (n=2891) found have PIM 69% medications used caution elderly, 22% avoid many most adults, 6.3% avoided their dosage adjusted based on kidney function 2.04% specific diseases/syndromes, 1.6% potentially clinically important non-anti-infective drug-drug interactions adults. Female gender polypharmacy significant use elderly.Potentially Medication common outpatients. more so need attention.

Язык: Английский

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Drug–Drug Interactions in Elderly Patients with Potentially Inappropriate Medications in Primary Care, Nursing Home and Hospital Settings: A Systematic Review and a Preliminary Study

Pharmaceutics, Год журнала: 2021, Номер 13(2), С. 266 - 266

Опубликована: Фев. 16, 2021

Drug–drug interactions (DDI) occurring with potentially inappropriate medications (PIM) are additional risk factors that may increase the character of PIM. The aim this study was (1) to describe prevalence and severity DDI in patients PIM (2) evaluate specifically regarding This systematic review is based on a search carried out PubMed Web-of-Science from inception June 30, 2020. We extracted data original studies assessed both elderly primary care, nursing home hospital settings. Four hundred forty unique were identified: 91 included qualitative analysis 66 quantitative analysis. 19.1% (95% confidence intervals (CI): 15.1–23.0%), 29.7% CI: 27.8–31.6%) 44.6% 28.3–60.9%), respectively. Clinically significant severe risk-rated averaged 28.9% 17.2–40.6), setting; approximately 7-to-9 lower care home, Surprisingly, only four these investigated involving Hence, given high PIM, further investigations should be which their character, adverse drug reactions.

Язык: Английский

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Global prevalence of polypharmacy and potentially inappropriate medication in older patients with dementia: a systematic review and meta-analysis

Frontiers in Pharmacology, Год журнала: 2023, Номер 14

Опубликована: Авг. 24, 2023

Background: Older patients with dementia always need multiple drugs due to comorbidities and cognitive impairment, further complicating drug treatment increasing the risk of potentially inappropriate medication. The objective our study is estimate global prevalence polypharmacy medication (PIM) explore factors PIM for older dementia. Methods: We searched PubMed, Embase (Ovid), Web Science databases identify eligible studies from inception 16 June 2023. conducted a meta-analysis observational reporting in using random-effect model. associated were meta-analyzed. Results: Overall, 62 included, which 53 reported 28 polypharmacy. pooled was 43% (95% CI 38–48) 62% 52–71), respectively. Sixteen referred use, 15 pooled. Polypharmacy (2.83, 95% 1.80–4.44), diabetes (1.31, 1.04–1.65), heart failure (1.17, 1.00–1.37), depression (1.45, 1.14–1.88), history cancer (1.20, 1.09–1.32), hypertension (1.46, 1.05–2.03), ischemic disease (1.55, 0.77–3.12), any cardiovascular (1.11, 1.06–1.17), vascular (1.09, 1.03–1.16), chronic obstructive pulmonary (1.39, 1.13–1.72), psychosis (1.91, 1.04–3.53) are positively use. Conclusion: highly prevalent Among different regions, use varied widely. Increasing closely For other such as diabetes, prescribing should be cautioned.

Язык: Английский

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High-Risk Medications in Persons Living With Dementia

JAMA Internal Medicine, Год журнала: 2024, Номер unknown

Опубликована: Окт. 21, 2024

Importance Individuals with Alzheimer disease (AD) and disease–related dementias (ADRD) may be at increased risk for adverse outcomes relating to inappropriate prescribing of certain high-risk medications, including antipsychotics, sedative-hypnotics, strong anticholinergic agents. Objective To evaluate the effect a patient/caregiver prescriber-mailed educational intervention on potentially patients AD or ADRD. Design, Setting, Participants This prospective, open-label, pragmatic randomized clinical trial, embedded in 2 large national health plans, was conducted from April 2022 June 2023. The trial included ADRD use any 3 drug classes targeted deprescribing (antipsychotics, anticholinergics). Interventions Patients were 1 arms: (1) mailing materials specific medication both patient their clinician; (2) clinician only; (3) usual care arm. Main Outcomes Measures Analysis performed using modified intention-to-treat approach. primary study outcome dispensing during 6-month observation period. Secondary changes medication-specific mean daily dose service utilization. Results Among 12 787 analysis, 8742 (68.4%) female, (SD) age 77.3 (9.4) years. cumulative incidence being dispensed 76.7% (95% CI, 75.4-78.0) prescriber group, 77.9% 76.5-79.1) only 77.5% 76.2-78.8) group. Hazard ratios 0.99 0.94-1.04) group 1.00 0.96-1.06) compared There no differences between groups secondary outcomes. Conclusions Relevance These findings suggest mailings targeting clinicians are not effective reducing medications. Trial Registration ClinicalTrials.gov Identifier: NCT05147428

