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Unfavorable impact of cancer cachexia on activity of daily living and need for inpatient care in elderly patients with advanced non-small-cell lung cancer in Japan: a prospective longitudinal observational study.
Naito, T, Okayama, T, Aoyama, T, Ohashi, T, Masuda, Y, Kimura, M, Shiozaki, H, Murakami, H, Kenmotsu, H, Taira, T, et al
BMC cancer. 2017;(1):800
Abstract
BACKGROUND Cancer cachexia in elderly patients may substantially impact physical function and medical dependency. The aim of this study was to estimate the impact of cachexia on activity of daily living (ADL), length of hospital stay, and inpatient medical costs among elderly patients with advanced non-small-cell lung cancer (NSCLC) receiving chemotherapy. METHODS Thirty patients aged ≥70 years with advanced NSCLC (stage III-IV) scheduled to receive first-line chemotherapy were prospectively enrolled between January 2013 and November 2014. ADL was assessed using the Barthel index. The disability-free survival time (DFS) was calculated as the time between the date of study entry and the date of onset of a disabling event, which was defined as a 10-point decrease in the Barthel index from that at baseline. The mean cumulative function of the length of hospital stay and inpatient medical costs (¥, Japanese yen) was calculated. RESULTS The study patients comprised 11 women and 19 men, with a median age of 74 (range, 70-82) years. Cachexia was diagnosed in 19 (63%) patients. Cachectic patients had a shorter DFS (7.5 vs. 17.1 months, p < 0.05). During the first year from study entry, cachectic patients had longer cumulative lengths of hospital stay (80.7 vs. 38.5 days/person, p < 0.05), more frequent unplanned hospital visits or hospitalizations (4.2 vs. 1.7 times/person, p < 0.05), and higher inpatient medical costs (¥3.5 vs. ¥2.1 million/person, p < 0.05) than non-cachectic patients. CONCLUSIONS Elderly NSCLC patients with cachexia showed higher risks for disability, prolonged hospitalizations, and higher inpatient medical costs while receiving chemotherapy than patients without cachexia. Our results might indicate that there is a potential need for an early intervention to minimize progression to or development of cachexia, improve functional prognosis, and reduce healthcare resource burden in this population. TRIAL REGISTRATION Trial registration number: UMIN000009768 . Name of registry: UMIN (University hospital Medical Information Network). Date of registration: 14 January 2013. Date of enrolment of the first participant to the trial: 23 January 2013.
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Rankin scale as a potential measure of global disability in early Parkinson's disease.
Simuni, T, Luo, ST, Chou, KL, Fernandez, H, He, B, Parashos, S
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2013;(9):1200-3
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Abstract
We conducted an exploratory analysis of the utility of the modified Rankin Scale (mRS) as a global measure of disability in early Parkinson's diesase (PD) using the baseline data from a large cohort of PD patients enrolled in a longitudinal study of creatine. The mRS is scored 0-6 with lower scores reflecting less disability. For the analysis the mRS score was dichotomized at <2 versus ≥2. We explored the association of the mRS with multiple measures of PD-related impairments, including the Unified Parkinson Disease Rating Scale (UPDRS); cognitive function characterized by the Symbol Digit Modalities--verbal, and Scales for Outcomes in Parkinson's disease--cognition (SCOPA-COG); quality of life (Parkinson's disease questionnaire [PDQ-39]) and EuroQOL; Beck Depression Inventory II (BDI); and Total Functional Capacity (TFC). We also investigated the interaction between variables. One thousand seven hundred forty-one patients were included in the analysis of which 374 had a mRS score of 2 or above. In the univariate model, all interested measures except SCOPA-COG (p=0.23) had significant association with mRS (p<0.001) after controlling for confounders. In the multivariate model, UPDRS Part II and III (activities of daily living and motor), BDI, TFC and PDQ-39 were significant (p<0.05). The mRS has a significant association with the wide spectrum of measures of impairment and quality of life in early PD and shows good potential to be a global measure of disability in early PD. The sensitivity of the mRS to change and performance of the scale in more advanced PD will have to be established longitudinally.
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Improved physical function and physical activity in older adults following a community-based intervention: Relationships with a history of depression.
