Progressieve Supranucleaire Verlamming. Interventie middels acetylcholineesteraseremmer?

Progressive supranucleair verlamming (PSP) is een zeldzame, ernstige progressieve neurologische aandoening met complexe symptomatologie. Wij beschrijven een 3-tal casussen, die in de periode 2005-2008 zijn vervolgd. Ondanks de aanwezigheid van internationale criteria sinds 1996, zijn de diagnosestelling en behandeling nog steeds moeilijk. In deze drie casussen is gekozen voor rivastigmine; redenen daarvoor worden kort toegelicht. Onder het gebruik van rivastigmine zijn cognitieve stoornissen nauwelijks toegenomen. Meer onderzoek hiernaar lijkt aangewezen

Remote timed up and go evaluation from activities of daily living reveals changing mobility after surgery

Background: Mobility impairment is common in older adults and negatively influences the quality of life. Mobility level may change rapidly following surgery or hospitalization in the elderly. The timed up and go (TUG) is a simple, frequently used clinical test for functional mobility; however, TUG requires supervision from a trained clinician, resulting in infrequent assessments. Additionally, assessment by TUG in clinic settings may not be completely representative of the individual's mobility in their home environment. Objective: In this paper, we introduce a method to estimate TUG from activities detected in free-living, enabling continuous remote mobility monitoring without expert supervision. The method is used to monitor changes in mobility following total hip arthroplasty (THA). Methods: Community-living elderly (n = 239, 65-91 years) performed a standardized TUG in a laboratory and wore a wearable pendant device that recorded accelerometer and barometric sensor data for at least three days. Activities of daily living (ADLs), including walks and sit-to-stand transitions, and their related mobility features were extracted and used to develop a regularized linear model for remote TUG test estimation. Changes in the remote TUG were evaluated in orthopaedic patients (n = 15, 55-75 years), during 12-weeks period following THA. Main results: In leave-one-out-cross-validation (LOOCV), a strong correlation (p = 0.70) was observed between the new remote TUG and standardized TUG times. Test-retest reliability of 3-days estimates was high (ICC = 0.94). Compared to week 2 post-THA, remote TUG was significantly improved at week 6 (11.7 +/- 3.9 s versus 8.0 +/- 1.8 s,p &lt;0.001), with no further change at 12-weeks (8.1 +/- 3.9s, p = 0.37). Significance: Remote TUG can be estimated in older adults using 3-days of ADLs data recorded using a wearable pendant. Remote TUG has discriminatory potential for identifying frail elderly and may provide a convenient way to monitor changes in mobility in unsupervised settings.</p

Haloperidol Use Among Elderly Patients Undergoing Surgery : A Retrospective 1-Year Study in a Hospital Population

BACKGROUND: Haloperidol, frequently used for delirium, can lead to serious side effects, of which QTc prolongation is the most worrisome since it is associated with an increased risk of fatal cardiac arrhythmia. OBJECTIVES: The aim of this study was to measure the frequency of haloperidol use after procedures in patients aged ≥65 years in a hospital in the Netherlands. METHODS: This was a retrospective study among patients hospitalized in the Netherlands who were aged ≥65 years and who underwent a procedure between January 2008 and January 2009. The hospital's electronic drug database was used to identify the use of haloperidol during hospital admission. RESULTS: A total of 7782 procedures took place in 5946 elderly patients, and 1357 patients were readmitted for a second procedure in the same year. The overall frequency of haloperidol use was 5.4 %. Procedures were classified as elective (90 %) and as major (18 %). A total of 28 % (n = 570) of patients who underwent acute procedures and 24 % (n = 1086) of patients who underwent major procedures received haloperidol. Patients receiving haloperidol had a significantly longer hospital stay (14 vs. 1 day, p < 0.001) than patients without haloperidol. Haloperidol users were more likely to have more than one intervention than non-users (16.0 vs. 1.7 %, p < 0.001). In multivariable analysis, haloperidol use was associated with older age (odds ratio [OR] 1.09; 95 % confidence interval [CI] 1.07-1.11, p < 0.001), acute surgery (OR 2.09; 95 % CI 1.65-2.94, p < 0.001), and major procedures (OR 15.4; 95 % CI 11.5-21.5, p < 0.001). CONCLUSION: We show a frequency of haloperidol use of 5.4 %. Based on this high frequency, surveillance of adverse events in hospital should be performed systematically, particularly in the high-risk population that undergoes acute major surgery