scholarly journals Baseline ECGs done in memory clinics in Leicestershire

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S71-S71
Author(s):  
Tamara Chithiramohan ◽  
Assad Kido ◽  
Mangesh Marudkar
Keyword(s):  
Vascular Dementia ◽  
Lewy Body Dementia ◽  
Memory Clinic ◽  
Mixed Dementia ◽  
Microsoft Excel ◽  
Nice Guidelines ◽  
Cardiac Side Effects ◽  
Number Of Patients ◽  
Memory Clinics ◽  
Key Aspects

AimsTo ascertain the compliance of the Mental Health Service of Older People (MHSOP) memory clinics in obtaining ECGs, based on the agreed criteria.BackgroundCholinesterase inhibitors are a main pharmacological treatment for Alzheimer's dementia (AD). These drugs may worsen pre-existing cardiac conditions or cause significant cardiac side effects. A baseline ECG can be beneficial before starting patients on these medications. Previously in Leicestershire, all memory clinic patients were receiving routine ECGs. However, new standards were set based on the NICE guidelines and criteria outlined in other regions, to reduce the use of this time consuming and expensive investigation for patients who may not require it.MethodA total of 120 patients attending memory clinics in Leicestershire over a 6 month period (April to September 2019), were randomly selected and their electronic records retrospectively reviewed. The data collection tool was designed to encompass the key aspects of the criteria for obtaining an ECG for those attending the memory clinic. The information was analysed using Microsoft Excel.ResultOf the 120 patients, 23 (19.2%) were diagnosed with AD, 10 (8.33%) with mixed and 19 (15.8%) with vascular dementia. 68 (56.7%) had a diagnosis of “other” which included mild cognitive impairment or diagnosis still under investigation. 0 patients were diagnosed with Lewy Body Dementia or Parkinson's dementia. Of the total number of patients, only 10 had an ECG done, 2 with a diagnosis of AD, 1 with mixed dementia, 1 with vascular dementia and 6 “other”. The 10 ECGs done were all requested by nursing staff.Although 27 (22.5%) patients were identified to have a diagnosis of AD or mixed dementia, plus at least one of the criteria for an ECG, only 6 (22.2%) were discussed with the Multi-Disciplinary Team (MDT) following which only 3 of the 27 patients (11.1%) had an ECGConclusionDespite having clear criteria for requesting an ECG for those attending the memory clinic, compliance over the 6 month period was low. The following recommendations may be useful in improving compliance:Displaying the ECG algorithm in the memory service clinic rooms.Raise awareness amongst memory service clinicians of the criteria for requesting ECGs.

Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

An open-label extension trial of galantamine in patients with probable vascular dementia and mixed dementia

2003 ◽  
Vol 25 (6) ◽  
pp. 1765-1782 ◽  
Author(s):  
Timo Erkinjuntti ◽  
Alexander Kurz ◽  
Gary W Small ◽  
Roger Bullock ◽  
Sean Lilienfeld ◽  
...  
Keyword(s):  
Vascular Dementia ◽  
Mixed Dementia ◽  
Open Label ◽  
Open Label Extension ◽  
Extension Trial

Alzheimer’s disease and its related Dementia types: A review on their management via nanotechnology based therapeutic strategies

2021 ◽  
Vol 18 ◽  
Author(s):  
Panoraia I. Siafaka ◽  
Gökce Mutlu ◽  
Neslihan Üstündağ Okur
Keyword(s):  
Alzheimer’S Disease ◽  
Drug Delivery ◽  
Alzheimer's Disease ◽  
Vascular Dementia ◽  
Drug Delivery Systems ◽  
Delivery Systems ◽  
The Body ◽  
Daily Routine ◽  
Mixed Dementia ◽  
The Brain

