Searchers be aware: limiting PubMed searches to 'humans' loses more than you think

Balance tasks requiring inhibitory control; a scoping review of studies in older adults

BACKGROUND

Age-related changes in inhibitory control (IC) affect cognitive as well as physical functioning, but how it affects performance of tasks that integrate IC and balance control is unclear. This review study aims to identify specific tasks that have been used to determine effects of IC on balance performance in older adults, and analyse task-specific features as well as reported effects.

METHODS

Based on a comprehensive literature search, a scoping review considered all studies that involved IC as part of static or dynamic balance tasks in healthy adults over 65. Studies which only involved IC as part of an -additional- cognitive task during a balance task were excluded.

RESULTS

Eleven studies met the inclusion criteria for this review. Eight out of the 11 studies focused on voluntary stepping; two studies used gait or gait initiation, and one study used foot lift as a balance task. Ten studies included conditions that required some form of perceptual inhibition, and 6 out of the 11 studies included conditions involving some form of motor inhibition. With few exceptions, all inhibitory control conditions showed a decreased task performance in older adults.

DISCUSSION

Although most studies addressed IC during some form of stepping, the approaches were heterogeneous in terms of tasks, outcome measures and standardisation. Despite the heterogeneity, the available studies unequivocally demonstrate the importance of IC for task performance. The discussion addresses aspects which are important in furthering our understanding of age-related changes in IC and its impact on performance.

Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: A systematic review and meta-analysis

AIM

The aim was to investigate associations between drugs with anticholinergic effects (DACEs) and cognitive impairment, falls and all-cause mortality in older adults.

METHODS

A literature search using CINAHL, Cochrane Library, Embase and PubMed databases was conducted for randomized controlled trials, prospective and retrospective cohort and case-control studies examining the use of DACEs in subjects ≥65 years with outcomes on falls, cognitive impairment and all-cause mortality. Retrieved articles were published on or before June 2013. Anticholinergic exposure was investigated using drug class, DACE scoring systems (anticholinergic cognitive burden scale, ACB; anticholinergic drug scale, ADS; anticholinergic risk scale, ARS; anticholinergic component of the drug burden index, DBIAC ) or assessment of individual DACEs. Meta-analyses were performed to pool the results from individual studies.

RESULTS

Eighteen studies fulfilled the inclusion criteria (total 124 286 participants). Exposure to DACEs as a class was associated with increased odds of cognitive impairment (OR 1.45, 95% CI 1.16, 1.73). Olanzapine and trazodone were associated with increased odds and risk of falls (OR 2.16, 95% CI 1.05, 4.44; RR 1.79, 95% CI 1.60, 1.97, respectively), but amitriptyline, paroxetine and risperidone were not (RR 1.73, 95% CI 0.81, 2.65; RR 1.80, 95% CI 0.81, 2.79; RR 1.39, 95% CI 0.59, 3.26, respectively). A unit increase in the ACB scale was associated with a doubling in odds of all-cause mortality (OR 2.06, 95% CI 1.82, 2.33) but there were no associations with the DBIAC (OR 0.88, 95% CI 0.55, 1.42) or the ARS (OR 3.56, 95% CI 0.29, 43.27).

CONCLUSIONS

Certain individual DACEs or increased overall DACE exposure may increase the risks of cognitive impairment, falls and all-cause mortality in older adults.

Slow-release oral morphine for opioid maintenance treatment: a systematic review

This review article summarizes the results of all available clinical trials considering the use of slow-release oral morphine (SROM) for opioid maintenance treatment (OMT). All studies published up to October 2010 and assessing SROM for OMT in adult patients are included. Three independent reviewers assessed the selected articles using a standardized checklist. Study design, study length and number of subjects included were recorded. Data about retention rate (proportion of participants remaining under maintenance treatment at the end of the study), quality of life, withdrawal symptoms, craving, additional drug consumption, driving capacity and adverse events were collected. We identified 13 articles corresponding to nine clinical trials considering the use of SROM for OMT. Among them, only one was a randomized trial and one was a controlled not randomized trial. All other studies were uncontrolled. Retention rates were good (from 80.6 to 95%) with SROM maintenance, but similar retention rates were obtained with methadone. Most of the studies showed that quality of life, withdrawal symptoms, craving and additional drug consumption improved with SROM. However, there was no comparison with other maintenance drugs. As most of the studies assessing SROM efficacy were uncontrolled, there is no definite evidence that SROM is an effective alternative to methadone for OMT.