Daniela C. Moga

Adverse Events Among the Elderly Receiving Chemotherapy for Advanced Non–Small-Cell Lung Cancer

PURPOSE To describe chemotherapy use and adverse events (AEs) for advanced-stage, non-small-cell lung cancer (NSCLC) in community practice, including descriptions according to variation by age. METHODS We interviewed patients with newly diagnosed, stages IIIB and IV NSCLC in the population-based cohort studied by the Cancer Care Outcomes Research and Surveillance Consortium, and we abstracted the patient medical records. AEs were medical events occurring during chemotherapy. Using logistic regression, we assessed the association between age and chemotherapy; with Poisson regression, we estimated event rate ratios and adjusted the analysis for age, sex, ethnicity, radiation therapy, stage, histology, and presence and grade of 27 comorbidities. RESULTS Of 1,371 patients, 58% (95% CI, 55% to 61%) received chemotherapy and 35% (95% CI, 32% to 38%) had AEs. After adjustment, 72% (95% CI, 65% to 79%) of those younger than 55 years and 47% (95% CI, 42% to 52%) of those age 75 years and older received chemotherapy. Platinum-based therapies were less common in the older-age groups. Pretreatment medical event rates were 18.6% for patients younger than 55 years and were only 9.2% for those age 75 years and older (adjusted rate ratio, 0.49; 95% CI, 0.26 to 0.91). In contrast, older adults were more likely to have AEs during chemotherapy. The adjusted rate ratios compared with age younger than 55 years were 1.70 for 65- to 74-year-olds (95% CI, 1.19 to 2.43) and 1.34 for those age 75 years and older (95% CI, 0.90 to 2.00). CONCLUSION Older patients who received chemotherapy had fewer pretherapy events than younger patients and were less likely to receive platinum-based regimens. Nevertheless, older patients had more adverse events during chemotherapy, independent of comorbidity. Potential implicit trade-offs between symptom management and treatment toxicity should be made explicit and additionally studied.

Outcomes after diagnosis of mild cognitive impairment in a large autopsy series

To determine clinical and neuropathological outcomes following a clinical diagnosis of mild cognitive impairment (MCI).

Atypical antipsychotic initiation and the risk of type II diabetes in children and adolescents

To estimate the risk of type II diabetes (T2DM) in children and adolescents initiating atypical antipsychotic (AAP) therapy.

National trends in off-label use of atypical antipsychotics in children and adolescents in the United States.

AbstractThe objectives of the study were as follows: to examine the national trend of pediatric atypical antipsychotic (AAP) use in the United States; to identify primary mental disorders associated with AAPs; to estimate the strength of independent associations between patient/provider characteristics and AAP use. Data are from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. First, average AAP prescription rates among 4 and 18-year-old patients between 1993 and 2010 were estimated. Second, data from 2007 to 2010 were combined and analyzed to identify primary mental disorders related to AAP prescription. Third, a multivariate logistic regression model was developed having the presence of AAP prescription as the dependent variable and patient/provider characteristics as explanatory variables. Adjusted odds ratios (AORs) with associated 95% confidence intervals (CIs) were estimated. Outpatient visits including an AAP prescription among 4 to 18-year-old patients significantly increased between 1993 and 2010 in the United States, and over 65% of those visits did not have diagnoses for US Food and Drug Administration-approved AAP indications. During 2007 to 2010, the most common mental disorder was attention-deficit hyperactivity disorder, accounting for 24% of total pediatric AAP visits. Among visits with attention-deficit hyperactivity disorder diagnosis, those with Medicaid as payer (AOR 1.66, 95% CI 1.01–2.75), comorbid mental disorders (e.g., psychoses AOR 3.34, 95% CI 1.35–8.26), and multiple prescriptions (4 or more prescriptions AOR 4.48, 95% CI 2.08–9.64) were more likely to have an AAP prescription. The off-label use of AAPs in children and adolescents is prevalent in the United States. Our study raises questions about the potential misuse of AAPs in the population.

Bladder antimuscarinics and cognitive decline in elderly patients

The evidence on the impact of bladder antimuscarinics initiation on cognitive function in older adults is inconsistent.

Longitudinal patterns of potentially inappropriate medication use following incident dementia diagnosis

Potentially inappropriate medication (PIM) use in older adults with dementia is an understudied area. We assessed longitudinal changes in PIM exposure by dementia type following dementia diagnosis.

Using administrative data for your research project: 10 considerations before you begin.

With increasing pressure to conduct research during residency training, and given the availability of administrative claims data, pharmacy residents will likely consider using large administrative databases for their research project. With competing time commitments and the short duration of residencies, residents and their preceptors must consider the 10 factors outlined above in order to produce a thoughtful, clinically relevant research project. While this discussion focused on the completion of a residency research project, these topics are also relevant to a broader pharmacy audience. Colleges of pharmacy are increasingly requiring research projects as part of their curriculum, and pharmacy students and practitioners often consider obtaining additional degrees requiring a research component. Both students and practitioners can use the guidance provided herein when planning research projects and investigations to aid in the successful completion of research using administrative claims data.

