Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission

The Lancet, Год журнала: 2024, Номер 404(10452), С. 572 - 628

Опубликована: Июль 31, 2024

Язык: Английский

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Prescribing in Older People

Опубликована: Апрель 10, 2025

Prescribing medications to older people is difficult due comorbidity, limited evidence for efficacy, increased risk of adverse drug reactions, polypharmacy, and altered pharmacokinetics. This article describes the principles underlying clinical geriatric pharmacology including approaches evaluating benefit, adjusting dose age related pharmacokinetic changes. The challenge general practitioner balance an incomplete base efficacy in frail, against problems reactions without denying potentially valuable pharmacotherapeutic interventions.

Язык: Английский

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Treatment of Alzheimer Disease

CONTINUUM Lifelong Learning in Neurology, Год журнала: 2024, Номер 30(6), С. 1823 - 1844

Опубликована: Дек. 1, 2024

ABSTRACT OBJECTIVE Symptom-oriented treatment has been the mainstay of Alzheimer disease (AD) pharmacotherapy for decades. This article reviews evidence basis symptomatic treatments AD and emerging data on amyloid-lowering therapies with possible disease-slowing effects. LATEST DEVELOPMENT Amyloid-lowering monoclonal antibody entered clinical use in 2021. In July 2023, lecanemab became first these to gain full US Food Drug Administration (FDA) approval limited Medicare payment coverage. Donanemab gained similar status 2024. The approved agents remove amyloid plaque from brain appear slow progression but can produce significant adverse events known as amyloid-related imaging abnormalities cerebral edema or effusion hemorrhages. Extensive safety monitoring is therefore required, including scheduled MRI scans. Also brexpiprazole agent specifically by FDA agitation associated AD. Suvorexant, an orexin receptor antagonist, previously was insomnia people mild moderate ESSENTIAL POINTS There robust acetylcholinesterase inhibitors patients mild, moderate, severe dementia due AD, outcomes beyond changes cognitive screening test scores. More studies support memantine stages. These have a primary effect delaying decline cognition function postponing emergence behaviors. Pharmacotherapy behavioral psychological symptoms less predictable, most trials had negative results. Anti-amyloid provide FDA-approved option alter pathology, understanding overall utility value remains its infancy.

Язык: Английский

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Depression in dementia with Lewy bodies: a critical update

Journal of Neural Transmission, Год журнала: 2023, Номер 130(10), С. 1207 - 1218

Опубликована: Июль 7, 2023

Язык: Английский

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Adapted problem adaptation therapy for depression in mild to moderate Alzheimer's disease dementia: A randomized controlled trial

Alzheimer s & Dementia, Год журнала: 2024, Номер 20(4), С. 2990 - 2999

Опубликована: Март 13, 2024

Abstract INTRODUCTION Trials of effectiveness treatment options for depression in dementia are an important priority. METHODS Randomized controlled trial to assess adapted Problem Adaptation Therapy (PATH) mild/moderate caused by Alzheimer's disease. RESULTS Three hundred thirty‐six participants with mild or moderate dementia, >7 on Cornell Scale Depression Dementia (CSDD), randomized PATH as usual. Mean age 77.0 years, 39.0% males, mean Mini‐Mental State Examination 21.6, CSDD 12.9. For primary outcome (CSDD at 6 months), no statistically significant benefit the (6 months: −0.58; 95% CI −1.71 0.54). The 3 months showed a small (−1.38; −2.54 −0.21) did EQ‐5D (−4.97; −9.46 −0.48). DISCUSSION An eight‐session course plus two booster sessions administered within NHS services was not effective people and dementia. Future studies should examine effect more intensive longer‐term therapy.

