Exposure to Anticholinergic and Sedative Drugs and Healthcare Costs in Older Patients with Neurocognitive Disorders

2021 ◽  
Vol 80 (4) ◽  
pp. 1515-1524
Author(s):  
Frederic Gervais ◽  
Virginie Dauphinot ◽  
Christelle Mouchoux ◽  
Pierre Krolak-Salmon
Keyword(s):  
Healthcare Costs ◽  
Older Patients ◽  
Psychological Symptoms ◽  
Functional Limitation ◽  
Neurocognitive Disorders ◽  
Neurocognitive Disorder ◽  
Pharmacological Interventions ◽  
Sedative Drugs ◽  
Substantial Economic Burden ◽  
Regional Public Health

Background: Literature supports an increasing number of older patients living with neurocognitive disorders alongside with their annual worldwide costs. Therapeutic management of behavioral and psychological symptoms includes the use of anticholinergic and sedative drugs for which significant exposure is negatively associated with clinical outcomes. Objective: The aim of this study was to assess the healthcare costs differences related to an increase in the exposure to anticholinergic and sedative drugs in older patients with neurocognitive disorder. Methods: A longitudinal study was conducted during 3 years on 1,604 participants of the MEMORA cohort linked with both regional public health insurance and hospital discharge databases between 2012 and 2017. Direct medical and non-medical costs were included. Exposure to anticholinergic and sedative drugs was measured by the drug burden index (DBI). Results: Costs difference associated with a DBI≥0.5 were + 338€ (p < 0.001). After adjustment on comorbidities, NCD stage, cognitive impairment, functional limitation, polypharmacy, and sociodemographic characteristics, a DBI≥0.5 was found to be an independent predictor of an increase of total healthcare costs by 22%(p < 0.001). Conclusion: Anticholinergic and sedative drugs have a substantial economic burden among older patients with neurocognitive disorder. More studies are required to assess the clinical and economic impact of an efficient strategy based on the reduction of the exposure to anticholinergic and sedative drugs and the promotion of non-pharmacological interventions.

Treatments for Neurocognitive Disorders

2015 ◽  
Author(s):  
Pei Huey Nie ◽  
David L. Sultzer
Keyword(s):  
Cognitive Deficits ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Treatment Options ◽  
Cognitive Disorders ◽  
Neurocognitive Disorders ◽  
Pharmacological Interventions ◽  
Course Of Disease ◽  
Clinical Syndromes ◽  
Diagnosis Of Dementia

Dementia, or neurocognitive disorders, refers to a number of clinical syndromes originating in brain pathology and characterized by cognitive deficits and functional impairment. This chapter provides an update on treatment options in addition to a brief summary of dementia types and an overview of the diagnostic criteria for cognitive disorders. The diagnosis of dementia is ultimately a clinical one and includes a multidimensional perspective; as such, treatment requires a comprehensive approach. This chapter addresses two aspects of the treatment of neurocognitive disorders: pharmacological interventions that can temporarily slow the decline of cognitive deficits and the management of behavioral and psychological symptoms (neuropsychiatric symptoms) associated with dementia syndromes. The chapter also reviews disease-modifying treatments in development that may beneficially alter the course of disease, or reduce or prevent symptom expression in those at risk.

scholarly journals What happens to anxiety disorders in later life?

2002 ◽  
Vol 24 (suppl 1) ◽  
pp. 74-80 ◽  
Author(s):  
Gerard JA Byrne
Keyword(s):  
Anxiety Disorders ◽  
Older People ◽  
Older Patients ◽  
Depressive Disorders ◽  
Late Onset ◽  
Reliability And Validity ◽  
Later Life ◽  
Pharmacological Interventions ◽  
Measuring Change ◽  
Pathological Anxiety

Anxiety disorders decline in prevalence with advancing age but remain more common than depressive disorders. They are often of late-onset and there is frequent comorbidity with depressive disorders and physical illness. While anxiety disorders in older people are likely to respond to the same non-pharmacological interventions that have been shown to work in younger people, there is currently little formal evidence of this. Although there is some evidence that the non-benzodiazepine anxiolytic medication, buspirone, is effective against late life anxiety symptoms, clinical trials in older people with rigorously diagnosed anxiety disorders are needed. An anxiety scale with demonstrated reliability and validity in older people is needed for screening for pathological anxiety and for measuring change in older patients undergoing treatment for anxiety disorders.