The Impact of Dementia Diagnosis on Patterns of Potentially Inappropriate Medication Use Among Older Adults

Background Use of potentially inappropriate medications (PIM) among people with dementia is common. We assessed the patterns of medication use from 1-year before dementia diagnosis, to 1-year after dementia diagnosis, compared with patterns of medication use in people without dementia. Methods We conducted longitudinal study using the National Alzheimers Coordinating Center data. Adults aged 65 years and older newly diagnosed with dementia (n = 2,418) during 2005-2015 were year, age, and sex matched 1:1 with controls. Generalized estimating equation models weighted for missingness and adjusted for 15 participant characteristics were fit. Results Among participants with dementia, number of medications reported 1-year prediagnosis was 8% lower than at diagnosis year (p < .0001) and 11% higher 1-year postdiagnosis compared with year of diagnosis (p < .0001). Among participants with dementia, the odds of PIM exposure, assessed using the 2015 Beers Criteria, was 17% lower 1-year prediagnosis (p < .0001) and 17% higher 1-year postdiagnosis (p = .006) compared with year of diagnosis. Among controls, there were approximately 6% more medications reported between consecutive years (p < .0001 each comparison) and the odds of PIM exposure increased 11% between consecutive years (p = .006 and p = .047). At each annual follow-up, participants with dementia had lower odds of PIM exposure than their controls (prediagnosis p < .0001, at diagnosis p = .0007, postdiagnosis p = .03, respectively). There were no differences in exposure to anticholinergic medications. Conclusions Number of medications and PIM use increased annually for participants with and without dementia. Persistent challenge of increasing PIM use in this group of older adults is of major concern and warrants interventions to minimize such prescribing.

POTENTIAL IMPACT OF INAPPROPRIATE MEDICATION USE ON PERFORMANCE IN TESTS OF ATTENTION AND EXECUTIVE FUNCTION

nally. Here, we present the groups’ trajectories of cognitive change from baseline to first follow-up. Methods:Eighty participants aged 40-89 completed verbal phonemic fluency, forward/ backward digit span, Trails A/B, Stroop, and the Wisconsin Card-Sorting Task (WCST). Participants with ADHD (n1⁄441) were identified using a selfand spouse-report questionnaire. Those with MCI (n1⁄439) were diagnosed by an experienced neurologist. All cognitive scores were age-, educationand sexadjusted using data from 116 controls. Performance at each time point and magnitude of change over time, were compared between groups using Mann-Whitney U and t-tests, respectively. Results: First follow-up was 19.4 months following baseline, on average (SD1⁄48.8). At baseline, relative to MCI participants, those with ADHD generated fewer perseverative errors (p1⁄4.012) and intrusions (p1⁄4.019) on semantic fluency, as well as fewer intrusions on phonemic fluency (p1⁄4.022). They made fewer set-loss errors on the WCST (p1⁄4.001) and were faster at completing Trails B (p1⁄4.008). At first follow-up, ADHD participants continued to outperform their MCI counterparts in terms of semantic fluency intrusions (p1⁄4.001), and phonemic perseverations (p1⁄4.003) and intrusions (p1⁄4.013) (Figure). Performance was similar on all other tests. Rates of change did not differ significantly between groups, but trended towards larger magnitudes in the MCI group. Conclusions:Trails B, WCST and verbal fluency in particular may be cost-effective measures to distinguish ADHD from MCI. Fluency may rely relatively more on temporal-lobe than frontal-lobe functions, and may be most sensitive to the earliest stages of Alzheimer’s disease. This preliminary study is an important initial step towards characterizing the longitudinal neuropsychological profile of ADHD in relation to MCI.

PREVALENCE OF POTENTIALLY INAPPROPRIATE MEDICATION USE AND INTERACTIONS IN A PRIVATELY INSURED ELDERLY POPULATION

cohort is the chilean core clinical project of the new Gerocenter on Brain Health and Metabolism (GERO). Methods: The Gero cohort aims at recruiting 300 elderly subjects (>70 years) from three areas of Santiago(Chile) following them up for at least 3 years. Eligible people are non-demented adults with a subjective cognitive complaint, which is reported by the participant and/or a knowledgeable informant. Participants are identified through a household census . The protocol of evaluation is based on a multidimensional approach: socio-demographic, general medical/ nursing, psychosocial, neuropsychological, neuropsychiatric, motor, neuroimaging, blood biomarkers and a genetic sample. Gero’s biobank stores blood samples which keep for long-term storage at -80 C in liquid nitrogen. The multidimensional protocol of evaluation is administered in months 0 (baseline), 18, and 36. In addition, in months 6, 24, and 30 a telephone interview will be done to collect data for a follow up protocol. Results: To our date the Gero cohort now includes over 50 subjects, and the majority of these have had a multilevel assessment and blood intake. Conclusions: Our work will allow us to determine the risks factors (biomedical, clinical and psychosocial) associated with the prognosis of elderly with cognitive complaint on the evolution to a significant functional decline. The Gero cohort will help to design public health policies tailored to prevent aging disease, and contribute to a better understanding of cognitive impairment and dementia in Latin America and the world. Gero’s aim is to establish a center for studying Brain Ageing in Chile including basic and clinical research.