Background: Dementia and its related types such as Alzheimer’s disease, vascular dementia and mixed dementia belong to brain associated diseases, resulting in long-term progressive memory loss. These diseases are so severe that can affect a person's daily routine. Up to date, treatment of de- mentias is still an unmet challenge due to their complex pathophysiology and unavailable efficient pharmacological approaches. The use of nanotechnology based pharmaceutical products could possibly improve the management of dementia given that nanocarriers could more efficiently deliver drugs to the brain. Objective: The objective of this study is to provide the current nanotechnology based drug delivery systems for the treatment of various dementia types. In addition, the current diagnosis biomarkers for the mentioned dementia types along with their available pharmacological treatment are being dis- cussed. Method: An extensive review of the current nanosystems such as brain drug delivery systems against Alzheimer’s disease, vascular dementia and mixed dementia was performed. Moreover, nan- otheranostics as possible imaging markers for such dementias were also reported. Results: The field of nanotechnology is quite advantageous for targeting dementia given that nanoscale drug delivery systems easily penetrate the blood brain barrier and circulate in the body for prolonged time. These nanoformulations consist of polymeric nanoparticles, solid lipid nanoparticles, nanostruc- tured lipid carriers, microemulsions, nanoemulsions, and liquid crystals. The delivery of the nan- otherapeutics can be achieved via various administration routes such as transdermal, injectable, oral, and more importantly, through the intranasal route. Nonetheless, the nanocarriers are mostly limited to Alzheimer’s disease targeting; thus, nanocarriers for other types of dementia should be developed. Conclusion: To conclude, understanding the mechanism of neurodegeneration and reviewing the cur- rent drug delivery systems for Alzheimer’s disease and other dementia types are significant for medical and pharmaceutical society to produce efficient therapeutic choices and novel strategies based on mul- tifunctional and biocompatible nanocarriers, which can deliver the drug sufficiently into the brain.

scholarly journals Assessment of memory complainers in São Paulo, Brazil: Three-year results of a memory clinic

2008 ◽  
Vol 2 (1) ◽  
pp. 52-56 ◽  
Author(s):  
Cássio Machado de Campos Bottino ◽  
Pedro Zucollo ◽  
Maria Del Pilar Quintero Moreno ◽  
Gislaine Gil ◽  
Carla Garcia Cid ◽  
...  
Keyword(s):  
Clinical Work ◽  
Cognitive Disorder ◽  
University Hospital ◽  
Memory Clinic ◽  
Cognitive Complaints ◽  
Outpatient Group ◽  
Memory Clinics ◽  
Icd 10 ◽  
The Usa ◽  
Primary Care Doctors

Abstract Memory clinics were established in the USA and European countries as services to attend patients who complain of cognitive deficits, referred by primary care doctors, specialists and other hospitals. Objective: We aimed to describe the clinical and cognitive profile of consecutively evaluated subjects during the initial three years of service of a memory clinic from a university hospital. Methods: Subjects were submitted to a clinical work-up for dementia, which included laboratory exams, cranial computerized tomography, cognitive tests, and a comprehensive neuropsychological battery. Diagnosis was made according to ICD-10 criteria. Results: We evaluated 104 subjects (67.3% females and 32.7% males), with mean age of 59.1 years, 88.8% aged 50 years or above. Mean schooling was 9.9 years. Patients were classified into 10 different primary diagnostic categories, namely Depression (26.9%), Alzheimer's disease (17.3%), Memory complaints without objective impairment (17.3%), Mild Cognitive Disorder - MCD (14.4%), and Anxiety (12.5%) the most frequent diagnosis. Comparing patients with dementia, MCD, Depression or Anxiety and Memory complainers, by age (below and above 60 years), dementia was more commonly diagnosed in older subjects, while a higher frequency of memory complainers was found in the younger group. Conclusions: This preliminary report from an outpatient group of referred patients with cognitive complaints showed a higher frequency of psychiatric disorders in this sample. The memory clinic approach should be considered as a model of service which can evaluate subjects with cognitive complaints effectively and improve the quality of care delivered to this patient group.

scholarly journals Cardiac monitoring in memory clinics: national survey of UK practice

2021 ◽  
pp. 1-6
Author(s):  
George Crowther ◽  
Noura Ahmed ◽  
Deepa Kasa ◽  
Zoe Goff ◽  
Muzahir H. Tayebjee
Keyword(s):  
Patient Safety ◽  
Clinical Skill ◽  
Acetylcholinesterase Inhibitors ◽  
Service Level ◽  
Cardiac Monitoring ◽  
National Guidelines ◽  
Cardiac Side Effects ◽  
Prescribing Practice ◽  
Memory Clinics ◽  
Electrocardiogram Ecg

