scholarly journals Baseline Prevalence of Polypharmacy in Older Hypertensive Study Subjects with Elevated Dementia Risk: Findings from the Risk Reduction for Alzheimer’s Disease Study (rrAD)

2020 ◽  
Vol 77 (1) ◽  
pp. 175-182
Author(s):  
Eric D. Vidoni ◽  
Ashwini Kamat ◽  
William P. Gahan ◽  
Victoria Ourso ◽  
Kaylee Woodard ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Risk Reduction ◽  
Structured Interview ◽  
Median Number ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Dementia Risk

Background: Little is known about the prevalence of polypharmacy, the taking of five or more medications a day, in older adults with specific dementia risk factors. Objective: To examine the prevalence of polypharmacy in participants at baseline in a vascular risk reduction focused Alzheimer’s disease (rrAD) trial targeting older patients with hypertension and elevated dementia risk. Methods: We conducted a detailed review of medications in a cross-sectional study of community-dwelling older adults with hypertension and elevated dementia risk. Medications were identified in a structured interview process with an onsite pharmacist or qualified designee. Polypharmacy was defined as use of five or more medications on a regular basis. Descriptive analyses were conducted on the sample as well as direct comparisons of subgroups of individuals with hypertension, diabetes, and hyperlipidemia. Results: The 514 rrAD participants, mean age 68.8 (standard deviation [sd] 6), reported taking different combinations of 472 unique medications at their baseline visit. The median number of medications taken by participants was eight [Range 0–21], with 79.2% exhibiting polypharmacy (n = 407). Sites differed in their prevalence of polypharmacy, χ2(3) = 56.0, p < 0.001. A nearly identical percentage of the 2,077 prescribed (51.8%) and over the counter (48.2%) medications were present in the overall medication profile. The presence of diabetes (87.5%), hyperlipidemia (88.2%), or both (97.7%) was associated with a higher prevalence of polypharmacy than participants who exhibited hypertension in the absence of either of these conditions (63.2%), χ2(3) = 35.8, p < 0.001. Conclusion: Participants in a dementia risk study had high levels of polypharmacy, with the co-existence of diabetes or hyperlipidemia associated with a greater prevalence of polypharmacy as compared to having hypertension alone.

scholarly journals Prescription of Benzodiazepines and Related Drugs in Patients with Mild Cognitive Deficits and Alzheimer’s Disease

2018 ◽  
Vol 52 (02) ◽  
pp. 84-91 ◽  
Author(s):  
Philipp Hessmann ◽  
Richard Dodel ◽  
Erika Baum ◽  
Matthias Müller ◽  
Greta Paschke ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Neuropsychiatric Symptoms ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Related Quality ◽  
Health Related ◽  
Lower Hrqol

Abstract Introduction Benzodiazepines and related drugs (BZDR) should be avoided in patients with cognitive impairment. We evaluated the relationship between a BZDR treatment and the health status of patients with Alzheimer’s disease (AD). Methods Cross-sectional study in 395 AD patients using bivariate and multiple logistic analyses to assess correlations between the prescription of BZDR and patients’ characteristics (cognitive and functional capacity, health-related quality of life (HrQoL), neuropsychiatric symptoms). Results BZDR were used in 12.4% (n=49) of all participants. In bivariate analyses, the prescription was associated with a lower HrQoL, a higher need of care, and the presence of anxiety. Multivariate models revealed a higher risk of BZDR treatment in patients with depression (OR 3.85, 95% CI: 1.45 – 10.27). Community-dwelling participants and those treated by neurologists/psychiatrists had a lower risk of receiving BZDR (OR 0.33, 95% CI: 0.12 – 0.89 and OR 0.16, 95% CI: 0.07 – 0.36). Discussion The inappropriate use of BZDR conflicts with national and international guidelines. We suggest evaluating indications and treatment duration and improving the knowledge of alternative therapies in healthcare institutions.

scholarly journals Affective Neuropsychiatric Symptoms as Early Signs of Dementia Risk in Older Adults

2020 ◽  
Vol 77 (3) ◽  
pp. 1195-1207
Author(s):  
Jung Yun Jang ◽  
Jean K. Ho ◽  
Anna E. Blanken ◽  
Shubir Dutt ◽  
Daniel A. Nation ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Latent Class ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Dementia Risk ◽  
Increased Risk ◽  
Risk Of Progression

