Tag Archives: research study

Unnecessary Medication Use Associated With Dementia Diagnosis




Introduction to the study:

A recent study conducted at the University of Sydney has found that inappropriate and unnecessary medications seem to be routinely prescribed for newly diagnosed dementia patients. This longitudinal research study of 2,500 people was conducted in collaboration with the University of Kentucky and Yale University and published in the Journals of Gerontology: Medical Sciences.

Estimates of people currently living with dementia is approximately 50 million worldwide. In Australia the estimate is approximately 425,000 costing the country more than $15 billion per year and is currently the second leading cause of death.




Study and Conclusions:

The lead author, Dr. Danijela Gnjidic, NHMRC Dementia Leadership Fellow and Senior Lecturer from the Faculty of Pharmacy and Charles Perkins Centre at University of Sydney stated that “Our study found that following a diagnosis of dementia in older people, medication use increased by 11 per cent in a year and the use of potentially inappropriate medications increased by 17 percent”. She went on to say, “These medications are typically recommended for short term use but are commonly used long term by people with dementia,”

Some of the more common unnecessary and inappropriate medications are pain pills, sleep aids, depression medications and drugs for acid reflux referred to as proton pump inhibitors

A number of reasons were given to account for this including a lack of time in the patient and physician encounters, inappropriate guidelines, difficulty in setting goals with the patient and difficulty in the communication and comprehension of the patient.
She stated, “These findings are of major concern and highlight the importance of weighing up the harms and benefits of taking potentially unnecessary medications as they may lead to increased risk of side effects such as sedation or drowsiness, and adverse drug events such as falls, fractures and hospitalization.” She felt that increased efforts need to be made to support the recognition and potential use of medications that are inappropriate to minimize harm to patients.
Finally, Dr. Gnjidic concluded that “For Australians living with dementia and their caregivers (who commonly are responsible for managing medications for people with dementia), the key is to communicate closely with general practitioners, pharmacists and other health professionals to make informed decisions and to practice good medicine management techniques to minimize the risk of side effects.” Also, she commented that “Deprescribing unnecessary medications may improve an individual’s quality of life and can reduce unnecessary healthcare cost.”

Adapted by Paul Susic Ph.D. Licensed Psychologist from article at ScienceDaily: Dementia Diagnosis Linked to Unnecessary Medication Use dated Apr. 19, 2018

Story Source:

Materials provided by University of Sydney. Note: Content may be edited for style and length.

Journal Reference:

Danijela Gnjidic, George O Agogo, Christine M Ramsey, Daniela C Moga, Heather Allore. The impact of dementia diagnosis on patterns of potentially inappropriate medication use among older adults. The Journals of Gerontology: Series A, 2018; DOI: 10.1093/gerona/gly078



New study says simple EEG can identify major depression or bipolar disorder.




EEG can identify major depression or bipolar disorder

A new study at Loyola University has concluded that a simple electrocardiogram that takes all of 15 minutes may help a doctor decide whether a patient has major depressive disorder or bipolar disorder. Because of the frequent misdiagnosis of both bipolar disorder and major depression, the study is believed to help distinguish between the two. Because the symptoms of major depression and the depressive phase of bipolar disorder are similar it is frequently hard to distinguish between the two. However, the treatments are very different.




When an individual has bipolar disorder they have experienced at some point in time at least one manic episode, which is an emotional high. Mania is not a normal characteristic of major depressive disorder and so, the treatments are significantly different. With bipolar disorder, when in the depressive phase an individual may be given an antidepressant along with a medication to stabilize the mood or sometimes an antipsychotic medication to prevent the patient from switching to a manic phase. A doctor misdiagnosing the bipolar disorder may attempt to treat the depression without treating the mania and prescribe an antidepressant without the mood stabilizing medication.

Heart Rate Variability: Depression and Bipolar Disorder

The Loyola study found that heart rate variability measured by an EEG or an electrocardiogram was able to identify whether individuals had bipolar disorder or major depression. The measure of heart rate variability is able to identify if there is a variation in the time interval between heartbeats.

