1.
Adverse drug reactions in elderly patients with cognitive disorders: A systematic review.
Kanagaratnam, L, Dramé, M, Trenque, T, Oubaya, N, Nazeyrollas, P, Novella, JL, Jolly, D, Mahmoudi, R
Maturitas. 2016;:56-63
Abstract
Elderly subjects with cognitive disorders are at particularly high risk of adverse drug reactions (ADRs). The objectives of our systematic review were to describe the prevalence of ADRs in elderly patients with cognitive disorders, the different types of ADRs and the medications suspected of involvement; to describe whether the ADRs were preventable or not, and to identify risk factors for occurrence of ADRs in this population. A bibliographic search was performed in the following databases: PubMed, Embase, Google Scholar, Opengrey and Scopus. The search included all publications up to and including 4th February 2015, with no specific start date specified. Studies concerning ADRs in elderly patients with cognitive disorders or dementia were included. Two senior authors identified eligible studies and extracted data independently. In total, 113 studies were identified by the bibliographic search, of which six full-text articles were retained and analyzed. Prevalence of ADRs ranged from 4.8 to 37%. The main ADRs reported were neurological and psychological disorders, gastro-intestinal disorders, dermatological and allergic disorders, falls, renal and urinary disorders, cardiovascular disorders, metabolic disorders and electrolyte imbalance, and hemorrhagic events. The medications most commonly suspected of involvement in the ADRs were drugs affecting the nervous system, cardiovascular drugs, anticoagulants, and painkillers. Medical prescriptions should take into account the presence of Alzheimer's disease and related syndromes. Compliance should systematically be evaluated, and cognitive disorders need to be better recognized. Therapeutic education of patients and/or their caregiver is key to management of elderly patients with cognitive disorders.
2.
Brain PET in suspected dementia: patterns of altered FDG metabolism.
Brown, RK, Bohnen, NI, Wong, KK, Minoshima, S, Frey, KA
Radiographics : a review publication of the Radiological Society of North America, Inc. 2014;(3):684-701
Abstract
The diagnosis of dementia syndromes can be challenging for clinicians, particularly in the early stages of disease. Patients with higher education levels may experience a marked decline in cognitive function before their dementia is detectable with routine testing methods. In addition, comorbid conditions (eg, depression) and the use of certain medications can confound the clinical assessment. Clinicians require a high degree of certainty before making a diagnosis of Alzheimer disease or some other neurodegenerative disorder, since the impact on patients and their families can be devastating. Moreover, accurate diagnosis is important because emerging therapeutic regimens vary depending on the cause of the dementia. Clinically based testing is useful; however, the results usually do not enable the clinician to make a definitive diagnosis. For this reason, imaging biomarkers are playing an increasingly important role in the workup of patients with suspected dementia. Positron emission tomography with 2-[fluorine-18]fluoro-2-deoxy-D-glucose allows detection of neurodegenerative disorders earlier than is otherwise possible. Accurate interpretation of these studies requires recognition of typical metabolic patterns caused by dementias and of artifacts introduced by image processing. Although visual interpretation is a vital component of image analysis, computer-assisted diagnostic software has been shown to increase diagnostic accuracy.
3.
Does caring for a spouse with dementia promote cognitive decline? A hypothesis and proposed mechanisms.
Vitaliano, PP, Murphy, M, Young, HM, Echeverria, D, Borson, S
Journal of the American Geriatrics Society. 2011;(5):900-8
Abstract
OBJECTIVE To discuss why spouse caregivers (CGs) of people with dementia may be at higher risk for cognitive problems and decline than demographically similar people not caring for a spouse with dementia (noncaregivers; NCGs). DESIGN Literature review. SETTING Community. PARTICIPANTS Older adults caring for a family member (primarily spouses) with dementia. MEASUREMENTS Cognitive, psychosocial, physiological, and behavioral. RESULTS This article reports a review of the literature examining relationships between CG status and cognitive problems in the context of a theoretical model of chronic stress. The model suggests that spouse CGs may be at higher risk of cognitive impairment or dementia than NCG spouses in response to several mediators, including psychosocial (e.g., depression, loneliness, social isolation, sleep problems), behavioral (e.g., exercise, diet), and physiological (e.g., metabolic syndrome and inflammation) variables. CONCLUSION This research has important implications because it considers modifiable risk factors for dementia that, if unchecked, may compromise the lives of CGs and their ability to function. It is hoped that an understanding of such stress-mediator-cognitive processes will help clinicians, researchers, policy-makers, and stakeholders mitigate what may be characterized as an "ironic tragedy"-dementia in both members of the caregiving dyad-if left unchecked.
4.
[Lifestyle-related diseases as risk factors for dementia].
Sekita, A, Kiyohara, Y
Brain and nerve = Shinkei kenkyu no shinpo. 2010;(7):709-17
Abstract
In this article, we have reviewed the findings of prospective cohort studies throughout the world to examine influences of lifestyle-related diseases on the risks of total dementia, Alzheimer disease (AD), and vascular dementia (VD). In some cohort studies on elderly populations, diabetes was found to be consistently associated with the risk of VD, but was inconsistently associated with the risk of AD. A cohort study on the elderly residents of the town of Hisayama, Japan, revealed the significant associations between glucose intolerance and the risks of both VD and AD. Clinical and experimental evidence has indicated that glucose intolerance and diabetes induce dementia through various mechanisms such as atherosclerosis,microvascular disease, glucose toxicity, and impaired insulin metabolism. No cohort studies have indicated significant associations between late-life hypertension and the risk of AD, and only 1 study has revealed the significant influence of hypertension on the risk of VD in an elderly population. The Hisayama study revealed that late-life hypertension was a significant risk factor for the development of VD but not for AD. A few cohort studies have suggested the presence of significant associations between midlife hypertension and the risks of late-life AD and VD. Metabolic syndrome has been shown to be a risk factor for the development of cognitive impairment, but no prospective cohort studies have investigated the significant influence of this syndrome on the risk of AD or VD. Some cohort studies have examined the associations of hypercholesterolemia with the risk of AD, but the results were inconsistent. Further studies are required to resolve these issues.