Язык: Английский

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Examining equity in service use across socioeconomic status in people with dementia

Опубликована: Фев. 19, 2025

Abstract INTRODUCTION Inequities associated with socioeconomic status (SES) manifest across dementia outcomes; however, research investigating service use SES in people is scarce. METHODS We conducted a repeated yearly cohort study of community‐dwelling Quebec incident (2000–2017), using health administrative data held at the National Institute Public Health (INSPQ). described 23 indicators and mortality levels material deprivation, derived from validated ecological index based on average income, employment, education residential neighborhoods. RESULTS Age‐standardized rates 15/23 differed SES. Among 193,834 older newly diagnosed dementia, those most deprived areas had more hospitalizations, emergency department visits, potentially inappropriate medication prescriptions, higher 1‐year mortality, though they care continuity. Conversely, were comparable groups for prescription dementia‐specific medications primary visits. DISCUSSION Stark differences by may indicate different needs and/or allude to pervasive inequities. These results can inform policies address lower SES, offer equitable, appropriate, needs‐based all living dementia.

Язык: Английский

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Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care

Revista Brasileira de Enfermagem, Год журнала: 2023, Номер 76(suppl 2)

Опубликована: Янв. 1, 2023

ABSTRACT Objective: to identify the prevalence and associations of polypharmacy potentially inappropriate medication use among older adults with hypertension treated in primary care. Methods: a cross-sectional study carried out at Family Health Strategy unit. Data collection included analysis medical records, interviews multidimensional assessment adults. Socio-demographic information clinical variables were collected. Statistical was performed by multiple logistic regression. Results: 38.09%, (PIM), 28.57%. There significant association between PIM use, altered sleep ethnicity. associated polypharmacy, worse family functioning, absence caregiver. Cognitive decline reduces these medications. Conclusions: represent problem this population, especially most vulnerable.

Язык: Английский

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Multicomponent intervention to tailor prescriptions to patients with dementia in an intermediate care hospital: pre-post quasi experimental study

BMC Geriatrics, Год журнала: 2025, Номер 25(1)

Опубликована: Фев. 27, 2025

In persons with dementia, polypharmacy may be discordant the goals of care. It is necessary to design interventions that align treatment regimens patient's situation, prognosis and preferences. The objectives this study conducted at an intermediate care were to: i) identify inappropriate prescribing per main goal; ii) compare pharmacotherapy data pre post a medication review based on degree cognitive impairment; iii) assess implementation proposed recommendations three months after discharge. Pre-post quasi-experimental study. Patients dementia discharged from hospital between November 2021 April 2022. Demographic, clinical evaluated admission. Medication reviews interviews caregivers pharmacologic therapies overall At discharge, information was shared primary team in discharge summary. Follow up evaluate during performed months. Of 97 patients included, 94.8% had least one inappropriately prescribed medication. mean number chronic medications taken patient decreased by 29.6%, 8.05(SD 3.5) 5.67(SD 2.7) (p < 0.001); anticholinergic burden 18.6%, 1.59(SD 1.0) 1.29(SD 0.9) therapeutic complexity 28.4%, 29.23(SD 13.8) 20.94(SD 11.3) 0.001). 3 90.0%. Admission provides ideal setting for multicomponent intervention, tailoring prescriptions preferences, improving parameters related side effects, ensuring are maintained over medium term.

Язык: Английский

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