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Rodriguez-Espeso EA, Verdejo-Bravo C, Cherubini A, Gudmundsson A, Petrovic M, Soiza RL, O'Mahony D, Cruz-Jentoft AJ. The Association of Dementia With Incident Adverse Drug Reactions in Hospitalized Older Adults. J Am Med Dir Assoc 2024; 25:105151. [PMID: 39013474 DOI: 10.1016/j.jamda.2024.105151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Older adults with dementia commonly receive multiple medications and have higher hospitalization rates, elevating the risk of potentially inappropriate prescribing and in-hospital adverse drug reactions (ADRs). There is limited evidence examining ADRs in older adults with dementia during hospitalization. OBJECTIVES Our aim was to assess the association between dementia and incidence of ADRs during hospitalization and to identify prevalent types of ADRs and medications linked to ADRs. DESIGN Secondary analysis of the SENATOR trial database, which was a randomized controlled trial of an intervention to reduce ADRs in older inpatients with multimorbidity. SETTING AND PARTICIPANTS A total of 1537 patients (47.2% females) with a mean age of 78.1 years were recruited from 6 European hospitals. METHODS Sociodemographic data, functional status, cognitive status, clinical information, and ADR-related outcomes were extracted from the SENATOR database. Inpatients with dementia were identified based on prior International Classification of Diseases, Tenth Revision (ICD-10), dementia diagnosis, receiving acetylcholinesterase inhibitors or memantine, or a Mini-Mental State Examination score ≤24 at admission without concurrent delirium. RESULTS Among participants, 392 (25.5%) were identified as having dementia. The proportion of patients with probable or certain incident in-hospital ADRs was similar between the groups with and without dementia (22.4% vs 25.4%, P > .05). However, in-hospital rates of probable or certain ADRs from 12 common categories were less frequently identified in patients with dementia compared to those without (19.4% vs 23%, P = .025). Major constipation (6.4% vs 9.9%, P = .03) and acute dyspepsia, nausea, or vomiting (2.8% vs 5%, P = .03) were less commonly observed ADRs in patients with dementia. CONCLUSIONS AND IMPLICATIONS We did not observe an increased risk of in-hospital ADRs among inpatients with dementia. However, ADRs related to the gastrointestinal tract and identified by subjective symptoms were less frequently identified in this group. This study lays the groundwork for developing new tools for ADR diagnosis for older patients with dementia.
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Affiliation(s)
| | | | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Roy L Soiza
- Ageing Clinical and Experimental Research (ACER) Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, Scotland, United Kingdom
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
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Zaidi AS, Peterson GM, Curtain CM, Salahudeen MS. Predictors of Adverse Drug Reaction-Related Hospitalisations Among People with Dementia: A Retrospective Case-Control Study. Drug Saf 2024; 47:771-781. [PMID: 38739234 PMCID: PMC11286664 DOI: 10.1007/s40264-024-01435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are common among people with dementia; however, little is known about the magnitude and predictors associated with ADR-related hospitalisation among these individuals. This study aimed to determine the magnitude, types, drugs implicated and predictors of ADRs associated with hospitalisation among people with dementia. METHODS This retrospective case-control study analysed medical records of individuals aged ≥ 65 years with dementia admitted to major public hospitals in Tasmania, Australia, from July 2010 to July 2021. Adverse drug reactions and implicated drugs were identified using administrative data and cross-checked with hospital medical records, with consensus reached among the research team. RESULTS Of the 7928 people admitted to hospital at least once within the study period, 1876 (23.7%) experienced at least one ADR-related hospitalisation. Of these, 300 case patients with 311 ADRs and 300 control patients were randomly selected. The most common types of ADRs were renal (acute kidney injury; AKI) (36.0%), followed by neuropsychiatric (17.6%), cardiovascular (16.0%) and haematological (13.1%). Diuretics, renin-angiotensin system (RAS) inhibitors and anti-thrombotics constituted the main implicated drug classes. The ADR-related hospitalisation was associated with: chronic kidney disease (CKD) (OR 8.00, 95% CI 2.63-24.28, p < 0.001), Australian-born (OR 1.62, 95% CI 1.08-2.43, p = 0.019), hypertension (OR 1.48, 95% CI 1.01-2.17, p = 0.044) and the number of medicines (OR 1.06, 95% CI 1.00-1.12, p = 0.022). Potentially inappropriate medication use and anticholinergic burden did not predict ADR-related hospitalisation. CONCLUSIONS These predictors could help identify the individuals at the highest risk and enable targeted interventions to be designed.
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Affiliation(s)
- Anum Saqib Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia.
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, 7001, Australia
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Mitchell AK, Ehrenkranz R, Franzen S, Han SH, Shakur M, McGowan M, Massett HA. Analysis of eligibility criteria in Alzheimer's and related dementias clinical trials. Sci Rep 2024; 14:15036. [PMID: 38951633 PMCID: PMC11217383 DOI: 10.1038/s41598-024-65767-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
Overly restrictive clinical trial eligibility criteria can reduce generalizability, slow enrollment, and disproportionately exclude historically underrepresented populations. The eligibility criteria for 196 Alzheimer's Disease and Related Dementias (AD/ADRD) trials funded by the National Institute on Aging were analyzed to identify common criteria and their potential to disproportionately exclude participants by race/ethnicity. The trials were categorized by type (48 Phase I/II pharmacological, 7 Phase III/IV pharmacological, 128 non-pharmacological, 7 diagnostic, and 6 neuropsychiatric) and target population (51 AD/ADRD, 58 Mild Cognitive Impairment, 25 at-risk, and 62 cognitively normal). Eligibility criteria were coded into the following categories: Medical, Neurologic, Psychiatric, and Procedural. A literature search was conducted to describe the prevalence of disparities for eligibility criteria for African Americans/Black (AA/B), Hispanic/Latino (H/L), American Indian/Alaska Native (AI/AN) and Native Hawaiian/Pacific Islander (NH/PI) populations. The trials had a median of 15 criteria. The most frequent criterion were age cutoffs (87% of trials), specified neurologic (65%), and psychiatric disorders (61%). Underrepresented groups could be disproportionately excluded by 16 eligibility categories; 42% of trials specified English-speakers only in their criteria. Most trials (82%) contain poorly operationalized criteria (i.e., criteria not well defined that can have multiple interpretations/means of implementation) and criteria that may reduce racial/ethnic enrollment diversity.
