Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the Dementia Study in Northern Norway

Inappropriate medical treatment of co-morbidities in Alzheimer’s disease (AD) is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway. Setting: Nine rural municipalities with 70 000 inhabitants in Northern Norway. Participants: Participants with and without AD recruited in general practice and by population based screening. 187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression. A co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1 ± 3.6 and 2.9 ± 2.4 respectively, p < 0.001 age and gender adjusted), also when adjusted for co-morbidity. AD participants used significantly more anticholinergic, sedative and antidepressant drugs. For nursing home residents with AD the mean number of drugs was significantly higher compared to AD participants living at home (6.9 ± 3.9 and 4.5 ± 3.3, respectively, p < 0.001). AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors

Mantle flow in regions of complex tectonics: insights from Indonesia

Indonesia is arguably one of the tectonically most complex regions on Earth today due to its location at the junction of several major tectonic plates and its long history of collision and accretion. It is thus an ideal location to study the interaction between subducting plates and mantle convection. Seismic anisotropy can serve as a diagnostic tool for identifying various subsurface deformational processes, such as mantle flow, for example. Here, we present novel shear wave splitting results across the Indonesian region. Using three different shear phases (local S, SKS, and downgoing S) to improve spatial resolution of anisotropic fabrics allows us to distinguish several deformational features. For example, the block rotation history of Borneo is reflected in coast-parallel fast directions, which we attribute to fossil anisotropy. Furthermore, we are able to unravel the mantle flow pattern in the Sulawesi and Banda region: We detect toroidal flow around the Celebes Sea slab, oblique corner flow in the Banda wedge, and sub-slab mantle flow around the arcuate Banda slab. We present evidence for deep, sub-520 km anisotropy at the Java subduction zone. In the Sumatran backarc, we measure trench-perpendicular fast orientations, which we assume to be due to mantle flow beneath the overriding Eurasian plate. These observations will allow to test ideas of, for example, slab–mantle coupling in subduction regions