Published in the World Journal of Biological Psychiatry senior author Angelos Halaras M.D., Ph.D. and professor in Loyola’s Department of Psychiatry and Behavioral and Neural Sciences and medical director of the adult psychiatry unit stated that “having a noninvasive, easy-to-use and affordable test to differentiate between major depression and bipolar disorder would be a major breakthrough in both psychiatric and primary care practices.”

Major depression is by far one of the most common mental health disorders with some estimates as high as 8% to 10% of the population having it at any one period in time. While bipolar disorder may be a little less prevalent, estimates are as high as 50 million people suffering from bipolar disorder worldwide. Both can be very severe and debilitating.

All of the subjects in the research study underwent electrocardiograms at the initiation of the study, rested comfortably for 15 minutes while a EEG was attached to their chest. EEG data was then collected for the next 15 minutes and the data was then converted by a special software package developed by the study’s co-author Stephen W Porges, Ph.D. of Indiana University’s Kinsey Institute.

Researchers then computed what is known to cardiologists as respiratory sinus arrhythmia (RSA) while measuring the heart rate variability. Researchers found that at the beginning of the study a baseline was set in which individuals with major depression had much higher RSA than subjects with bipolar disorder.

Researchers also found that subjects with bipolar disorder also had higher blood levels of inflammation that individuals with major depressive disorder. Inflammation is believed to be increased when the immune system experiences heightened stress as may be experienced by an individual with bipolar disorder.

Article adapted by Paul Susic Ph.D. Licensed Psychologist from ScienceDaily Dated November 21, 2017: Simple electrocardiogram can determine whether a patient has major depression or bipolar disorder, study finds

Journal Reference:

Brandon Hage, Briana Britton, David Daniels, Keri Heilman, Stephen W. Porges, Angelos Halaris. Low cardiac vagal tone index by heart rate variability differentiates bipolar from major depression. The World Journal of Biological Psychiatry, 2017; 1 DOI: 10.1080/15622975.2017.1376113


Increased mortality found in Alzheimer’s patients who use benzodiazepines.




Overview:

A recent research study conducted by the University of Eastern Finland found that individuals with Alzheimer’s disease may have an increase in mortality of 40% when using benzodiazepines. These findings were recently published in the International Journal of Geriatric Psychiatry.




Increased risk of mortality with benzodiazepine use:

Researchers found that the risk of death was increased at the baseline or initiation of use with these drugs (benzodiazepines) which includes such medications as Ativan, Valium and Xanax. Increased mortality was believed to be from adverse events that seem to derive directly from the use of these medications such as injuries related to falling down such as hip fractures as well as from stroke and pneumonia.

The research was conducted on persons diagnosed with Alzheimer’s disease in Finland during 2005 and 2011. Individuals who had used benzodiazepines prior to the research study were excluded from the research population including 10,380 new users of these medications. They were compared to the control group of 20,760 subjects who did not use these medications.

Conclusions:

Although many treatment guidelines recommend nonpharmacological treatments as opposed to medications for first-line treatment of anxiety, insomnia and agitation, these medications continue to be somewhat routinely prescribed. If benzodiazepines seem to be necessary for patients with Alzheimer’s or other forms of dementia, it is recommended that they only be used on a short-term basis. These research findings encourage a more reflective approach to the use of benzodiazepines among patients with dementia and a consideration of the increased risk of mortality.

Information adapted by Paul Susic Ph.D. Licensed Psychologist from “Benzodiazepines increase mortality in persons with Alzheimer’s disease”. (Published November 20, 2017 ScienceDaily)

Story Source:

Materials provided by University of Eastern Finland. Note: Content may be edited for style and length.

Journal Reference:

Laura Saarelainen, Anna-Maija Tolppanen, Marjaana Koponen, Antti Tanskanen, Jari Tiihonen, Sirpa Hartikainen, Heidi Taipale. Risk of death associated with new benzodiazepine use among persons with Alzheimer disease: A matched cohort study. International Journal of Geriatric Psychiatry, 2017; DOI: 10.1002/gps.4821



Key to longevity may mean learning and staying in shape.