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Affiliation(s)
| | | | - Sanne Franzen
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, 20852, USA
| | - Mujaahida Shakur
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA
| | - Melissa McGowan
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA
| | - Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, 7201 Wisconsin Ave., Ste 2S-603, Bethesda, MD, 20814, USA.
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Ashford MT, Jin C, Neuhaus J, Diaz A, Aaronson A, Tank R, Eichenbaum J, Camacho MR, Fockler J, Ulbricht A, Flenniken D, Truran D, Mackin RS, Weiner MW, Mindt MR, Nosheny RL. Participant completion of longitudinal assessments in an online cognitive aging registry: The role of medical conditions. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12438. [PMID: 38188606 PMCID: PMC10767283 DOI: 10.1002/trc2.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION This study aimed to understand whether older adults' longitudinal completion of assessments in an online Alzheimer's disease and related dementias (ADRD)-related registry is influenced by self-reported medical conditions. METHODS Brain Health Registry (BHR) is an online cognitive aging and ADRD-related research registry that includes longitudinal health and cognitive assessments. Using logistic regressions, we examined associations between longitudinal registry completion outcomes and self-reported (1) number of medical conditions and (2) eight defined medical condition groups (cardiovascular, metabolic, immune system, ADRD, current psychiatric, substance use/abuse, acquired, other specified conditions) in adults aged 55+ (N = 23,888). Longitudinal registry completion outcomes were assessed by the completion of the BHR initial questionnaire (first questionnaire participants see at each visit) at least twice and completion of a cognitive assessment (Cogstate Brief Battery) at least twice. Models included ethnocultural identity, education, age, and subjective memory concern as covariates. RESULTS We found that the likelihood of longitudinally completing the initial questionnaire was negatively associated with reporting a diagnosis of ADRD and current psychiatric conditions but was positively associated with reporting substance use/abuse and acquired medical conditions. The likelihood of longitudinally completing the cognitive assessment task was negatively associated with number of reported medical conditions, as well as with reporting cardiovascular conditions, ADRD, and current psychiatric conditions. Previously identified associations between ethnocultural identity and longitudinal assessment completion in BHR remained after accounting for the presence of medical conditions. DISCUSSION This post hoc analysis provides novel, initial evidence that older adults' completion of longitudinal assessments in an online registry is associated with the number and types of participant-reported medical conditions. Our findings can inform future efforts to make online studies with longitudinal health and cognitive assessments more usable for older adults with medical conditions. The results need to be interpreted with caution due to selection biases, and the under-inclusion of minoritized communities.
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Affiliation(s)
- Miriam T. Ashford
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Chengshi Jin
- University of California San Francisco Department of Epidemiology and Biostatistics San FranciscoSan FranciscoCaliforniaUSA
| | - John Neuhaus
- University of California San Francisco Department of Epidemiology and Biostatistics San FranciscoSan FranciscoCaliforniaUSA
| | - Adam Diaz
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Anna Aaronson
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Rachana Tank
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Dementia Research CentreUCL Institute of NeurologyUniversity College LondonLondonUK
| | - Joseph Eichenbaum
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Monica R. Camacho
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Juliet Fockler
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Aaron Ulbricht
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Derek Flenniken
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Diana Truran
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
| | - Robert Scott Mackin
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Department of MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of NeurologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Monica Rivera Mindt
- Psychology, Latin American Latino Studies Institute& African and African American StudiesFordham UniversityJoint Appointment in NeurologyIcahn School of Medicine at Mount Sinai ‐ New YorkNew YorkNew YorkUSA
| | - Rachel L. Nosheny
- Department of Veterans Affairs Medical CenterNorthern California Institute for Research and Education (NCIRE)San FranciscoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Findlay MC, Khan M, Kundu M, Johansen CM, Lucke-Wold B. Innovative Discoveries in Neurosurgical Treatment of Neurodegenerative Diseases: A Narrative Review. Curr Alzheimer Res 2023; 20:394-402. [PMID: 37694797 DOI: 10.2174/1567205020666230911125646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023]
Abstract
Neurodegenerative diseases (NDDs) encapsulate conditions in which neural cell populations are perpetually degraded and nervous system function destroyed. Generally linked to increased age, the proportion of patients diagnosed with a NDD is growing as human life expectancies rise. Traditional NDD therapies and surgical interventions have been limited. However, recent breakthroughs in understanding disease pathophysiology, improved drug delivery systems, and targeted pharmacologic agents have allowed innovative treatment approaches to treat NDDs. A common denominator for administering these new treatment options is the requirement for neurosurgical skills. In the present narrative review, we highlight exciting and novel preclinical and clinical discoveries being integrated into NDD care. We also discuss the traditional role of neurosurgery in managing these neurodegenerative conditions and emphasize the critical role of neurosurgery in effectuating these newly developed treatments.
