Polypharmacy is associated with functional decline in Alzheimer's disease and Lewy body dementia

Antecedentes: en la demencia, varios factores pueden influir en el deterioro funcional además de la cognición. En Este estudio, nuestro objetivo es estudiar la posible asociación del número de medicamentos prescritos con funcional trayectorias de declive durante un seguimiento de cinco años en personas diagnosticadas con enfermedad de Alzheimer leve (EA) o Demencia con cuerpos de Lewy (LBD). Métodos: Este es un análisis longitudinal de un estudio de cohorte noruego titulado "El estudio de la demencia de occidente Noruega". Se incluyeron 196 pacientes con diagnóstico reciente de EA (n = 111) y LBD (n = 85), seguidos anualmente durante 5 años. Realizamos modelos lineales de efectos mixtos para analizar la asociación del número de medicamentos con declive funcional medido por la Escala Rápida de Calificación de Discapacidad - 2. Resultados: La media de medicamentos prescritos al inicio del estudio fue 4,18∓2,60, para AD 3,92∓2,51 y LBD 4,52∓2,70. El número de medicamentos aumentó durante el seguimiento; en el quinto año, la media de EA fue de 7,28∓4,42 y para LBD 8.11∓5.16. El uso de más medicamentos se asoció con un deterioro funcional más rápido en la EA (Est. 0.04, SE0.01, valor p 0.003) y LBD (Est 0.08, SE 0.03, valor p 0.008) después de ajustar por edad, sexo, comorbilidad, síntomas neuropsiquiátricos y cognición. Para cada medicamento agregado durante el seguimiento, funcional las trayectorias empeoraron en un 1% para AD y 2% para LBD. El número de medicamentos no se asoció con factores cognitivos. disminución. Conclusión: Encontramos que un mayor número de medicamentos se relacionó con un deterioro funcional más rápido, tanto en la EA y LBD. La prescripción, especialmente en la demencia, debe evaluarse cuidadosamente, por lo que el pronóstico en la demencia podría posiblemente se mejore.Q1Q1Background: In dementia, a number of factors may influence functional decline in addition to cognition. In this study, we aim to study the potential association of the number of prescribed medications with functional decline trajectories over a five-year follow-up in people diagnosed with mild Alzheimer's disease (AD) or Lewy Body dementia(LBD). Methods: This is a longitudinal analysis of a Norwegian cohort study entitled “The Dementia Study of Western Norway”. We included 196 patients newly diagnosed with AD (n=111) and LBD (n=85), followed annually for 5 years. We conducted linear mixed-effects models to analyze the association of the number of medications with functional decline measured by the Rapid Disability Rating Scale – 2. Results: The mean prescribed medications at baseline was 4.18∓2.60, for AD 3.92∓2.51 and LBD 4.52∓2.70. The number of medications increased during the follow-up; at year five the mean for AD was 7.28∓4.42 and for LBD 8.11∓5.16. Using more medications was associated with faster functional decline in AD (Est 0.04,SE0.01, p-value 0.003) and LBD (Est 0.08, SE 0.03, p-value 0.008) after adjusting for age, sex, comorbidity, neuropsychiatric symptoms, and cognition. For each medication added during the follow-up, functional trajectories worsened by 1% for AD and 2% for LBD. The number of medications was not associated with cognitive decline. Conclusion: We found that higher number of medications was related to a faster functional decline, both in AD and LBD. Prescription especially in dementia should be carefully assessed, thus prognosis in dementia might possibly be improved.https://orcid.org/0000-0001-5832-0603https://scholar.google.com/citations?user=MrICwaMAAAAJ&hl=enhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001429659&lang=esRevista Internacional - Indexad

Cognitive decline in dementia with Lewy bodies: a 5-year prospective cohort study

OBJECTIVES: We report the cognitive decline in persons diagnosed with mild dementia with Lewy bodies (DLB) and mild Alzheimer's disease (AD) during 5 years of annual follow-ups. METHODS: Patients were recruited into the study from geriatric, psychiatric and neurology clinics in Western Norway during 2005–2013. They were diagnosed according to clinical consensus criteria, based on standardised clinical rating scales. Autopsy-based diagnoses were available for 20 cases. Cognitive decline for up to 5 years was assessed using the Clinical Dementia Rating (CDR) scale and the Mini-Mental State Examination (MMSE). Survival analysis including Cox regression (time to reach severe dementia) and linear mixed-effects (lme) modelling were used to model the decline on MMSE. RESULTS: At least one follow-up assessment was available for 67 patients with DLB and 107 patients with AD, with a median follow-up time of 4.3 years. The time to reach severe dementia was significantly shorter in DLB (median 1793 days) compared with AD (1947 days; p=0.033), and the difference remained significant in the multiple Cox regression analysis (HR=2.0, p<0.02). In the adjusted lme model, MMSE decline was faster in DLB (annual decline 4.4 points) compared with AD (3.2 points; p<0.008). CONCLUSIONS: Our findings show that from the mild dementia stage, patients with DLB have a more rapid cognitive decline than in AD. Such prognostic information is vital for patients and families and crucial for planning clinical trials and enabling health economic modelling

White Matter Hyperintensities and the Course of Depressive Symptoms in Elderly People with Mild Dementia