Background: Affective neuropsychiatric symptoms (aNPS: depression, anxiety, apathy, irritability) have been linked to increased dementia risk. However, less is known whether this association is independent of Alzheimer’s disease (AD) pathophysiology. Objective: To investigate the contribution of early aNPS to dementia risk in cognitively normal (CN) older adults and mild cognitive impairment (MCI) patients, with and without AD biomarker abnormality. Methods: Participants included 763 community-dwelling, stroke-free older adults identified as CN and 617 with MCI at baseline, drawn from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Baseline assessments included a neuropsychological battery, the Neuropsychiatric Inventory (NPI), and apolipoprotein E ɛ4 (ApoE4) genotyping. A participant subset completed cerebrospinal fluid (CSF) AD biomarker assessment. Time to progression to dementia was measured based on months at follow-up when an individual was diagnosed with dementia, over the follow-up period of 48 months. Results: Latent class analysis identified 3 subgroups of older adults in CN and MCI, indicated by the baseline profiles of neuropsychiatric symptoms (NPS). Subgroups with higher aNPS were at increased risk of progression to dementia in both CN (HR = 3.65, 95% CI [1.80, 7.40]) and MCI (HR = 1.52, 95% CI [1.16, 2.00]; HR = 1.86 [1.05, 3.30]) groups, adjusting for age, sex, global cognition, and ApoE4, compared with their counterparts with minimal NPS. There was no difference between higher aNPS and minimal NPS subgroups in their CSF AD biomarker profiles. Conclusion: Findings suggest that aNPS may represent a neurobiological vulnerability that uniquely contribute to the dementia risk, independent of AD biomarker profiles.

scholarly journals SERUM 25(OH)D SIGNIFICANTLY IMPACTS ALZHEIMER’S DISEASE IN OLDER ADULTS LIVING IN LONG-TERM CARE COMMUNITIES.

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S863-S863
Author(s):  
Robert A Churchill ◽  
Ronna Robbins ◽  
Nalini Ranjit ◽  
Sara Sweitzer ◽  
Margaret Briley
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Serum Levels ◽  
Cross Sectional Study ◽  
Vitamin D Supplementation ◽  
Cross Sectional ◽  
Term Care ◽  
Logistic Regression Models ◽  
Hydroxyvitamin D

Abstract 6.08 million Americans suffer from Alzheimer’s Disease (AD), with some estimating diagnoses will reach 15.0 million by 2060. Age is the strongest risk factor for AD, and the prevalence of AD among older adults necessitates investigation into preventable risk factors. 25-hydroxyvitamin D [25(OH)D] deficiency is more prevalent in older adults than other age demographics. Research shows a strong correlation between deficient 25(OH)D serum levels (≤20ng/ml) and AD diagnosis. The association with insufficient (≤30 ng/ml) levels remains unclear. Older adults (age &gt; 65 yo) of five LTC communities in Texas participated in the cross-sectional study. One-year medical history and demographics were abstracted from medical records using double-blinded data abstraction and entry. Blood draws measured 25(OH)D serum levels. Adjusted logistic regression models examined if insufficient 25(OH)D serum levels (≤30 ng/ml) are associated with AD diagnosis. Confounders were total daily vitamin D supplementation, BMI, race, gender, age, years in community, and diagnosis of liver and renal disease. Participants (n=174, mean age: 83 yo) consisted of 63% female and 89% Caucasian. Fifty five percent had insufficient serum 25(OH)D levels (mean level: 32.6 ng/ml; mean supplementation rate: 1,138 IU per/d), and 20% had diagnosis of AD. 25% had both insufficient serum levels and AD, while 12.6% had adequate serum levels and AD. Those with insufficient 25(OH)D serum levels had elevated odds (OR=2.8; CL: 1.14, 7.02; p=0.024) of having AD after adjusting for confounders. Insufficient serum 25(OH)D levels (≤30 ng/ml) are associated with increased diagnoses of AD, indicating the importance of adequate levels among LTC residents.