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Affiliation(s)
- Matthew C Findlay
- School of Medicine, University of Utah, Salt Lake City, Utah 84043, USA
| | - Majid Khan
- School of Medicine, University of Nevada, Reno, NV 89036, USA
| | - Mrinmoy Kundu
- Institute of Medical Sciences and SUM hospital, Bhubaneswar, India
| | - Chase M Johansen
- Department of Neurosurgery, Albany Medical College, Albany, New York 10001, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida 32013, USA
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Ashford MT, Raman R, Miller G, Donohue MC, Okonkwo OC, Mindt MR, Nosheny RL, Coker GA, Petersen RC, Aisen PS, Weiner MW. Screening and enrollment of underrepresented ethnocultural and educational populations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). Alzheimers Dement 2022; 18:2603-2613. [PMID: 35213778 PMCID: PMC9402812 DOI: 10.1002/alz.12640] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An analysis of the ethnocultural and socioeconomic composition of Alzheimer's Disease Neuroimaging Initiative (ADNI) participants is needed to assess the generalizability of ADNI data to diverse populations. METHODS ADNI data collected between October 2004 and November 2020 were used to determine ethnocultural and educational composition of the sample and differences in the following metrics: screening, screen fails, enrollment, biomarkers. RESULTS Of 3739 screened individuals, 11% identified as being from ethnoculturally underrepresented populations (e.g., Black, Latinx) and 16% had <12 years of education. Of 2286 enrolled participants, 11% identified as ethnoculturally underrepresented individuals and 15% had <12 years of education. This participation is considerably lower than US Census data for adults 60+ (ethnoculturally underrepresented populations: 25%; <12 years of education: 4%). Individuals with <12 years of education failed screening at a higher rate. DISCUSSION Our findings suggest that ADNI results may not be entirely generalizable to ethnoculturally diverse and low education populations.
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Affiliation(s)
- Miriam T. Ashford
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center - San Francisco (United States)
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Garrett Miller
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael C. Donohue
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research Center and The Department of Medicine, University of Wisconsin School Of Medicine And Public Health - Madison (United States)
| | - Monica Rivera Mindt
- Psychology & Latin American Latino Studies Institute, Fordham University, Joint Appointment in Neurology, Icahn School of Medicine at Mount Sinai - New York (United States)
| | - Rachel L. Nosheny
- Department Of Psychiatry, University of California San Francisco - San Francisco (United States)
| | - Godfrey A. Coker
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | | | - Paul S. Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael W. Weiner
- Department Of Radiology and Biomedical Imaging, University of California San Francisco - San Francisco (United States)
| | - Alzheimer’s Disease Neuroimaging Initiative
- Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). A complete listing of ADNI investigators can be found at:http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf
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Husebo BS, Vislapuu M, Cyndecka MA, Mustafa M, Patrascu M. Understanding Pain and Agitation Through System Analysis Algorithms in People With Dementia. A Novel Explorative Approach by the DIGI.PAIN Study. FRONTIERS IN PAIN RESEARCH 2022; 3:847578. [PMID: 35369536 PMCID: PMC8970316 DOI: 10.3389/fpain.2022.847578] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMany people with dementia (PwD) live and die with undiagnosed and untreated pain and are no longer able to report their suffering. Several pain assessment tools have been developed, tested, and implemented in clinical practice, but nursing home patients are reported to be still in pain. Clinicians and research groups worldwide are seeking novel approaches to encode the prediction, prevalence, and associations to pain in PwD.ParticipantsThe data in this analysis are acquired from the COSMOS study, a cluster-randomized controlled trial (2014 to 2015), aimed to improve the quality of life in nursing home patients (N = 723) through the implementation of a multicomponent intervention. We utilize baseline data of PwD (N = 219) with complete datasets of pain and agitation.MethodSystems analysis explores the relationship between pain and agitation using the Mobilization-Observation-Behavior-Intensity-Dementia (MOBID-2) Pain Scale, Cohen-Mansfield Agitation Inventory (CMAI), and Neuropsychiatric Inventory-Nursing Home version (NPI-NH). For each patient, the individualized continuous time trajectory, and rates of change of pain and agitation are estimated. We determine the relationship between these rates by analyzing them across the entire group.ResultsWe found that the new analysis method can generate individualized estimations for pain and agitation evolution for PwD, as well as their relationship. For 189 of 219 PwD, results show that whenever pain increases or decreases, agitation does too, with the same rate. The method also identifies PwD for whom pain or agitation remains constant while the other varies over time, and patients for whom agitation and pain do not change together. The algorithm is scalable to other variables and compatible with wearable devices and digital sensors.ConclusionWe presented a new approach to clinical data analysis using systems concepts and algorithms. We found that it is possible to quantify and visualize relationships between variables with a precision only dependent on the precision of measurements. This method should be further validated, but incipient results show great potential, especially for wearable-generated continuous data.
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Affiliation(s)
- Bettina S. Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Department of Nursing Home Medicine, Bergen, Norway
- *Correspondence: Bettina S. Husebo
| | - Maarja Vislapuu
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
| | | | - Manal Mustafa
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Monica Patrascu
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Complex Systems Laboratory, Department of Automatic Control and System Engineering, University Politehnica of Bucharest, Bucharest, Romania
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Duara R, Barker W. Heterogeneity in Alzheimer's Disease Diagnosis and Progression Rates: Implications for Therapeutic Trials. Neurotherapeutics 2022; 19:8-25. [PMID: 35084721 PMCID: PMC9130395 DOI: 10.1007/s13311-022-01185-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/03/2023] Open
Abstract
The clinical presentation and the pathological processes underlying Alzheimer's disease (AD) can be very heterogeneous in severity, location, and composition including the amount and distribution of AB deposition and spread of neurofibrillary tangles in different brain regions resulting in atypical clinical patterns and the existence of distinct AD variants. Heterogeneity in AD may be related to demographic factors (such as age, sex, educational and socioeconomic level) and genetic factors, which influence underlying pathology, the cognitive and behavioral phenotype, rate of progression, the occurrence of neuropsychiatric features, and the presence of comorbidities (e.g., vascular disease, neuroinflammation). Heterogeneity is also manifest in the individual resilience to the development of neuropathology (brain reserve) and the ability to compensate for its cognitive and functional impact (cognitive and functional reserve). The variability in specific cognitive profiles and types of functional impairment may be associated with different progression rates, and standard measures assessing progression may not be equivalent for individual cognitive and functional profiles. Other factors, which may govern the presence, rate, and type of progression of AD, include the individuals' general medical health, the presence of specific systemic conditions, and lifestyle factors, including physical exercise, cognitive and social stimulation, amount of leisure activities, environmental stressors, such as toxins and pollution, and the effects of medications used to treat medical and behavioral conditions. These factors that affect progression are important to consider while designing a clinical trial to ensure, as far as possible, well-balanced treatment and control groups.