Key to longevity may mean learning and staying in shape

A major research study has recently found that possibly the most important keys to increasing lifespan is to maintain or reduce your weight to a moderate level and to continue learning. In a recent study at the University of Edinburg it was found that people who are overweight may possibly reduce their life expectancy by two months for every extra kilogram of weight they carry. The study also found that education leads to a longer life, with almost a year added for each year spent studying beyond one’s formal education.

Other important findings were that if people give up smoking, in conjunction with studying longer and are more open to new unique experiences they can also expect to live longer.




The University of Edinburg evaluated the genetic information of approximately 600,000 people along with records of their parents. Researchers were able to evaluate the genetic information from each parent and calculate the impact of various aspects of their lifestyle. While it may be concluded that lifestyle choices may be influenced to some degree by genes which may be linked to increased alcohol consumption and addiction, researchers were able to calculate which lifestyle choices seem to have the greatest influence on lifespan.

They found that cigarette smoking probably had the largest impact upon either lengthening or shortening lifespan. It was concluded that smoking a pack of cigarettes per day over a lifetime may reduce life expectancy by approximately seven years. However, smokers who quit may eventually increase their lifespan to approximately the same level as those who have never smoked.

Factors related to body fat and diabetes were also concluded to have a high impact upon lifespan. Researchers found two important DNA differences that affect lifespan. The first is identified to be a gene that affects blood cholesterol levels in effect reducing lifespan by about eight months. The second was a gene linked to the immune system which seemed to add about a half years of life expectancy.

Data for this research was drawn from 25 separate populations from Europe, North America and Australia.
Dr. Peter Joshi, Chancellor’s fellow at the University of Edinburg’s Usher Institute concluded that “our study has estimated the causal effect of lifestyle choices. We found out, on average smoking a pack a day reduces lifespan by seven years, whilst losing 1 kg of weight will increase your lifespan by two months”

Article adapted from research study Learning and Staying in Shape Key to Longer Life Span, study at ScienceDaily.com (Dated October 13, 2017) by Paul Susic Ph.D. Licensed Psychologist

Source:

Materials provided by University of Edinburgh. Note: Content may be edited for style and length.

Journal Reference:

1. Peter K. Joshi, Nicola Pirastu, Katherine A. Kentistou, Krista Fischer, Edith Hofer, Katharina E. Schraut, David W. Clark, Teresa Nutile, Catriona L. K. Barnes, Paul R. H. J. Timmers, Xia Shen, Ilaria Gandin, Aaron F. McDaid, Thomas Folkmann Hansen, Scott D. Gordon, Franco Giulianini, Thibaud S. Boutin, Abdel Abdellaoui, Wei Zhao, Carolina Medina-Gomez, Traci M. Bartz, Stella Trompet, Leslie A. Lange, Laura Raffield, Ashley van der Spek, Tessel E. Galesloot, Petroula Proitsi, Lisa R. Yanek, Lawrence F. Bielak, Antony Payton, Federico Murgia, Maria Pina Concas, Ginevra Biino, Salman M. Tajuddin, Ilkka Seppälä, Najaf Amin, Eric Boerwinkle, Anders D. Børglum, Archie Campbell, Ellen W. Demerath, Ilja Demuth, Jessica D. Faul, Ian Ford, Alessandro Gialluisi, Martin Gögele, MariaElisa Graff, Aroon Hingorani, Jouke-Jan Hottenga, David M. Hougaard, Mikko A. Hurme, M. Arfan Ikram, Marja Jylhä, Diana Kuh, Lannie Ligthart, Christina M. Lill, Ulman Lindenberger, Thomas Lumley, Reedik Mägi, Pedro Marques-Vidal, Sarah E. Medland, Lili Milani, Reka Nagy, William E. R. Ollier, Patricia A. Peyser, Peter P. Pramstaller, Paul M. Ridker, Fernando Rivadeneira, Daniela Ruggiero, Yasaman Saba, Reinhold Schmidt, Helena Schmidt, P. Eline Slagboom, Blair H. Smith, Jennifer A. Smith, Nona Sotoodehnia, Elisabeth Steinhagen-Thiessen, Frank J. A. van Rooij, André L. Verbeek, Sita H. Vermeulen, Peter Vollenweider, Yunpeng Wang, Thomas Werge, John B. Whitfield, Alan B. Zonderman, Terho Lehtimäki, Michele K. Evans, Mario Pirastu, Christian Fuchsberger, Lars Bertram, Neil Pendleton, Sharon L. R. Kardia, Marina Ciullo, Diane M. Becker, Andrew Wong, Bruce M. Psaty, Cornelia M. van Duijn, James G. Wilson, J. Wouter Jukema, Lambertus Kiemeney, André G. Uitterlinden, Nora Franceschini, Kari E. North, David R. Weir, Andres Metspalu, Dorret I. Boomsma, Caroline Hayward, Daniel Chasman, Nicholas G. Martin, Naveed Sattar, Harry Campbell, Tōnu Esko, Zoltán Kutalik, James F. Wilson. Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity. Nature Communications, 2017; 8 (1) DOI: 10.1038/s41467-017-00934-5