Porter, KN, Fischer, JG, Johnson, MA
Maturitas. 2011;(3):290-4
Abstract
The purpose of this study was to explore the relationship of a history of depression with moderate physical activity and physical function before and after a physical activity intervention of congregate meal participants in senior centers from all 12 Georgia Area Agencies on Aging (AAA). Participants were a convenience sample of older adults (n=376, mean age=76 years, 82% female, 64% Caucasian, 36% African American, 22% a history of depression). The physical activity intervention included educator-led chair exercises that incorporated balls and bands. Pre- and post-tests assessed moderate physical activity and physical function. At the pre-test, a history of depression was not related to moderate physical activity or physical function. Following the intervention there were significant increases in both moderate physical activity and physical function, but a history of depression was a negative predictor of improvements in physical activity when controlled for site, demographics, and health-related conditions. These results provide an evidence base for the effectiveness of this intervention in improving moderate physical activity and physical function in a community setting, but additional efforts may be needed to improve the impact of this type of intervention among older adults with a history of depression.
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A randomized, observer-blind, controlled trial of the traditional Chinese medicine Yi-Gan San for improvement of behavioral and psychological symptoms and activities of daily living in dementia patients.
Iwasaki, K, Satoh-Nakagawa, T, Maruyama, M, Monma, Y, Nemoto, M, Tomita, N, Tanji, H, Fujiwara, H, Seki, T, Fujii, M, et al
The Journal of clinical psychiatry. 2005;(2):248-52
Abstract
OBJECTIVE This randomized, observer-blind, controlled trial examined the efficacy and safety of the traditional Chinese herbal medicine Yi-Gan San (YGS, Yokukan-San in Japanese) in the improvement of behavioral and psychological symptoms of dementia (BPSD) and activities of daily living (ADL). METHOD Fifty-two patients with mild-to-severe dementia (24 men and 28 women, mean +/- SD age = 80.3 +/- 9.0 years) according to DSM-IV criteria were investigated. Participants were randomly assigned to the YGS group (N = 27) or control (drug-free) group (N = 25) and treated for 4 weeks. The Neuropsychiatric Inventory (NPI) for the assessment of BPSD, the Mini-Mental State Examination (MMSE) for cognitive function, and the Barthel Index for ADL were administered at baseline and the end of the treatment. The frequency of extrapyramidal symptoms (EPS) and other adverse events was recorded. If patients showed insufficient response to treatment after 1 week, tiapride hydrochloride, a dopamine D(1) selective neuroleptic, was added to the regimen. Data were collected from January 2004 to March 2004. RESULTS All participants in both groups completed the trial. In the control group, 11 patients required treatment with tiapride hydrochloride. Significant improvements in mean +/- SD NPI (from 37.9 +/- 16.1 to 19.5 +/- 15.6) and Barthel Index (from 56.4 +/- 34.2 to 62.9 +/- 35.2) scores were observed in the YGS group, but not in the control group. MMSE results were unchanged in both groups. EPS were not observed in either group, but dizziness and impaired postural sway were observed in 6 patients treated with tiapride hydrochloride. CONCLUSION Yi-Gan San improves BPSD and ADL. Follow-up studies using a double-blinded, placebo-controlled design are recommended.
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Cognition, function, and caregiving time patterns in patients with mild-to-moderate Alzheimer disease: a 12-month analysis.
Feldman, HH, Van Baelen, B, Kavanagh, SM, Torfs, KE
Alzheimer disease and associated disorders. 2005;(1):29-36
Abstract
Placebo data were pooled from two 1-year, randomized, double-blind, placebo-controlled trials of sabeluzole in patients with mild-to-moderate Alzheimer disease (AD). Cognition was assessed using the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) and activities of daily living (ADL) with the Disability Assessment in Dementia (DAD). Time spent assisting with ADL was estimated according to the caregiver for each DAD domain in the 2 weeks before assessment. Progressive annual decline was seen on ADAS-cog (5.6 +/- 7.3 [mean +/- SD]) and DAD (-12.4 +/- 17.8), with greater decline in moderate patients (Mini-Mental State Examination [MMSE] < or =18) than mild patients (MMSE >18). An MMSE score of 16 appeared to be a key transition point at which most instrumental ADL were lost and major losses of basic ADL began to occur over the next 12 months. Caregivers spent, on average, 14 hours more assisting with ADL over 2 weeks at the end of 1 year. The proportion of care provided by paid caregivers increased relative to the time spent by informal caregivers. Patients with mild-to-moderate AD experience predictable annual decline in cognition and daily functioning, with measurably increased caregiver time. Small changes in ADAS-cog are nevertheless associated with a substantial measurable effect on the daily lives of both patients and caregivers.