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Affiliation(s)
- Ranjan Duara
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
- Departments of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Warren Barker
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA.
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Brambilla M, Parra MA, Della Sala S, Alemanno F, Pomati S. Challenges to recruitment of participants with MCI in a multicentric neuropsychological study. Aging Clin Exp Res 2021; 33:2007-2010. [PMID: 33052589 DOI: 10.1007/s40520-020-01729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data on recruitment of Mild Cognitive Impairment (MCI) samples are seldom reported and this issue can be an important source of research waste. AIM To describe the recruitment challenges and reasons for non-eligibility faced during a bi-centre clinical study assessing the predictive value of a neuropsychological battery of the progression to dementia. METHODS Potential MCI participants were identified from databases of the two memory clinics based in Milan (Italy) and invited to the screening assessment. RESULTS About 50% of the cases initially identified were ineligible according to inclusion/exclusion criteria and the two sites took 22 months to recruit the planned 150 people. The main reasons for non-eligibility were the MMSE score (41%), age (14%), presence of cerebrovascular disorders (9%), perceptual deficits (6%), neurological (6%) or psychiatric (4%) comorbidities and low education (5%). CONCLUSION Awareness of the reasons for exclusion and of the time needed to recruit the planned sample would provide hints for the planning of future studies on MCI.
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Affiliation(s)
- Michela Brambilla
- Neurology Unit, Centre for the Treatment and Study of Cognitive Disorders, Luigi Sacco Hospital, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Sergio Della Sala
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK
| | - Federica Alemanno
- Department of Clinical Neuroscience, Specialistic Neurorehabilitation of Neurological, Cognitive and Motor Disorders, San Raffaele Scientific Institute, Milan, Italy
| | - Simone Pomati
- Neurology Unit, Centre for the Treatment and Study of Cognitive Disorders, Luigi Sacco Hospital, Via Giovanni Battista Grassi 74, 20157, Milan, Italy.
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Walker VM, Kehoe PG, Martin RM, Davies NM. Repurposing antihypertensive drugs for the prevention of Alzheimer's disease: a Mendelian randomization study. Int J Epidemiol 2021; 49:1132-1140. [PMID: 31335937 PMCID: PMC7751008 DOI: 10.1093/ije/dyz155] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 02/02/2023] Open
Abstract
Background Evidence concerning the potential repurposing of antihypertensives for Alzheimer’s disease prevention is inconclusive. We used Mendelian randomization, which can be more robust to confounding by indication and patient characteristics, to investigate the effects of lowering systolic blood pressure, via the protein targets of different antihypertensive drug classes, on Alzheimer’s disease. Methods We used summary statistics from genome-wide association studies of systolic blood pressure and Alzheimer’s disease in a two-sample Mendelian randomization analysis. We identified single-nucleotide polymorphisms (SNPs) that mimic the action of antihypertensive protein targets and estimated the effect of lowering systolic blood pressure on Alzheimer’s disease in three ways: (i) combining the protein targets of antihypertensive drug classes, (ii) combining all protein targets and (iii) without consideration of the protein targets. Results There was limited evidence that lowering systolic blood pressure, via the protein targets of antihypertensive drug classes, affected Alzheimer’s disease risk. For example, the protein targets of calcium channel blockers had an odds ratio (OR) per 10 mmHg lower systolic blood pressure of 1.53 [95% confidence interval (CI): 0.94 to 2.49; p = 0.09; SNPs = 17]. We also found limited evidence for an effect when combining all protein targets (OR per 10 mmHg lower systolic blood pressure: 1.14; 95% CI: 0.83 to 1.56; p = 0.41; SNPs = 59) and without consideration of the protein targets (OR per 10 mmHg lower systolic blood pressure: 1.04; 95% CI: 0.95 to 1.13; p = 0.45; SNPs = 153). Conclusions Mendelian randomization suggests that lowering systolic blood pressure via the protein targets of antihypertensive drugs is unlikely to affect the risk of developing Alzheimer’s disease. Consequently, if specific antihypertensive drug classes do affect the risk of Alzheimer’s disease, they may not do so via systolic blood pressure.
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Affiliation(s)
- Venexia M Walker
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Patrick G Kehoe
- Dementia Research Group, University of Bristol, Bristol, UK.,Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Richard M Martin
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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11
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Adherence to the Class-Based Component of a Tai Chi Exercise Intervention for People Living With Dementia and Their Informal Carers. J Aging Phys Act 2021; 29:721-734. [PMID: 33395630 DOI: 10.1123/japa.2020-0119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
The objective of this study was to understand the experiences of people living with dementia and their informal carers' taking part together (in dyads) in Tai Chi classes and the aspects influencing their adherence. Dyads' experiences of taking part in Tai Chi classes for 20 weeks within the TACIT Trial were explored through class observations (n = 22 dyads), home-interviews (n = 15 dyads), and feedback. Data were inductively coded following thematic analysis. Tai Chi classes designed for people with dementia and their informal carers were enjoyable and its movements, easy to learn. Facilitators of participants' adherence were the socializing component and their enjoyment of the classes, whereas unexpected health problems were the main barrier. Finding the optimal level of challenge in the class setting might be crucial for people with dementia to feel satisfied with their progression over sessions and enable their continued participation.
