Fred Unverzagt

Medication Adherence in Older Adults With Cognitive Impairment: A Systematic Evidence-Based Review

BACKGROUNDnCognitive impairment challenges the ability to adhere to the complex medication regimens needed to treat multiple medical problems in older adults.nnnOBJECTIVEnOur aim was to conduct a systematic evidence-based review to identify barriers to medication adherence in cognitively impaired older adults and interventions aimed at improving medication adherence.nnnMETHODSnA search of MEDLINE, EMBASE, PsycINFO, GoogleDocs, and CINAHL for articles published between 1966 and February 29, 2012 was performed. Studies included older adults with a diagnosis of cognitive impairment of any degree (mild cognitive impairment or mild, moderate, or severe dementia). To identify barriers to adherence, we reviewed observational studies. To identify relevant interventions, we reviewed clinical trials targeting medication adherence in cognitively impaired older adults. We excluded studies lacking a measure of medication adherence or lacking an assessment of cognitive function, case reports or series, reviews, and those focusing on psychiatric disorders or infectious diseases. Population demographics, baseline cognitive function, medication adherence methods, barriers to adherence, and prospective intervention methodologies were extracted.nnnRESULTSnThe initial search identified 594 articles. Ten studies met inclusion criteria for barriers to adherence and three met inclusion criteria for interventional studies. Unique barriers to adherence included understanding new directions, living alone, scheduling medication administration into the daily routine, using potentially inappropriate medications, and uncooperative patients. Two studies evaluated reminder systems and showed no benefit in a small group of participants. One study improved adherence through telephone and televideo reminders at each dosing interval. The results of the review are limited by reviewing only published articles, missing barriers or interventions due to lack of subgroup analysis, study selection and extraction completed by 1 reviewer, and articles with at least an abstract published in English.nnnCONCLUSIONSnThe few studies identified limit the assessment of barriers to medication adherence in the cognitively impaired population. Successful interventions suggest that frequent human communication as reminder systems are more likely to improve adherence than nonhuman reminders.

Advanced cognitive training for breast cancer survivors: a randomized controlled trial

The purpose of this study was to evaluate the preliminary efficacy and satisfaction/acceptability of training in memory or speed of processing versus wait-list control for improving cognitive function in breast cancer survivors. 82 breast cancer survivors completed a three-group randomized, controlled trial. Primary outcomes were objective neuropsychological tests of memory and speed of processing. Secondary outcomes were perceived cognitive functioning, symptom distress (mood disturbance, anxiety, and fatigue), quality of life, and intervention satisfaction/acceptability. Data were collected at baseline, post-intervention, and 2-month follow-up. Using repeated-measures mixed-linear ANCOVA models, each intervention was compared to wait-list control while adjusting for age, education, and baseline measures. The effect sizes for differences in means and the reliable improvement percentage were reported. The results show that domain-specific effects were seen for both interventions: memory training improved memory performance at 2-month follow-up (pxa0=xa00.036, dxa0=xa00.59); speed of processing training improved processing speed post-intervention (pxa0=xa00.040, dxa0=xa00.55) and 2-month follow-up (pxa0=xa00.016; dxa0=xa00.67). Transfer effects to non-trained domains were seen for speed of processing training with improved memory post-intervention (pxa0=xa00.007, dxa0=xa00.75) and 2-month follow-up (pxa0=xa00.004, dxa0=xa00.82). Both interventions were associated with improvements in perceived cognitive functioning, symptom distress, and quality of life. Ratings of satisfaction/acceptability were high for both interventions. It was concluded that while both interventions appeared promising, speed of processing training resulted in immediate and durable improvements in objective measures of processing speed and verbal memory. Speed of processing training may have broader benefits in this clinical population.

Albuminuria, Kidney Function, and the Incidence of Cognitive Impairment Among Adults in the United States

BACKGROUNDnAlbuminuria and estimated glomerular filtration rate (eGFR) are each associated with increased risk of cognitive impairment, but their joint association is unknown.nnnSTUDY DESIGNnProspective cohort study.nnnSETTING & PARTICIPANTSnA US national sample of 19,399 adults without cognitive impairment at baseline participating in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) Study.nnnPREDICTORSnAlbuminuria was assessed using urine albumin-creatinine ratio (UACR) and GFR was estimated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation.nnnOUTCOMESnIncident cognitive impairment was defined as score ≤4 on the 6-Item Screener at the last follow-up visit.nnnRESULTSnDuring a mean follow-up of 3.8 ± 1.5 years, UACRs of 30-299 and ≥300 mg/g were associated independently with 31% and 57% higher risk of cognitive impairment, respectively, relative to individuals with UACR <10 mg/g. This finding was strongest for those with high eGFRs and attenuated at lower levels (P = 0.04 for trend). Relative to eGFR ≥60 mL/min/1.73 m(2), eGFR <60 mL/min/1.73 m(2) was not associated independently with cognitive impairment. However, after stratifying by UACR, eGFR <60 mL/min/1.73 m(2) was associated with a 30% higher risk of cognitive impairment in participants with UACR <10 mg/g, but not higher UACRs (P = 0.04 for trend).nnnLIMITATIONSnSingle measures of albuminuria and eGFR, screening test of cognition.nnnCONCLUSIONSnWhen eGFR was preserved, albuminuria was associated independently with incident cognitive impairment. When albuminuria was <10 mg/g, low eGFR was associated independently with cognitive impairment. Albuminuria and low eGFR are complementary, but not additive, risk factors for incident cognitive impairment.