Aims and method People diagnosed with dementia are often started on acetylcholinesterase inhibitors (AChEIs). As AChEIs can be associated with cardiac side-effects, an electrocardiogram (ECG) is sometimes requested before treatment. Previous work has suggested there is little consensus as to when or how ECGs should be obtained. This can create inconsistent practice, with patient safety, economic and practical repercussions. We surveyed 305 UK memory clinic practitioners about prescribing practice. Results More than 84% of respondents completed a pulse and cardiac history before prescribing AChEIs. Opinion was divided as to who should fund and conduct ECGs. It was believed that obtaining an ECG causes patients inconvenience and delays treatment. Despite regularly interpreting ECGs, 76% of respondents did not update this clinical skill regularly. Clinical implications The variation in practice observed has service-level and patient implications and raises potential patient safety concerns. Implementing national guidelines or seeking novel ways of conducting cardiac monitoring could help standardise practice.

scholarly journals A survey of memory clinic practice in Scotland

2008 ◽  
Vol 32 (12) ◽  
pp. 467-469 ◽  
Author(s):  
Jane Foy
Keyword(s):  
Memory Clinic ◽  
National Guidelines ◽  
Common Component ◽  
Prescribing Practice ◽  
Memory Clinics ◽  
Assessment Techniques ◽  
Old Age Psychiatry ◽  
Clinical Autonomy ◽  
Clinic Practice ◽  
The Cost

Aims and MethodA questionnaire survey of all memory clinics in Scotland to obtain information about clinic characteristics, assessment techniques and prescribing practice.ResultsMemory clinics are a common component of old age psychiatry services within Scotland. There is variability in clinic characteristics, assessment techniques and treatment approaches. Most clinicians appear to rely on their own clinical judgement rather than national guidelines when making decisions about investigations and the prescription of anti-dementia medications.Clinical ImplicationsThere is considerable variation in memory clinic practice across the country. Would standardisation of practice ensure equity in service provision/patient care? However, would such standardisation be at the cost of clinical autonomy?

Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia

2017 ◽  
Vol 17 (4-5) ◽  
pp. 127-134 ◽  
Author(s):  
Cassandra J. Anor ◽  
Sean O'Connor ◽  
Amardeep Saund ◽  
David F. Tang-Wai ◽  
Ron Keren ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Vascular Dementia ◽  
Neuropsychiatric Symptoms ◽  
Mixed Dementia

Vascular Dementia: A Diagnostic Challenge

2003 ◽  
Vol 15 (S1) ◽  
pp. 111-114 ◽  
Author(s):  
Gabriel Gold
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Vascular Dementia ◽  
Clinical Diagnosis ◽  
Clinical Studies ◽  
Mixed Dementia ◽  
Diagnostic Challenge ◽  
Clinical Criteria ◽  
Clinicopathological Correlations ◽  
Broad Consensus

Although vascular dementia was described over a century ago, it remains a difficult and challenging diagnosis. Several sets of clinical criteria have been published in an effort to establish the presence or absence of vascular dementia in a standardized fashion. Clinical studies have demonstrated that they identify different groups of patients and are thus not interchangeable. Retrospective clinicopathological correlations have shown that most are insufficiently sensitive, although they are generally relatively specific. They accurately exclude pure Alzheimer's disease but may include 9% to 39% of mixed dementia cases (Alzheimer's disease and vascular dementia combined). Further studies are needed to develop better performing criteria that could lead to a broad consensus on the clinical diagnosis of vascular and mixed dementia.

Somatic comorbidity in patients with dementia: Alzheimer Disease versus Mixed Dementia and Vascular Dementia

1998 ◽  
Vol 13 (S4) ◽  
pp. 274s-274s
Author(s):  
C.A. de Mendonca Lima ◽  
S. Leon Sanchez ◽  
I. Tschan ◽  
I. Simeone
Keyword(s):  
Alzheimer Disease ◽  
Vascular Dementia ◽  
Mixed Dementia ◽  
Somatic Comorbidity
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