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12
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Indorewalla KK, O’Connor MK, Budson AE, Guess (DiTerlizzi) C, Jackson J. Modifiable Barriers for Recruitment and Retention of Older Adults Participants from Underrepresented Minorities in Alzheimer's Disease Research. J Alzheimers Dis 2021; 80:927-940. [PMID: 33612540 PMCID: PMC8150544 DOI: 10.3233/jad-201081] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 01/05/2023]
Abstract
Clinical Alzheimer's disease (AD) trials currently face a critical shortfall of thousands of eligible participants, which inflates the duration and cost of the clinical study as well as threatens the scientific merit of promising clinical interventions. This recruitment crisis is further compounded by the fact that underrepresented and marginalized populations-particularly those identifying as a racial or ethnic minority, those with low socioeconomic status, or living in rural areas-have been historically underrepresented in ongoing AD clinical trials despite overwhelming evidence that such populations are at increased risk for developing dementia. As a result of various recruitment barriers, current AD clinical studies frequently reflect a decreasingly representative segment of the US population, which threatens the overall generalizability of these findings. The current narrative review provides an updated examination and critique of common recruitment barriers and potential solutions, as well as a discussion of theoretical approaches that may address barriers disproportionately experienced by underrepresented communities. AD clinical researchers are encouraged to take purposive action aimed at increasing diversity of enrolled AD clinical trial cohorts by actively identifying and quantifying barriers to research participation-especially recruitment barriers and health disparities that disproportionately prevent underrepresented and marginalized populations from participating in research. Furthermore, researchers are encouraged to closely track which individuals who express interest in AD research ultimately enroll in research studies to examine whether AD research participation is appropriately representative of the intended population for whom these new and novel AD interventions are being designed.
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Affiliation(s)
| | - Maureen K. O’Connor
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Andrew E. Budson
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Christina Guess (DiTerlizzi)
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jonathan Jackson
- Boston University Alzheimer’s Disease Research Center, Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- CARE Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Nguyen TA, Gilmartin-Thomas J, Tan ECK, Kalisch-Ellett L, Eshetie T, Gillam M, Reeve E. The Impact of Pharmacist Interventions on Quality Use of Medicines, Quality of Life, and Health Outcomes in People with Dementia and/or Cognitive Impairment: A Systematic Review. J Alzheimers Dis 2020; 71:83-96. [PMID: 31356204 DOI: 10.3233/jad-190162] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medication use in people with dementia and/or cognitive impairment (PWD/CI) is challenging. As medication experts, pharmacists have an important role in improving care of this vulnerable population. OBJECTIVE Systematically review evidence for the effectiveness of pharmacist-led interventions on quality use of medicines, quality of life, and health outcomes of PWD/CI. METHODS A systematic review was conducted using MEDLINE, EMBASE, PsycINFO, Allied and Complementary Medicine (AMED) and Cumulative index to Nursing and Allied Health Literature (CINAHL) databases from conception to 20 March 2017. Full articles published in English were included. Data were synthesized using a narrative approach. RESULTS Nine studies were eligible for inclusion. All studies were from high-income countries and assessed pharmacist-led medication management services. There was great variability in the content and focus of services described and outcomes reported. Pharmacists were found to provide a number of cognitive services including medication reconciliation, medication review, and medication adherence services. These services were generally effective with regards to improving quality use of medicines and health outcomes for PWD/CI and their caregivers, and for saving costs to the healthcare system. Pharmacist-led medication and dementia consultation services may also improve caregiver understanding of dementia and the different aspects of pharmacotherapy, thus improving medication adherence. CONCLUSION Emerging evidence suggests that pharmacist-led medication management services for PWD/CI may improve outcomes. Future research should confirm these findings using more robust study designs and explore additional roles that pharmacists could undertake in the pursuit of supporting PWD/CI.
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Affiliation(s)
- Tuan Anh Nguyen
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.,Health Strategy and Policy Institute, Ministry of Health of Vietnam
| | - Julia Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Parkville, Australia
| | - Edwin Chin Kang Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, NSW, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia.,Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Tesfahun Eshetie
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Marianne Gillam
- Quality Use of Medicines & Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Emily Reeve
- NHMRC Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Geriatric Medicine Research and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, NS, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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14
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O'Caoimh R, Gao Y, Svendrovski A, Illario M, Iaccarino G, Yavuz BB, Kehoe PG, Molloy DW. Effect of Visit-to-Visit Blood Pressure Variability on Cognitive and Functional Decline in Mild to Moderate Alzheimer's Disease. J Alzheimers Dis 2020; 68:1499-1510. [PMID: 30909214 DOI: 10.3233/jad-180774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Visit-to-visit blood pressure (BP) variability (VVV) is increasingly recognized as a marker of cardiovascular risk. Although implicated in cognitive decline, few studies are currently available assessing its effects on established dementia. OBJECTIVE To investigate if VVV is associated with one-year rate of decline in measures of cognition and function in patients with mild to moderate Alzheimer's disease (AD) in the Doxycycline And Rifampicin for Alzheimer's Disease study. METHODS Patients were included if ≥3 BP readings were available (n = 392). VVV was defined using different approaches including the coefficient of variation (CV) in BP readings between visits. Outcomes included rates of decline in the Standardized Alzheimer's Disease Assessment Scale-Cognitive Subscale (SADAS-cog), Standardized MMSE, Clinical Dementia Rating Scale, the Quick Mild Cognitive Impairment screen and the Lawton-Brody activities of daily living (ADL) scale. RESULTS Half of the patients (196/392) had a ≥4-point decline in the SADAS-cog over one-year. Using this cut-off, there were no statistically significant associations between any measures of VVV, for systolic or diastolic BP, with and without adjustment for potential confounders including treatment allocation, history of hypertension and use of anti-hypertensive and cognitive enhancing medications. Multiple regression models examining the association between systolic BP CV by quartile and decline over one-year likewise showed no clinically significant effects, apart from a U-shaped pattern of ADL decline of borderline clinical significance.∥Conclusions: This observational study does not support recent research showing that VVV predicts cognitive decline in AD. Further studies are needed to clarify its effects on ADL in AD.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Geata an Eolais, University Road, Galway, Ireland