New study shows, being unaware of memory loss may predict Alzheimer’s disease




Most clinicians and researchers are aware that while memory loss is an early symptom of Alzheimer’s disease its presence doesn’t necessarily mean that an individual has dementia. A recent research study has found that a clinically useful way to predict whether an individual will develop Alzheimer’s disease may be based upon their awareness of their memory problems according to a new study at the Centre for Addiction and Mental Health (CAMH).
The research found that people who were unaware of the loss of memory which is referred to as anosognosia were more likely to progress to a clinical diagnosis of Alzheimer’s disease according to a study published in the Journal of Clinical Psychiatry published recently. Those who are aware of their memory deficits were much less likely to develop dementia.




Unawareness and dementia

Dr. Philip Gerretsen, Clinician Scientist in CAMH’s Geriatric Division and Campbell Family Mental Health Research Institute stated that “If patients complain of memory problems, but their partner or caregiver isn’t overly concerned, it’s likely that the memory loss is due to other factors, possibly depression or anxiety.” He also went on to state that “they can be reassured that they are unlikely to develop dementia, and the other causes of memory loss should be addressed.”

On the contrary, family members or caregivers are much more likely to be distressed when the patients do not believe they have memory problems while it seems apparent they do. This lack of awareness brings upon additional burdens to family members and caregivers. Both unawareness (anosognosia) and memory loss can be assessed objectively using questionnaires.

Huge Study:

This study, believed to be the largest of its kind included data on 1062 people aged 55 to 90 years old from the Alzheimer’s Disease Neuroimaging Initiative. They also evaluated the brain’s uptake of glucose which is a type of sugar the brain cells need to function which seems to be impaired in Alzheimer’s disease patients, in order to identify which parts of the brain were affected in what has been referred to as “impaired illness awareness”.
PET brain scans show that those with “impaired illness awareness” also had reduced glucose uptake in specific brain regions even while factoring in additional factors such as age and degree of memory loss.

Future dementia research

In future research, Dr. Philip Gerretsen and colleagues will next track whether older adults with mild cognitive impairment receiving some type of intervention can prevent the development of Alzheimer’s dementia. This research will combine brain training exercises and brain stimulation using a mild electrical current to stimulate brain cells and improve learning and memory. While the main study will focus on dementia prevention, Dr. Garretson will also be assessing whether the intervention improves “illness awareness” along with preventing an individual’s progression to dementia.

Adapted by Paul Susic Ph.D. Licensed Psychologist from ScienceDaily.com article : Being unaware of memory loss predicts Alzheimer’s disease, new study shows.

Article Source:
Materials provided by Centre for Addiction and Mental Health. Note: Content may be edited for style and length.

Journal Reference:
1. Philip Gerretsen, Jun Ku Chung, Parita Shah, Eric Plitman, Yusuke Iwata, Fernando Caravaggio, Shinichiro Nakajima, Bruce G. Pollock, Ariel Graff-Guerrero. Anosognosia Is an Independent Predictor of Conversion From Mild Cognitive Impairment to Alzheimer’s Disease and Is Associated With Reduced Brain Metabolism. The Journal of Clinical Psychiatry, 2017; DOI: 10.4088/JCP.16m11367