Apolipoprotein E polymorphism and age of onset for Alzheimer's disease in a bi-ethnic sample

2004 ◽  
Vol 16 (3) ◽  
pp. 317-326 ◽  
Author(s):  
Dylan G. Harwood ◽  
Warren W. Barker ◽  
Raymond L. Ownby ◽  
Peter St. George-Hyslop ◽  
Michael Mullan ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Apolipoprotein E ◽  
Age Of Onset ◽  
Disease Onset ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Ε4 Allele ◽  
The Impact

Objective: This study examined the association between the Apolipoprotein-E ε4 allele (APOE ε4) and age of disease onset in a bi-ethnic sample of community dwelling Alzheimer's disease (AD) patients.Design: Cross-sectional study of AD patients evaluated at a University-affiliated outpatient memory disorders clinic.Subjects: A clinic-based cohort of white non-Hispanic (WNH; n=601) and white Hispanic (WH; n=359) patients diagnosed with possible or probable AD according to NINCDS-ADRDA diagnostic criteria.Measures: Global cognitive functioning of the subjects was evaluated using the Mini-mental State Exam. The age of onset of AD was calculated from the patient's current age minus the reported duration of disease obtained from a knowledgeable family member.Results: A significant relationship was discovered between APOE ε4 and age of onset for WNH, with lower ages of onset among patients carrying the ε4/ε4 and ε3˜/ε4 genotypes in relation to patients with the ε3/ε3 genotype. The results revealed a more modest effect for APOE genotype in the WH cohort, with a lower age of onset witnessed among ε4 positive patients (ε2/ε4, ε3/ε4 and ε4/ε4 genotypes) in comparison to ε4 negative patients (ε2/ε2, ε2/ε3 and ε3/ε3 genotypes).Conclusion: The association between the ε4 allele and earlier age of onset was more pronounced in WNH compared to WH patients, suggesting the impact of APOE polymorphism on clinical phenotype may be different for distinct ethnic groups in the U.S.

scholarly journals Visual Acuity’s Association With Levels of Leisure-Time Physical Activity in Community-Dwelling Older Adults

2012 ◽  
Vol 20 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Mark W. Swanson ◽  
Eric Bodner ◽  
Patricia Sawyer ◽  
Richard M. Allman
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Visual Acuity ◽  
Leisure Time ◽  
Leisure Time Physical Activity ◽  
Cross Sectional Study ◽  
Community Dwelling ◽  
University Of Alabama ◽  
Cross Sectional ◽  
The University

Little is known about the effect of reduced vision on physical activity in older adults. This study evaluates the association of visual acuity level, self-reported vision, and ocular disease conditions with leisure-time physical activity and calculated caloric expenditure. A cross-sectional study of 911 subjects 65 yr and older from the University of Alabama at Birmingham Study of Aging (SOA) cohort was conducted evaluating the association of vision-related variables to weekly kilocalorie expenditure calculated from the 17-item Leisure Time Physical Activity Questionnaire. Ordinal logistic regression was used to evaluate possible associations while controlling for potential confounders. In multivariate analyses, each lower step in visual acuity below 20/50 was significantly associated with reduced odds of having a higher level of physical activity, OR 0.81, 95% CI 0.67, 0.97. Reduced visual acuity appears to be independently associated with lower levels of physical activity among community-dwelling adults.

Recruitment and Screening Methods in Alzheimer’s Disease Research: The FIT-AD Trial

2021 ◽  
Author(s):  
Susan Greimel ◽  
Jean F Wyman ◽  
Lin Zhang ◽  
Fang Yu
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Exercise Intervention ◽  
Community Outreach ◽  
Community Dwelling ◽  
Single Site ◽  
Recruitment Strategy ◽  
Screening Methods ◽  
Screening Process

Abstract Background Recruiting older adults with Alzheimer’s disease (AD) dementia into clinical trials is challenging requiring multiple approaches. We describe recruitment and screening processes and results from the FIT-AD Trial, a single site, pilot randomized controlled trial testing the effects of a 6-month aerobic exercise intervention on cognition and hippocampal volume in community-dwelling older adults with mild-to moderate AD dementia. Methods Ten recruitment strategies and a four-step screening process were used to ensure a homogenous sample and exercise safety. The initial target sample was 90 participants over 48 months which was increased to 96 to allow those in the screening process to enroll if qualified. A tertiary analysis of recruitment and screening rates, recruitment yields and costs, and demographic characteristics of participants was conducted. Results During the 48-month recruiting period, 396 potential participants responded to recruitment efforts, 301 individuals were reached and 103 were tentatively qualified. Of these, 67 (69.8%) participants completed the optional magnetic resonance (MRI) imaging and seven were excluded due to abnormal MRI findings. As a result, we enrolled 96 participants with a 2.92 screen ratio, 2.14 recruitment rate, and 31.9% recruitment yield. Referrals (28.1%) and Alzheimer’s Association events/services (21.9%) yielded over 49% of the enrolled participants. Total recruitment cost was $ 38,246 or $ 398 per randomized participant. Conclusions A multi-prong approach involving extensive community outreach was essential in recruiting older adults with AD dementia into a single-site trial. For every randomized participant, three individuals needed to be screened. Referrals were the most cost-effective recruitment strategy.

