Shana B. Traina

The Efficacy of Omega–3 Fatty Acids on Cognitive Function in Aging and Dementia: A Systematic Review

We systematically reviewed the published literature on the effects of omega–3 fatty acids on measures of cognitive function in normal aging, incidence and treatment of dementia. Computerized databases were searched for published literature to identify potentially relevant studies with the intent to conduct a meta-analysis. We screened 5,865 titles, reviewed 497 studies of which 49 underwent a detailed review, and found 5 studies that pertained to our objectives. We included controlled clinical trials and observational studies, including prospective cohort, case-control, and case series designs; we excluded case reports. We had no language restrictions. We abstracted data on the effects of omega–3 fatty acids and on study design, relevant outcomes, study population, source, type, amount, and duration of omega–3 fatty acid consumption, and parameters of methodological quality. A single cohort study has assessed the effects of omega–3 fatty acids on cognitive function with normal aging and found no association for fish or total omega–3 consumption. In four studies that assessed the effects of omega–3 fatty acids on incidence and treatment of dementia, a trend in favor of omega–3 fatty acids (fish and total omega–3 consumption) toward reducing risk of dementia and improving cognitive function was reported. The available data are insufficient to draw strong conclusions about the effects of omega–3 fatty acids on cognitive function in normal aging or on the incidence or treatment of dementia. However, limited evidence suggests a possible association between omega–3 fatty acids and reduced risk of dementia.

The complexity of care for patients with rheumatoid arthritis: metrics for better understanding chronic disease care.

Background:Patients with rheumatoid arthritis (RA) provide an important opportunity for understanding care of patients with a serious chronic condition. Objectives:We sought to characterize the complexity of care for patients with RA, including metrics describing the patient, the disease, and use of the health care system across time and place. Methods:We undertook a prospective cohort study of 568 community-dwelling patients with RA by using observational data from clinically detailed telephone interviews at baseline and 2 years later in addition to medical record abstraction. Health status, comorbidity, use of disease-modifying antirheumatic drugs, visits, providers, provider types, encounter settings, and the discontinuity between patients and providers were studied. Results:Within a 12-month window, 568 patients had 8686 outpatient encounters with the health care system with a mean of 3.41 unique providers per patient associated with a mean of 5 primary care and 6 rheumatologist visits. Half did not see a primary care physician, and 20% did not see a rheumatologist during 6-month periods despite their use of potentially toxic drugs, a mean of 4 comorbidities and progressive RA. Over the course of 24 months, 29% of patients changed their primary care provider, and 15% changed their rheumatologist. Patients were moderately impaired with mean SF-12 physical component score 37 (SD, 9). Conclusion:Patients with RA have frequent encounters with multiple providers and also frequent discontinuity of care. Recognizing the complexity of the care of patients with a chronic disease across multiple dimensions provides an opportunity to better understand challenges and opportunities in delivering high quality care.