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[Delay in progression of dependency and need of care of dementia patients treated with Ginkgo special extract EGb 761].
Haan, J, Hörr, R
Wiener medizinische Wochenschrift (1946). 2004;(21-22):511-4
Abstract
In studies on the efficacy of antidementia drugs, a delay in symptom progression was often postulated based on a comparison of the change upon treatment and an assumed "natural" progression. Such comparisons were usually based on the cognitive subscore of the Alzheimer's Disease Assessment Scale (ADAS-cog), using either the drug-placebo differences after randomized treatment or the changes upon active drug treatment in open-label extension studies. Considering quality of life, competence, cost of care, and economics of therapeutic measures, a delay in the progression of dependency and need of care appears to be more relevant than a delay in cognitive abilities not directly related to activities of daily living. Therefore, for dementia patients treated with the Ginkgo special extract EGb 761, the delay in loss of capacities needed to cope with the demands of daily living was estimated, based on the Geriatric Evaluation of Relative's Rating Instrument (GERRI). The drug-placebo differences documented after 26 and 52 weeks of treatment corresponded to a delay in progression by 10 and 21 months, respectively. Regarding the subgroup with dementia of the Alzheimer type, the estimated delay was 16 and 25 months, respectively. It could thus be shown that by treatment with EGb 761 the progression of dependency and need of care can be slowed down, which may have an impact on costs for care, e.g. by delaying nursing home placement.
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[Handipark: a simple test of the impact of Parkinson's disease on activities of daily living].
Ziégler, M, de Broucker, T, Damier, P, Humbert, R, Clerson, P, Richard-Berthe, C
Revue neurologique. 2003;(8-9):767-74
Abstract
Handipark, a new score for measuring the impact of Parkinson's disease on daily life activities is presented. The global score ranging from 1 to 10 (without half points) is easy to determine. For a given patient, the score takes into account 5 items describing the global impact of the disease;Inter- and intra-observer reproducibility were determined. The reliability of the score was tested during two sessions separated by a 3-week interval. Five qualified neurologists scored 30 Parkinson's patients presented randomly for scoring using a semi-structured video-recorded interview. Intra-observer reproducibility was good (concordance coefficient; k=0.74, Spearman's correlation coefficient; r=0.88). Inter-observer reproducibility was also good: r=0.96 (first session), r=0.87 (second session); the agreement coefficient between the 5 observers was k=0.85 (first session), k=0.82 (second session). Distribution curves of the Hanipark score was described in 150 Parkinson's disease patients to study the correlation with items of other scales specific for Parkinson's disease (UPDRS, Hoehn & Yahr). A number significant correlations were found. Handipark is a reliable tool easy to use in clinical practice by a large panel of physicians caring for Parkinson's disease patients to assess the impact of Parkinson's disease. Further studies are needed to assess its usefulness for the follow-up of patients and assess the therapeutic impact.
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[The effect of ginkgo biloba on healthy elderly subjects].