A comparative study to screen dementia and APOE genotypes in an ageing East African population

Previous studies have established cross-cultural methods to screen for ageing- related dementia and susceptibility genes, in particular Alzheimers disease (AD) among the Canadian Cree, African Americans and Yoruba in Nigeria. We determined whether the Community Screening Interview for Dementia (CSID), translated into Kikuyu, a major language of Kenya, could be used to evaluate dementia of the Alzheimer type. Using two sets of coefficients of cognitive and informant scores, two discriminant function (DF) scores were calculated for each of 100 elderly (>65 years) Nyeri Kenyans. When the cut-off points were selected for 100% sensitivities, the specificities of the DF scores were remarkably similar (93.75%) in the Kenyan sample. We propose the adapted CSID can be utilised to detect dementia among East Africans. We also show that apolipoprotein E epsilon 4 allele frequencies were high (approximately 30%) and not different between normal subjects and those with probable AD. There was no evidence to suggest years of education or vascular factors were associated with dementia status.

Risk factors for the progression of mild cognitive impairment to dementia.

The increasing prevalence of cognitive impairment among the older adult population warrants attention to the identification of practices that may minimize the progression of early forms of cognitive impairment, including the transitional stage of mild cognitive impairment (MCI), to permanent stages of dementia. This article identifies both markers of disease progress and risk factors linked to the progression of MCI to dementia. Potentially modifiable risk factors may offer researchers a point of intervention to modify the effect of the risk factor and to minimize the future burden of dementia.

Behavioral symptoms in community-dwelling elderly Nigerians with dementia, mild cognitive impairment, and normal cognition.

Few studies have examined the neuropsychiatric status of patients with dementia and cognitive impairment in the developing world despite the fact that current demographic trends suggest an urgent need for such studies.

Music Cognition in Breast Cancer Survivors

Advances in breast cancer treatment have resulted in improved survival rates and concomitant reports of chemotherapy-related cognitive dysfunction. Music cognition, a form of general cognition, also may be negatively affected by chemotherapy. Moreover, chemotherapy may have general ototoxic effects. The goal of this study was to explore whether breast cancer survivors (BCS) had similar hearing thresholds and music cognition abilities compared with age-matched healthy controls (HC). A total of 56 women (28 BCS and 28 HC) completed the audiometric tests and the Montreal Battery Evaluation of Amusia (MBEA). Results indicate the 2 groups have similar hearing thresholds. A comparison of music cognition variables suggests possible differences in some music cognition tasks, with HC scoring slightly, but not significantly, better in melodic perception. The BCS scored slightly better, though not significantly, on melodic memory. An adequately powered study including cognitive variables is needed for verification of findings and to establish clinical meaningfulness.

Anticholinergics Influence Transition from Normal Cognition to Mild Cognitive Impairment in Older Adults in Primary Care

To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care.

SCENE-ENCODING ACTIVATION AND RESTING-STATE FUNCTIONAL CONNECTIVITY IN OLDER ADULTS WITH SUBJECTIVE COGNITIVE DECLINE AND MILD COGNITIVE IMPAIRMENT

orbital part of middle frontal gyrus and left fusiform. Similar altered pattern was found among aMCI patients. Furthermore, significant correlations between normalized amplitude index and the MMSE were found for all the identified brain regions except for orbital part of middle frontal gyrus (Figure 2). Conclusions: The present study provided robust impaired brain spontaneous activity patterns in AD based on multi-center rsfMRI data. A novel finding was the identification of the strong correlation between the identified brain regions and cognitive performances. This profile indicates the potential of spontaneous activity pattern in the resting state as biomarkers or predictors of disease progression in MCI/AD.

HIGH RED MEAT INTAKE IS ASSOCIATED WITH INCREASED TAU ON [18F]FLORTAUCIPIR PET AND POORER MEMORY

adherence defined as a total score>53), cognitive complaints using the ‘Cognitive change index’ self-report (CCI) and depressive symptoms using ‘Center for Epidemiologic Studies Depression Scale’ (CES-D). Using logistic regression analyses, we investigated whether adherence to dietary guidelines was associated with age, sex, education, BMI, MMSE, depressive symptoms or cognitive complaints. Results:90 (54%) of our subjects adhered to the Dutch dietary guidelines. The adhering and non-adhering groups differed at all dietary components, except for fibers (Figure 1). In the non-adherence group, dietary scores were lowest on the components trans fatty acids, saturated fat, salt and fish. Logistic regression analysis showed a relationship between male sex (OR and 95% CI: 0.364 [0.170-0.779]) and more depressive symptoms (CES-D; OR and 95% CI: 0.920 [0.865-0.979]) with less adherence to the dietary guidelines. We found no association between MMSE or cognitive complaints and adherence to dietary guidelines (Table 1). Conclusions: Almost half of the SCD subjects did not adhere to the dietary guidelines. Our findings suggest that the diet of SCD subjects offers room for improvement, mainly in fat, salt and fish consumption, and could be a target for programs aiming to improve brain health.