Functional Decline Associated with Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults with Dementia

This study provides empirical evidence on whether polypharmacy and potentially inappropriate prescription medications (PIRx, as defined by the 2003 Beers criteria) increase the likelihood of functional decline among community-dwelling older adults with dementia. Data were from the National Alzheimer's Coordinating Center, Uniform Data Set (9/2005-9/2009). Study sample included 1,994 community-dwelling subjects aged ≥65 with dementia at baseline. Results showed that subjects having ≥5 medications were more likely to have functional decline than subjects having <5 medications. However, the increased likelihood was only apparent in subjects who did not have PIRx. Instead of magnifying the associated risk as hypothesized, PIRx appeared to have a protective effect albeit marginally statistically significant. Therefore, increased medication burden may be associated with functional decline in community-dwelling older adults with dementia who are not prescribed with PIRx. More research is needed to understand which classes of medications have the most deleterious effect on this population

Additional file 2: Figure S2. of Evidence for an early innate immune response in the motor cortex of ALS

MCP1+ cells and CCR2+ cells are present in the motor cortex and they are in close proximity to CSMN in the MCP1-CCR2-hSOD1G93A mice. (a) Representative image showing very few MCP1+ cells in the motor cortex of MCP1-CCR2-WT mice. (b) Representative image showing increased numbers of MCP1+ cells in the motor cortex of MCP1-CCR2-hSOD1G93A mice. MCP1+ cells express microglia marker CD11b. Insets enlarged to the right (b’-b”’). (c) Experimental design depicting retrograde transduction of CSMN approach using AAV-eGFP in the MCP1-CCR2-WT and MCP1-CCR2-hSOD1G93A mice. AAV2-eGFP was injected into the CST of mice at P30, and tissue was collected at P60. (d, e) Representative images show MCP1+ cells near transduced CSMN (eGFP+) in the layer V of the motor cortex (d, e) and in the layer II/III of the motor cortex (f, g) in MCP1-CCR2-hSOD1G93A mice. (h, j) Representative images show MCP1+ cells expressing phagocytic marker CD68 and their interaction with transduced CSMN in the layer V of motor cortex in the MCP1-CCR2-hSOD1G93A mice. (k-n) Representative image showing CCR2+ cells in layer II/III of motor cortex co-localizing with monocyte marker CD45 and infiltrating monocyte marker Ly6C. Scale bar:s: a,b,d-g =20 μm; k-n = 10 μm. (PDF 1521 kb

Additional file 3: Figure S3. of Evidence for an early innate immune response in the motor cortex of ALS

MCP1+ cells express neither Arginase 1 (Arg1) nor inducible nitric oxide synthase (iNOS) in the MCP1-CCR2-hSOD1G93A mice. (a) Representative images of Arg1+ cells (arrowheads) and MCP1+ cells (arrows) in the liver of MCP1-CCR2- hSOD1G93A mice 6 h post LPS I.P. injection (positive control). (b) Representative images of 2° only for Arg1 (negative control) and MCP1+ cells (arrows) in the liver of MCP1-CCR2- hSOD1G93A mice 6 h post LPS I.P. injection. (c) Representative images of MCP1+ cells (arrows) in the spleen of MCP1-CCR2- hSOD1G93A mice 6 h post LPS I.P. injection (positive control) show co-localization with iNOS (arrows). (d) Representative images of 2° only for iNOS (negative control) and MCP1+ cells (arrows) in the spleen of MCP1-CCR2- hSOD1G93A mice 6 h post LPS I.P. injection. (e) Experimental design depicting retrograde transduction of CSMN approach using AAV-eGFP in the MCP1-CCR2-WT and MCP1-CCR2-hSOD1G93A mice. AAV2-eGFP was injected into the CST of mice at P30, and tissue was collected at P60. (f-g) Representative images of the layer II/III of motor cortex show lack of co-localization of MCP1+ cells with Arg1 in MCP1-CCR2-WT mice (f) and MCP1-CCR2- hSOD1G93A mice (g). (h-i) Representative images of the layer II/III of motor cortex show lack of co-localization of MCP1+ cells with iNOS in MCP1-CCR2-WT mice (h) and MCP1-CCR2- hSOD1G93A mice (i). Scale bar = 10 μm. (PDF 961 kb