Objectives: To explore the relationship between white matter hyperintensities (WMH) and the prevalence and course of depressive symptoms in mild Alzheimer’s disease (AD) and Lewy body dementia. Design: This is a prospective cohort study conducted in secondary care outpatient clinics in western Norway. Subjects: The study population consisted of 77 elderly people with mild dementia diagnosed according to standardised criteria. Methods: Structured clinical interviews and physical, neurological, psychiatric, and neuropsychological examinations were performed and routine blood tests were taken. Depression was assessed using the depression subitem of the Neuropsychiatric Inventory and the Montgomery-Åsberg Depression Rating Scale (MADRS). A standardised protocol for magnetic resonance imaging scan was used, and the volumes of WMH were quantified using an automated method, followed by manual editing. Results: The volumes of total and frontal deep WMH were significantly and positively correlated with baseline severity of depressive symptoms, and depressed patients had significantly higher volumes of total and frontal deep WMH than non-depressed patients. Higher volumes of WMH were also associated with having a high MADRS score and incident and persistent depression at follow-up. After adjustment for potential confounders, frontal deep WMH, in addition to prior depression and non-AD dementia, were still significantly associated with baseline depressive symptoms (p = 0.015, OR 3.703, 95% CI 1.294–10.593). Similar results emerged for total WMH. Conclusion: In elderly people with mild dementia, volumes of WMH, in particular frontal deep WMH, were positively correlated with baseline severity of depressive symptoms, and seemed to be associated with persistent and incident depression at follow-up. Further studies of the mechanisms that determine the course of depression in mild dementia are needed

Long-Term Mortality in a Cohort of Home-Dwelling Elderly with Mild Alzheimer's Disease and Lewy Body Dementia

&lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; To study mortality in subjects with mild dementia in Norway with a special focus on patients with Lewy body dementia (LBD) compared to Alzheimer's disease (AD). &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; All referrals of mild dementia patients to dementia clinics in western Norway from March 2005 to March 2007 were included and followed until December 2012. Diagnoses were based on a comprehensive standardized assessment program. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Of 209 patients, 137 (66%) had AD and 53 (25%) had LBD. Dementia was associated with increased mortality (standardized mortality ratio = 1.8, AD 1.5, LBD 2.6). The median survival time was 6.2 years (95% CI 5.4-6.9). Predictors of mortality were age at diagnosis (HR 1.1 per year) and LBD diagnosis (HR 2.4). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Dementia patients had an increased mortality, particularly those with LBD.</jats:p

Accuracy of Clinical Diagnosis of Dementia with Lewy Bodies versus Neuropathology

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Factores asociados con el deterioro funcional en adultos mayores mexicanos

Introduction: Functional status decline is related to many negative outcomes.Objective: To explore the relationship of sociodemographic, medical, and psychological factors with the incidence of functional status decline in Mexican older adults.Materials and methods: Data from the 2012 and 2015 waves of the Mexican Health and Aging Study (MHAS) survey were analyzed. Participants with previous functional status decline at baseline were excluded. We assessed functional status decline individually with activities of daily living (ADL) and instrumental ADL (IADLs) in an individual way.Results: Age was associated with functional limitations in ADL. Being male had an association with limitations for IADL. A poor financial situation and lower education related to higher limitations for ADL. Furthermore, pain, comorbidities, and depression were found to be independently associated with limitations in ADL. IADL limitation was associated with age, poor education, comorbidities, and depression, as well as cognitive impairment.Conclusions: We found that factors such as age, financial status, educational level, pain, and the number of comorbidities were associated with the incidence of functional status decline. Pain had a greater association in the 3-year functional ADL decline incidence when compared with cognitive impairment. Studying functional decline by domains allowed us to find more detailed information to identify factors susceptible to intervention with the aim to reduce the incidence of functional status decline and dependence.Introducción. El deterioro funcional está relacionado con muchos resultados adversos.Objetivo. Explorar la relación de los factores sociodemográficos, médicos y psicológicos con la incidencia del deterioro funcional en los adultos mayores mexicanos.Materiales y métodos. Se analizaron los datos de las cohortes de 2012 y 2015 de la encuesta del Estudio Mexicano de Salud y Envejecimiento. Se excluyeron los participantes con discapacidad funcional en el período de referencia (2012). Se evaluó de forma individual el deterioro funcional en las actividades básicas de la vida diaria (AVD) y en las instrumentales (AIVD).Resultados. Se encontró que el dolor, las comorbilidades, el nivel educativo, el estatus socioeconómico y la depresión se asociaban independientemente con el deterioro de las AVD. El deterioro de las AIVD se asoció con la edad, la educación deficiente, las comorbilidades, la depresión y el deterioro cognitivo.Conclusiones. La edad, el sexo, el estado financiero, el nivel educativo, el dolor y el número de comorbilidades se asociaron con la incidencia del deterioro funcional. El dolor tuvo una mayor asociación con la incidencia del deterioro funcional en las AVD a los tres años, en comparación con el deterioro cognitivo. El estudio del deterioro funcional por dominios permitió recabar información más detallada para determinar los factores que pueden intervenirse con el objetivo de reducir la incidencia del deterioro funcional y la dependencia

Multiple logistic regression analysis of the effect of APOEε4 status on likelihood of having WMH volume in highest vs. lowest quartile (final model).

<p>APOE = apolipoprotein E; WMH = white matter hyperintensities; CI = confidence interval.</p

Demographic and clinical characteristics.

<p>IQR = interquartile range; MMSE = Mini-Mental State Examination, normal range 24–30; AD = Alzheimer’s Disease; DLB = Dementia with Lewy Bodies; PDD = Parkinson’s Disease Dementia; VaD = vascular dementia; FTD = Frontotemporal Dementia; CIRS = Cumulative Illness Rating Scale, range 0 (no impairment)-52 (extremely severe impairment); APOE = Apolipoprotein E.</p>*<p>antianginals, antihypertensives, tricyclic antidepressants, paroxetine,MAO inhibitors, dopamine agonists, diazepam, dipyridamole, phenothiazines, clozapine, quetiapine, haloperidol.</p><p>Significant results are shown in <b>bold</b> typeface.</p