| | - Yang Gao
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
| | | | - Maddalena Illario
- Division on Health Innovation, Campania Region Health Directorate; DISMET/R&D Unit, Federico II University and Hospital, Naples, Italy
| | - Guido Iaccarino
- Department of Medicine and Surgery, University of Salerno, Baronissi, SA, Italy
| | - Burcu Balam Yavuz
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Patrick Gavin Kehoe
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork, Ireland
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15
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Zaidi AS, Peterson GM, Bereznicki LRE, Curtain CM, Salahudeen M. Outcomes of Medication Misadventure Among People With Cognitive Impairment or Dementia: A Systematic Review and Meta-analysis. Ann Pharmacother 2020; 55:530-542. [PMID: 32772854 DOI: 10.1177/1060028020949125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To investigate mortality and hospitalization outcomes associated with medication misadventure (including medication errors [MEs], such as the use of potentially inappropriate medications [PIMs], and adverse drug events [ADEs]) among people with cognitive impairment or dementia. DATA SOURCES Ovid MEDLINE, Ovid EMBASE, Ovid International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception to December 2019. STUDY SELECTION AND DATA EXTRACTION Relevant studies using any study design were included. Reviewers independently performed critical appraisal and extracted relevant data. DATA SYNTHESIS The systematic review included 10 studies that reported the outcomes of mortality or hospitalization associated with medication misadventure, including PIMs (n=5), ADEs (n=2), a combination of MEs and ADEs (n=2), and drug interactions (n=1). Five studies examining the association between PIMs and mortality/hospitalization were included in the meta-analyses. Exposure to PIMs was not associated with either mortality (odds ratio [OR]=1.36; 95%CI=0.79-2.35) or hospitalization (OR=1.02; 95%CI=0.83-1.26). In contrast, single studies indicated that ADEs with cholinesterase inhibitors were associated with mortality and hospitalization. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Individuals with cognitive impairment or dementia are at increased risk of medication misadventure; based on relatively limited published data, this does not necessarily translate to increased mortality and hospitalization. CONCLUSIONS Overall, medication misadventure was not associated with mortality or hospitalization in people with cognitive impairment or dementia, noting the limited number of studies, difficulty in controlling potential confounding variables, and that most studies focus on PIMs.
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Affiliation(s)
- Anum Saqib Zaidi
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia.,Faculty of Health, University of Canberra, Australia
| | - Luke R E Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
| | - Mohammed Salahudeen
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Australia
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16
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Sakiris MA, Sawan M, Hilmer SN, Awadalla R, Gnjidic D. Prevalence of adverse drug events and adverse drug reactions in hospital among older patients with dementia: A systematic review. Br J Clin Pharmacol 2020; 87:375-385. [PMID: 32520427 DOI: 10.1111/bcp.14417] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS This systematic review aimed to quantify the prevalence of adverse drug events (ADEs) and adverse drug reactions (ADRs) in older inpatients with dementia. METHODS A systematic search of observational studies was performed in Embase, Medline, PsycINFO, International Pharmaceutical Abstracts, Scopus and Informit. Articles published in English that reported the prevalence of ADEs or ADRs in hospital patients aged 65 years or older with dementia were included. Two authors reviewed titles and abstracts and all eligible full-text articles. Relevant information relating to ADEs, ADRs and dementia was obtained from each article. RESULTS In total, 5 articles were included. One study reported the prevalence of ADEs to be 81.5%, defined using the Naranjo algorithm. Four studies assessed the prevalence of ADRs, ranging from 12.7 to 24.0%, assessed using various methods. One study defined ADRs according to the World Health Organization-Uppsala Monitoring Centre criteria, 2 studies employed the World Health Organization definition and 1 study did not explicitly define ADRs. The most frequently reported drug classes implicated in ADEs and ADRs were psychotropic, antihypertensive and analgesic drugs. CONCLUSION Our findings suggest a high prevalence of ADEs and ADRs in older inpatients with dementia. However, only 1 study documented ADEs and there was variability in approaches to ADR assessment. A greater understanding of ADEs and ADRs, as well as tailored assessment tools, will promote prevention of ADEs and ADRs in people with dementia.
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Affiliation(s)
- Marissa Anne Sakiris
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mouna Sawan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Nicole Hilmer
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Departments of Aged Care and Clinical Pharmacology, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Rebecca Awadalla
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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17
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Eshetie TC, Nguyen TA, Gillam MH, Kalisch Ellett LM. Potentially inappropriate prescribing in people with dementia: An Australian population-based study. Int J Geriatr Psychiatry 2019; 34:1498-1505. [PMID: 31173395 DOI: 10.1002/gps.5160] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/01/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the prevalence of potentially inappropriate prescribing (PIP) using the Screening Tool of Older Person's Prescriptions (STOPP) criteria in people with dementia compared with people without dementia. METHODS A retrospective cohort study was conducted using the Pharmaceutical Benefits Scheme 10% sample of pharmacy claims. People with dementia were defined as those dispensed a medicine for dementia (cholinesterase inhibitors, memantine, or risperidone for behavioural and psychological symptoms of dementia) between 1 January 2005 and 31 December 2015, aged 65 years or older at 1 January 2016 and alive at the end of 2016. An age- and gender-matched comparison cohort of people not dispensed medicines for dementia was identified. PIP prevalence was determined between 1 January 2016 and 31 December 2016. RESULTS In total, 8280 people dispensed medicines for dementia and 41 400 comparisons not dispensed medicines for dementia were included: 63% were female and the median age was 82 years. PIP prevalence was 79% among people with dementia compared with 70% among the comparison group (P < .0001). Use of anticholinergics, long-term use of high-dose proton pump inhibitors, and use of benzodiazepines were the most common instances of PIP in people with dementia. After adjustments for age, gender, comorbidity, and number of prescribers, people with dementia were more likely to be exposed to PIP than comparisons (adjusted OR 1.44, 95% CI, 1.35-1.53, P < .0001). CONCLUSIONS PIP was more common in people dispensed medicines for dementia than comparisons. These results highlight the need for effective interventions to optimize prescribing in people with dementia.