Non-pharmacological interventions to prevent or treat pressure ulcers in older patients: Clinical practice recommendations. The SENATOR-ONTOP series

2016 ◽  
Vol 7 (2) ◽  
pp. 142-148 ◽  
Author(s):  
M. Vélez-Díaz-Pallarés ◽  
I. Lozano-Montoya ◽  
A. Correa-Pérez ◽  
I. Abraha ◽  
A. Cherubini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Older Patients ◽  
Pressure Ulcers ◽  
Pharmacological Interventions ◽  
Practice Recommendations

The potential of volunteers to implement non-pharmacological interventions to reduce agitation associated with dementia in nursing home residents

2012 ◽  
Vol 24 (11) ◽  
pp. 1790-1797 ◽  
Author(s):  
Eva S. van der Ploeg ◽  
Tapiwa Mbakile ◽  
Sandra Genovesi ◽  
Daniel W. O'Connor
Keyword(s):  
Psychological Symptoms ◽  
Negative Mood ◽  
Nursing Home Residents ◽  
Aged Care ◽  
Pharmacological Interventions ◽  
Staff Members ◽  
Beneficial Effects ◽  
New Methods ◽  
Care Facilities ◽  
Aged Care Facilities

ABSTRACTBackground: Advanced dementia may be accompanied by behavioral and psychological symptoms of dementia (BPSD). BPSD stemming from pain, depression, or psychosis benefit from treatment with drugs, but in other cases, medications have limited efficacy and may elicit adverse effects. Therefore, more attention has been paid to non-pharmacological interventions, which have fewer risks and can be successful in reducing agitation and negative mood. However, these interventions are frequently not implemented in nursing homes due to staffing constraints. This study explores the potential of volunteers to further assist staff.Methods: We interviewed 18 staff members and 39 volunteers in 17 aged care facilities in southeast Melbourne, Australia.Results: Three-quarters of the facilities in this region worked with at least one regular volunteer. Both self-interest and altruistic reasons were identified as motives for volunteering. Volunteers were perceived by facility representatives as helpful to residents through provision of stimulation and company. However, they were discouraged from engaging with individuals with prominent BPSD. A majority of facility representatives and volunteers had experienced some difficulties in negotiating working relationships but most were easily resolved. A large majority of volunteers expressed an interest in learning new methods of interacting with residents.Conclusion: Despite their beneficial effects for agitated residents, non-pharmacological interventions are often not implemented in aged care facilities. Staff members often lack time but current volunteers in the sector are available, experienced, and interested in learning new methods of interacting. Volunteers therefore potentially are a valuable resource to assist with the application of new treatments.

Ursachen und Therapie des Delirs

2019 ◽  
Vol 144 (02) ◽  
pp. 101-107
Author(s):  
Matthias Maschke
Keyword(s):  
Older Patients ◽  
Mixed Type ◽  
Geriatric Patients ◽  
Metabolic Diseases ◽  
Central Nervous System Infection ◽  
Acute Onset ◽  
Pharmacological Treatments ◽  
Wernicke Encephalopathy ◽  
Pharmacological Interventions ◽  
Short Period

AbstractDelirium is a potentially life-threating acute disease accompanied by a mortality up to 30 % of all affected patients. It occurs more frequently in older patients ≥ 65 years. Delirium is defined as acute onset of disturbances in attention, awareness and cognition that develops within a short period of time and fluctuates in severity. It can be subdivided in hyperactive, hypoactive and a mixed type. The hypoactive type occurs more frequently in geriatric patients and has the highest mortality of all types. Differential diagnosis of delirium include stroke, central nervous system infection, metabolic diseases, disturbances in electrolytes as well as Wernicke encephalopathy and psychiatric diseases. Treatment should be initiated rapidly and includes non-pharmacological interventions and specific pharmacological treatments. The review summarizes diagnosis and clinical management of patients with delirium.

scholarly journals Neuropsychiatric Symptoms in Mild Cognitive Impairment

2017 ◽  
Vol 62 (3) ◽  
pp. 161-169 ◽  
Author(s):  
Damien Gallagher ◽  
Corinne E. Fischer ◽  
Andrea Iaboni
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Neuropsychiatric Symptoms ◽  
Later Life ◽  
Neurocognitive Disorders ◽  
Prognostic Indicators ◽  
Neurocognitive Disorder ◽  
Clinical Stages ◽  
Before And After

Objective: Neuropsychiatric symptoms (NPS) may be the first manifestation of an underlying neurocognitive disorder. We undertook a review to provide an update on the epidemiology and etiological mechanisms of NPS that occur in mild cognitive impairment (MCI) and just before the onset of MCI. We discuss common clinical presentations and the implications for diagnosis and care. Method: The authors conducted a selective review of the literature regarding the emergence of NPS in late life, before and after the onset of MCI. We discuss recent publications that explore the epidemiology and etiological mechanisms of NPS in the earliest clinical stages of these disorders. Results: NPS have been reported in 35% to 85% of adults with MCI and also occur in advance of cognitive decline. The occurrence of NPS for the first time in later life should increase suspicion for an underlying neurocognitive disorder. The presenting symptom may provide a clue regarding the etiology of the underlying disorder, and the co-occurrence of NPS may herald a more accelerated cognitive decline. Conclusions: NPS are prevalent in the early clinical stages of neurocognitive disorders and can serve as both useful diagnostic and prognostic indicators. Recognition of NPS as early manifestations of neurocognitive disorders will become increasingly important as we move towards preventative strategies and disease-modifying treatments that may be most effective when deployed in the earliest stages of disease.

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