Язык: Английский

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Depressive symptoms and cognitive decline in older adults

International Psychogeriatrics, Год журнала: 2024, Номер 36(11), С. 1039 - 1050

Опубликована: Апрель 16, 2024

Objectives:Few studies have examined the impact of late-life depression trajectories on specific domains cognitive function. This study aims to delineate how different depressive symptom specifically affect function in older adults.Design:Prospective longitudinal cohort studySetting:Australia and United States AmericaParticipants:In total, 11,035 community-dwelling adults with a mean age 75 yearsMeasurements:Depressive were modelled from symptoms according annual Centre for Epidemiological Studies Depression Scale 10 (CES-D-10) surveys. Four identified: low ("nondepressed"), consistently mild ("subthreshold depression"), moderate ("persistent initially but increasing ("emerging depression"). Global cognition (Modified Mini-Mental State Examination [3MS]), verbal fluency (Controlled Oral Word Association Test [COWAT]), processing speed (Symbol Digit Modalities [SDMT]), episodic memory (Hopkins Verbal Learning – Revised [HVLT-R]), composite z-score assessed over subsequent median 2 years.Results:Subthreshold predicted impaired performance SDMT (Cohen's d −0.04) score (−0.03); emerging (−0.13), HVLT-R (−0.09), 3 MS (−0.08) (−0.09); persistent (−0.08), (−0.11), (−0.09).Conclusions:Depressive are associated later speed. These effects small. Diverse impacts

Язык: Английский

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The contribution of person-centred cultures to the aetiology and management of depression among older adults in nursing homes: a realist review protocol

HRB Open Research, Год журнала: 2025, Номер 8, С. 30 - 30

Опубликована: Фев. 10, 2025

Background Depression is highly prevalent among older adults in nursing homes and living has been reported to be associated with depression. While depression can attributable many causes, it may organisational culture quality of care homes. Person-centredness espoused the regulatory standards informed cultures. However, systematic reviews impact person-centred practices on have yielded mixed results prevalence remains high. This realist review protocol gives details about background this study how authors intend carry out a review. The aims gather evidence as whether cultures contribute aetiology management homes, how, why, for whom what contexts? Method theory-driven will follow four-step design follows: define scope review, search appraise evidence, extract synthesize findings develop narrative. Evidence gathered form context, mechanisms outcomes (CMOs) from both published unpublished sources grey literature test refine initial programme theories collaboration an expert panel. Findings according RAMESES publication guidelines shared stakeholders. Conclusion It anticipated that detailed outline give insight explain or not, way, why provide guidance embedding was registered PROSPERO July 2024 (CRD4202456825).

Язык: Английский

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Conversion to Mild Cognitive Impairment and Alzheimer’s Disease Dementia Related to Apathy, APOE Genotype and Antidepressant Use

Journal of Geriatric Psychiatry and Neurology, Год журнала: 2025, Номер unknown

Опубликована: Апрель 14, 2025

Objective Apathy and APOE ε4 genotype are risk factors for developing Alzheimer’s disease dementia (ADD). Antidepressant use is known to induce apathy. This study aimed examine associations between ε4, apathy, antidepressant with progression from cognitively normal (CN) mild cognitive impairments (MCI), MCI ADD. Methods Participants aged 55-90 were recruited the Disease Neuroimaging Initiative. CN or had at baseline completed least 3 consecutive visits. The NPI NPI-Q apathy subscales used index presence of Antidepressants by participants included SSRIs, SNRIs, AYTADs. Cox proportional hazards analyses examined combined effects genotype, on conversion Results associated increased along CN-MCI-ADD continuum. was ADD, in non-apathetic carriers. Conclusion Our findings support as robust predictors demonstrate novel conversion. Future research should explore whether ADD causes apathetic symptoms serves apathy/depression severity.

Язык: Английский

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Dementia

Annals of Internal Medicine, Год журнала: 2024, Номер 177(11), С. ITC161 - ITC176

Опубликована: Ноя. 1, 2024

Dementia, or major neurocognitive disorder, is defined as a decline in 1 more cognitive domains that causes impairment everyday function. Alzheimer disease the most common type of dementia United States, with an estimated 6.9 million adults who have and are 65 years older. This article discusses latest findings preventing decline. It also screening, diagnosis, treatment, quality life for persons their caregivers.

Язык: Английский

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Associations Between Neuropsychiatric Symptoms and Inflammation in Neurodegenerative Dementia: A Systematic Review

Journal of Inflammation Research, Год журнала: 2024, Номер Volume 17, С. 6113 - 6141

Опубликована: Сен. 1, 2024

Neuropsychiatric symptoms are common in dementia and linked to adverse outcomes. Inflammation is increasingly recognized as playing a role driver of early disease progression Alzheimer's (AD) related dementias. has also been primary psychiatric disorders, however its association with neuropsychiatric neurodegenerative dementias remains uncertain.

Язык: Английский

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