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Affiliation(s)
- Tesfahun C Eshetie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Tuan A Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Marianne H Gillam
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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18
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Nguyen TA, Pham T, Vu HTT, Nguyen TX, Vu TT, Nguyen BTT, Nguyen NQ, Nguyen BT, Nguyen BT, Nguyen TN, Phan SV, Nguyen AT, Pham TL, Dang HT, Kalisch-Ellett L, Gillam M, Pratt N, Qiang S, Wang H, Kanjanarach T, Hassali MAA, Babar ZUD, Razak AA, Chinwong D, Roughead EE. Use of Potentially Inappropriate Medications in People With Dementia in Vietnam and Its Associated Factors. Am J Alzheimers Dis Other Demen 2018; 33:423-432. [PMID: 29642720 PMCID: PMC10852524 DOI: 10.1177/1533317518768999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
This study examined the use of potentially inappropriate medicines that may affect cognition (PIMcog) in people with dementia and its associated factors. Medical records of all outpatients with dementia attending a tertiary hospital in Vietnam between January 1, 2015, and December 31, 2016, were examined. Medicine use was assessed against a list of PIMcog. Variables associated with having a PIMcog were assessed using a multiple logistic regression. Of the 128 patients, 41% used a PIMcog, 39.1% used cholinesterase inhibitors (CEIs) concomitantly with anticholinergics, and 18% used antipsychotics. The number of hospital visits (adjusted odds ratio [OR]: 1.08; 95% confidence interval [CI]: 1.02-1.16) and number of treating specialists (adjusted OR: 0.61; 95% CI: 0.45-0.83) were associated with PIMcog use. This study highlights a high-level use of medicines that can further impair cognition or reduce the effectiveness of CEIs in people with dementia. Efforts to improve quality use of medicines for this population are warranted.
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Affiliation(s)
- Tuan Anh Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Thang Pham
- National Geriatric Hospital of Vietnam, Hanoi, Vietnam
| | | | | | - Trinh Thi Vu
- National Geriatric Hospital of Vietnam, Hanoi, Vietnam
| | | | | | | | | | | | | | | | - Tuan Le Pham
- Hanoi Medical University and Ministry of Health of Vietnam, Hanoi, Vietnam
| | - Ha Thu Dang
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Marianne Gillam
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Sun Qiang
- Center for Health Management and Policy, School of Health Care Management, Shandong University, Jinan, China
| | - Haipeng Wang
- Center for Health Management and Policy, School of Health Care Management, Shandong University, Jinan, China
| | | | | | | | - Asrenee Ab Razak
- Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Dujrudee Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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19
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Nosheny RL, Camacho MR, Insel PS, Flenniken D, Fockler J, Truran D, Finley S, Ulbricht A, Maruff P, Yaffe K, Mackin RS, Weiner MW. Online study partner-reported cognitive decline in the Brain Health Registry. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2018; 4:565-574. [PMID: 30386821 PMCID: PMC6205111 DOI: 10.1016/j.trci.2018.09.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Methods for efficiently identifying cognitive decline and Alzheimer's disease (AD) are a critical unmet need. The goal of this work was to validate novel online study partner (SP)-reported outcomes to identify cognitive decline in older adults. METHODS In older adults enrolled in the Brain Health Registry, we analyzed associations between SP-reported cognitive decline, measured by the Everyday Cognition Scale, and either (1) participant cognition, assessed by Cogstate Brief Battery or (2) participant-reported diagnosis of mild cognitive impairment or AD. RESULTS We found strong associations between SP-reported Everyday Cognition Scale and both Cogstate scores and participant diagnosis. The associations were cognitive domain specific, dependant on participant diagnosis, and were stronger in spouse dyads and those who knew each other longer. DISCUSSION Collecting SP-reported data online from a large cohort is feasible. Results support the construct validity of our approach, which has the potential to facilitate clinical AD and aging research.
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Affiliation(s)
- Rachel L. Nosheny
- UCSF Department of Psychiatry, San Francisco, CA, USA
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Monica R. Camacho
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Philip S. Insel
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
- UCSF Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
| | - Derek Flenniken
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Juliet Fockler
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Diana Truran
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Shannon Finley
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Aaron Ulbricht
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | | | - Kristine Yaffe
- UCSF Department of Psychiatry, San Francisco, CA, USA
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - R. Scott Mackin
- UCSF Department of Psychiatry, San Francisco, CA, USA
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
| | - Michael W. Weiner
- UCSF Department of Psychiatry, San Francisco, CA, USA
- San Francisco Veteran's Administration Medical Center, San Francisco, CA, USA
- UCSF Department of Radiology and Biomedical Imaging, San Francisco, CA, USA
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20
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Eshetie TC, Nguyen TA, Gillam MH, Kalisch Ellett LM. A narrative review of problems with medicines use in people with dementia. Expert Opin Drug Saf 2018; 17:825-836. [DOI: 10.1080/14740338.2018.1497156] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tesfahun C. Eshetie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Tuan A. Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Marianne H. Gillam
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Lisa M. Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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21
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Mechanisms of vascular disease in dementia: what does industry want to know? Clin Sci (Lond) 2017; 131:799-802. [PMID: 28424374 DOI: 10.1042/cs20160724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 11/17/2022]
Abstract
Despite recent advances in basic and clinical science, dementia remains an area of high unmet medical need. The role of cerebrovascular mechanisms in the pathogenesis and progression of cognitive and functional impairment in dementia is being revived. In order to facilitate the development of therapeutic approaches, it is critical that a number of fundamental elements are integrated into research strategies investigating cerebrovascular pathologies as these will maximize the opportunity of bringing medicines to patients in a timely manner.