scholarly journals Relationship between Oral Hypofunction and Sarcopenia in Community-Dwelling Older Adults: The Otassha Study

2021 ◽  
Vol 18 (12) ◽  
pp. 6666
Author(s):  
Yoshihiro Kugimiya ◽  
Masanori Iwasaki ◽  
Yuki Ohara ◽  
Keiko Motokawa ◽  
Ayako Edahiro ◽  
...  
Keyword(s):  
Older Adults ◽  
Logistic Regression ◽  
Cross Sectional Study ◽  
Albumin Level ◽  
Community Dwelling ◽  
Tongue Pressure ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Community Dwelling Older Adults ◽  
The Relationship

Oral hypofunction, resulting from a combined decrease in multiple oral functions, may affect systemic-condition deterioration; however, few studies have examined the association between oral hypofunction and general health among older adults. In this cross-sectional study, we examined the relationship between oral hypofunction and sarcopenia in community-dwelling older adults. We included 878 adults (268 men and 610 women, mean age 76.5 ± 8.3 years). Tongue coating index, oral moisture, occlusal force, oral diadochokinesis (/pa/,/ta/,/ka/), tongue pressure, mas-ticatory function, and swallowing function were evaluated as indicators of oral hypofunction. Grip strength, gait speed, and skeletal muscle mass index were measured as diagnostic sarcopenia parameters. The association between oral hypofunction and sarcopenia was examined via logistic regression using sarcopenia as the dependent variable. Oral hypofunction prevalence was 50.5% overall, 40.3% in men, and 54.9% in women. The prevalence of sarcopenia was 18.6% overall, 9.7% in men, and 22.5% in women. A logistic regression showed oral hypofunction, age, body mass index, higher-level functional capacity, and serum albumin level were significantly associated with sarcopenia. Sarcopenia occurred at an increased frequency in patients diagnosed with oral hypofunction (odds ratio: 1.59, 95% confidence interval: 1.02–2.47); accordingly, oral hypofunction appears to be significantly associated with sarcopenia.

scholarly journals Perceived stress and depressive symptoms not neuropsychiatric symptoms predict caregiver burden in Alzheimer’s disease: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manee Pinyopornpanish ◽  
Kanokporn Pinyopornpanish ◽  
Atiwat Soontornpun ◽  
Surat Tanprawate ◽  
Angkana Nadsasarn ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Depressive Symptoms ◽  
Caregiver Burden ◽  
Perceived Stress ◽  
Neuropsychiatric Symptoms ◽  
Cross Sectional Study ◽  
Assessment Tools ◽  
Sectional Study ◽  
Cross Sectional

Abstract Background Caregiver burden affects the caregiver’s health and is related to the quality of care received by patients. This study aimed to determine the extent to which caregivers feel burdened when caring for patients with Alzheimer’s Disease (AD) and to investigate the predictors for caregiving burden. Methods A cross-sectional study was conducted. One hundred two caregivers of patients with AD at Maharaj Nakorn Chiang Mai Hospital, a tertiary care hospital, were recruited. Assessment tools included the perceived stress scale (stress), PHQ-9 (depressive symptoms), Zarit Burden Interview-12 (burden), Clinical Dementia Rating (disease severity), Neuropsychiatric Inventory Questionnaires (neuropsychiatric symptoms), and Barthel Activities Daily Living Index (dependency). The mediation analysis model was used to determine any associations. Results A higher level of severity of neuropsychiatric symptoms (r = 0.37, p < 0.01), higher level of perceived stress (r = 0.57, p < 0.01), and higher level of depressive symptoms (r = 0.54, p < 0.01) were related to a higher level of caregiver burden. The direct effect of neuropsychiatric symptoms on caregiver burden was fully mediated by perceived stress and depressive symptoms (r = 0.13, p = 0.177), rendering an increase of 46% of variance in caregiver burden by this parallel mediation model. The significant indirect effect of neuropsychiatric symptoms by these two mediators was (r = 0.21, p = 0.001). Conclusion Caregiver burden is associated with patients’ neuropsychiatric symptoms indirectly through the caregiver’s depressive symptoms and perception of stress. Early detection and provision of appropriate interventions and skills to manage stress and depression could be useful in reducing and preventing caregiver burden.

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