Cieza, A, Maier, P, Pöppel, E
Fortschritte der Medizin. Originalien. 2003;(1):5-10
Abstract
BACKGROUND AND AIM Over the past 25 years, numerous studies have confirmed the positive effect of the special ginkgo extract EGb 761 on the mental ability and emotional well-being of patients with cognitive disorders of vascular genesis, and Alzheimer-type dementia. The following study investigated the short-term effect of the special ginkgo extract EGb 761 on the subjective emotional well-being of healthy elderly subjects. STUDY POPULATION AND METHOD The study was designed as a randomized double-blind, monocenter study with parallel groups. It included 66 healthy subjects of both sexes aged between 50 and 65 with no age-related cognitive impairments. For a period of 4 weeks, 34 subjects received a daily dose of 240 mg EGb 761, and 32 a placebo. Prior to starting medication and after 28 days of treatment, subjects completed the following scales and questionnaires to establish subjective emotional well-being: the Profile of Mood States (POMS), the Self Rating Depression Scale (SDS), three Visual Analog Scales to assess the quality of life (VAS-QoL), general health (VAS-GH) and mental health (VAS-MH), and a new instrument for assessing changes in general subjective well-being, the Subjective Intensity Score Mood (SIS Mood). Depending on the underlying distribution of the variables analyzed, parametric (t-tests) or nonparametric tests (U-tests) were performed to compare mean values and distributions both within and between the treatment groups. RESULTS The final examination revealed a statistically significant difference between the two groups for the VAS mental health and quality of life, as also for SIS Mood at the telephone interview in week 2. A comparison of baseline with the final examination within the groups showed a statistically significant improvement in the EGb 761 group for the variables: depression, fatigue, anger and SDS. For none of the variables investigated was a worsening observed in the EGb 761 group. CONCLUSIONS The results suggest a positive effect of EGb 761 on the subjective emotional well-being of healthy elderly persons.
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Clinical, functional and quality of life changes after balneokinesis with sulphurous water in patients with varicose veins.
Mancini, S, Piccinetti, A, Nappi, G, Mancini, S, Caniato, A, Coccheri, S
VASA. Zeitschrift fur Gefasskrankheiten. 2003;(1):26-30
Abstract
BACKGROUND Purpose of this study was to assess the effects of thermal hydrotherapy (balneokinesis) with a sulphurous water on clinical symptoms, quality of life and some functional parameters in patients with varicose veins. PATIENTS AND METHODS 70 patients with primary or secondary symptomatic varicosis were enrolled and submitted to elastic compression therapy. Patients were then randomized to receive (50 pts, group A) or not receive (20 pts, group B) balneokinetic treatment for 12 days "on top" of elastic compression. Clinical symptoms, quality of life and functional parameters obtained with light reflex plethysmography (PPG) and laser Doppler fluxmetry (LDF) were assessed after 3 and 6 months. RESULTS Scores for subjective symptoms as pain, edema, and venous claudication were decreased after 6 months in both groups, but more evidently in group A submitted to balneokinesis. Some parameters related to quality of life evaluation as "bodily pain" and "emotional role" were improved only in patients undergoing balneokinesis. Regarding functional parameters, with PPG venous refilling time after foot exercise moderately increased in both groups. With LDF a significant improvement in the veno-arteriolar reflex was seen in the group treated with balneokinesis. CONCLUSIONS These results show additional benefits of balneokinetic treatment in patients with symptomatic varices submitted to elastic compression. In fact, clinical and quality of life improvements were observed. The associated amelioration in the veno-arteriolar reflex may support these subjective benefits.
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Action-based memory in Alzheimer's disease: a longitudinal look at tea making.
Rusted, J, Sheppard, L
Neurocase. 2002;(1-2):111-26
Abstract
In this paper we report the results of a longitudinal study which examined memory for a single routine activity of daily living in people with dementia of the Alzheimer type. We assessed memory in a natural setting, visiting volunteers in their homes. We video-taped performance on the selected task and analysed the record for the presence or absence of each of its component actions over a period of 6 years. In this way, we obtained longitudinal data for a small group of people moving from the mild-moderate stages of dementia through to severe dysfunction. In the first section of this paper we examine the nature of the errors which are made in recall of a routine activity by volunteers with dementia of the Alzheimer type and what happens to that routine as the dementia erodes memory. In the second section we examine the consequence of moving the routine from a familiar setting to a novel setting. We observed large differences in the rate of decline of our volunteers, with substantial preservation of performed recall of the everyday task, even in the more severe phases of the disease. The pattern of decline suggests a benign degradation of the memory trace, with omissions comprising the most common category of errors, and this result is contrasted with the more dramatic action disorganization syndrome associated with frontal injury. The results have implications both for theoretical models of action-based memory and intervention programmes aimed at maintaining functional independence for people with dementia.