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22
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Khan A, Corbett A, Ballard C. Emerging amyloid and tau targeting treatments for Alzheimer’s disease. Expert Rev Neurother 2017; 17:697-711. [DOI: 10.1080/14737175.2017.1326819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ayesha Khan
- Institute for NanoBiotechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Anne Corbett
- King’s College London, Wolfson Centre for Age-Related Diseases, London, UK
| | - Clive Ballard
- King’s College London, Wolfson Centre for Age-Related Diseases, London, UK
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23
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Hager K, Baseman AS, Nye JS, Brashear HR, Han J, Sano M, Davis B, Richards HM. Effect of concomitant use of memantine on mortality and efficacy outcomes of galantamine-treated patients with Alzheimer's disease: post-hoc analysis of a randomized placebo-controlled study. ALZHEIMERS RESEARCH & THERAPY 2016; 8:47. [PMID: 27846868 PMCID: PMC5111338 DOI: 10.1186/s13195-016-0214-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/12/2016] [Indexed: 11/17/2022]
Abstract
Background A large, prospective, 2-year, randomized study in patients with mild-to-moderate Alzheimer’s disease or mixed dementia demonstrated reductions in mortality and cognitive/functional decline in galantamine-treated patients. A post-hoc analysis was conducted to study the effect of (the presence or absence of) concomitant memantine use on treatment outcome. Methods Randomized patients (N = 2045) were divided into subgroups based on memantine use. Analyses included demographic and clinical characteristics (age, nursing home placement, Mini-Mental State Examination (MMSE) and Disability Assessment for Dementia (DAD) scores) and mortality endpoints. Results Overall, 496 (24.3 %) patients were memantine users and were older (mean (SD), 74.0 (8.76) vs 72.8 (8.76), p = 0.008), with lower MMSE scores (18.2 (4.16) vs 19.2 (4.02), p < 0.0001) and DAD scores (58.0 (23.49) vs 62.5 (20.52), p < 0.0001) than nonusers. Mortality rates (per 100 patient-years) in memantine nonusers (n = 1549) were lower for galantamine (1.39) vs placebo-treated patients (4.15). In memantine users, mortality rates were similar for placebo-treated (4.49) and galantamine-treated patients (5.57). In memantine nonusers at 24 months, the decline in MMSE scores (effect size (95 % CI) 0.25 (0.14; 0.36)) and DAD scores (0.17 (0.06; 0.28)) from baseline was lower in galantamine patients vs placebo patients. The absence of these benefits in memantine users could not be explained by baseline age, MMSE, or DAD scores. Conclusion This post-hoc analysis shows that the beneficial effects of galantamine at 2 years post treatment were not observed in patients who had been placed on background memantine. The reasons for memantine treatment and the possibility of interaction between memantine and galantamine merit further investigation. Trial registration ClinicalTrials.gov NCT00679627. Registered 15 May 2008. Electronic supplementary material The online version of this article (doi:10.1186/s13195-016-0214-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Klaus Hager
- Clinic for Medicine of the Elderly, Hannover, Germany
| | - Alan S Baseman
- Janssen Research and Development, LLC, Titusville, NJ, USA. .,Janssen Research and Development, LLC, 850 Ridgeview Drive, Horsham, PA, 19044, USA.
| | - Jeffrey S Nye
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | | | - John Han
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Mary Sano
- The Mount Sinai Medical Center, New York, NY, USA
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Calamia M, Bernstein JPK, Keller JN. I'd Do Anything for Research, But I Won't Do That: Interest in Pharmacological Interventions in Older Adults Enrolled in a Longitudinal Aging Study. PLoS One 2016; 11:e0159664. [PMID: 27438465 PMCID: PMC4954686 DOI: 10.1371/journal.pone.0159664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/05/2016] [Indexed: 12/15/2022] Open
Abstract
Alzheimer’s disease (AD) ranks as the 6th leading cause of death in the United States, yet unlike other diseases in this category, there are no disease-modifying medications for AD. Currently there is significant interest in exploring the benefits of pharmacological treatment before the onset of dementia (e.g., in those with mild cognitive impairment); however, recruitment for such studies is challenging. The current study examined interest in pharmacological intervention trials relative to other types of clinical interventions. A total of 67 non-demented older adults enrolled in a longitudinal cognitive aging study completed a questionnaire assessing interest in participating in a variety of hypothetical research study designs. Consistent with past research, results showed that the opportunities for participants to advance science, receive feedback about their current health, and help themselves or others, were associated with increased interest in clinical trial participation. Some factors were not associated with change in interest (e.g., a doctor not recommending participation) while others were associated with decreased interest (e.g., having to come in for multiple visits each week). Relative to other types of interventions, pharmacological intervention trials were associated with the least interest in participation, despite pharmacological interventions being rated as more likely to result in AD treatment. Decreased interest was not predicted by subjective memory concerns, number of current medications, cardiovascular risk, or beliefs about the likely success of pharmacological treatments. These results highlight the challenges faced by researchers investigating pharmacological treatments in non-demented older individuals, and suggest future research could contribute to more effective ways of recruiting participants in AD-related clinical trials.
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Affiliation(s)
- Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
- * E-mail:
| | - John P. K. Bernstein
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Jeffrey N. Keller
- Pennington Biomedical Research Center, Institute for Dementia Research and Prevention, Baton Rouge, Louisiana, United States of America
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Black BS, Taylor HA, Rabins PV, Karlawish J. Study partners perform essential tasks in dementia research and can experience burdens and benefits in this role. DEMENTIA 2016; 17:1471301216648796. [PMID: 27179001 PMCID: PMC5107353 DOI: 10.1177/1471301216648796] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most studies that enroll individuals with dementia require a study partner for each participant. Study partners-usually family members-perform several key roles: accompanying the participant to visits, providing information about the participant, and assisting with procedures such as taking medication. Little is known, however, about their experiences when performing these roles. Dementia researchers and institutional review boards need to know these experiences because the study partner role is one key factor in a study's success. This prospective qualitative study, using up to three semi-structured interviews with 62 study partners involved in a range of dementia studies, documented their subjective experiences. Content analysis demonstrates that study partners perform a range of tasks-often within the context of being a caregiver-that enable cognitively impaired individuals to participate in dementia research. These tasks present study partners with unique burdens and benefits, some of which dementia researchers and institutional review boards can address.
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Affiliation(s)
- Betty S Black
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Holly A Taylor
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peter V Rabins
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason Karlawish
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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