Psychological well-being in elderly adults with extraordinary episodic memory

<div><p>Objectives</p><p>The Northwestern University SuperAging Program studies a rare cohort of individuals over age 80 with episodic memory ability at least as good as middle-age adults to determine what factors contribute to their elite memory performance. As psychological well-being is positively correlated with cognitive performance in older adults, the present study examined whether aspects of psychological well-being distinguish cognitive SuperAgers from their cognitively average-for-age, same-age peers.</p><p>Method</p><p>Thirty-one SuperAgers and 19 cognitively average-for-age peers completed the Ryff 42-item Psychological Well-Being questionnaire, comprised of 6 subscales: Autonomy, Positive Relations with Others, Environmental Mastery, Personal Growth, Purpose in Life, and Self-Acceptance.</p><p>Results</p><p>The groups did not differ on demographic factors, including estimated premorbid intelligence. Consistent with inclusion criteria, SuperAgers had better episodic memory scores. Compared to cognitively average-for-age peers, SuperAgers endorsed greater levels of Positive Relations with Others. The groups did not differ on other PWB-42 subscales.</p><p>Discussion</p><p>While SuperAgers and their cognitively average-for-age peers reported similarly high levels of psychological well-being across multiple dimensions, SuperAgers endorsed greater levels of positive social relationships. This psychological feature could conceivably have a biological relationship to the greater thickness of the anterior cingulate gyrus and higher density of von Economo neurons previously reported in SuperAgers.</p></div

Demographic & neuropsychological characteristics of the sample.

<p>There were no significant between-group differences in age, education, gender, or race. SuperAgers outperformed their cognitively average-for-age peers on measures of episodic memory and category fluency. There were no other significant between-group differences on neuropsychological measures, including estimated premorbid intelligence.</p

Inclusion criteria for SuperAgers and cognitively average elderly adults.

<p>Inclusion criteria for SuperAgers and cognitively average elderly adults.</p

Supplemental Material - The Paradox in Positive and Negative Aspects of Emotional Functioning Among Older Adults with Early Stages of Cognitive Impairment

Supplemental Material for The Paradox in Positive and Negative Aspects of Emotional Functioning Among Older Adults with Early Stages of Cognitive Impairment by Manrui Zhang, Emily Ho, Cindy J. Nowinski, Rina S. Fox, Ezgi Ayturk, Tatiana Karpouzian-Rogers, Miriam Novack, Hiroko H Dodge, Sandra Weintraub, Richard Gershon in Journal of Aging and Health.</p

Ryff & Keyes psychological well-being 42-item questionnaire subscale descriptions[22, 23].

<p>Examples of positively worded and negatively worded items are provided.</p

Psychological well-being in SuperAgers and cognitively average-for-age elderly adults.

<p>Boxplots for Psychological Well-Being 42-Item (PWB-42) subscale scores are shown (medians, interquartile range, and upper/lower quartile ranges). SuperAgers endorsed significantly greater levels of positive relations with others compared to their cognitively average peers (Median SuperAger: 40, Cognitively Average Elderly: 36; <i>p</i> = 0.005). The groups did not differ on other subscales of the PWB-42 (<i>p’s</i>>0.0083) including Autonomy (Median SuperAger: 34, Cognitively Average Elderly: 34), Environmental Mastery (Median SuperAger: 40.5, Cognitively Average Elderly: 37), Personal Growth (Median SuperAger: 36, Cognitively Average Elderly: 37), Purpose in Life (Median SuperAger: 37.5, Cognitively Average Elderly: 37), or Self-Acceptance (Median SuperAger: 38, Cognitively Average Elderly: 37).</p