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Introduction Potentially inappropriate medication (PIM) prescribing is a global problem. Limited data are available on the prevalence of PIMs in elderly patients with chronic kidney disease (CKD). We examined the PIM prevalence in elderly patients with CKD, the most common drugs implicated and the levels of polypharmacy in this group. Methods A retrospective case record analysis of patients with CKD above the age of 70 years was carried out on 100 consecutive inpatients between January 2008 and June 2008 at a University Teaching Hospital. PIMs were defined using the modified Beers' criteria and latest British National Formulary (BNF) guidance for prescribing in patients with renal impairment using creatinine clearance calculated by the Cockroft–Gault formula. Results The mean age of the cohort was 80 years with a female predominance (62%). The mean estimated glomerular filtration rate (eGFR) was 17.2 ml/min/1.73 m2. 56 patients had one or more PIMs prescribed during the acute admission period. 81 out of the 622 medications prescribed were ‘inappropriate’; therefore, the prevalence of PIMs prescribed was 13%. Antibiotics and antihypertensives accounted for the majority of PIMs. Each patient received an average of six drugs. Conclusions The prevalence of PIMs in elderly inpatients with CKD is high. Inclusion of drugs prescribed acutely and use of the BNF to identify PIMs as well as the Beers' criteria may account for this. Use of screening tools may lead to better identification of PIMs in this high risk group. Routine calculation and documentation of eGFR on the medication chart on admission may help reduce PIMs.

Purpose Parkinson’s disease (PD) is associated with non-motor symptoms (NMS) that can cause progressive disability and impact quality of life of people with PD (PwP) and increase burden on care partners. This survey was designed to evaluate the prevalence, impact, and educational preferences regarding NMS on PwP and their care partners. Patients and methods A 17-question survey was sent to the total membership of PMDAlliance, a nonprofit organization reaching 3,685 households of PwP. Care partners and other interested individuals could also respond. The survey was conducted using Survey Monkey, an online survey platform, and included distinct questions for respondents with and without NMS. Results A total of 700 individuals responded to the survey. Of the respondents, 378 (54%) were care partners and 287 (41%) were PwP. About 90% of the respondents reported having experience with NMS in PwP, including sleep problems (84%), cognitive symptoms (76%), anxiety (65%), depression (56%), hallucinations (40%), and delusions (23%). NMS in PwP were reported by more care partners (97%) than PwP (80%). NMS had at least some impact on quality of life for 84% of the respondents; 48% indicated that NMS represented a greater challenge than motor symptoms. Care partners were more likely than PwP to report that NMS were more challenging than motor symptoms (58% vs 32%). Respondents with and without NMS indicated a desire for NMS education. Conclusion This survey underscores the significant impact of NMS on the quality of life of PwP and highlights the need for improved recognition and education about its effects.

Background: Apathy is a common and early symptom in Alzheimer's disease (AD) and is linked to poorer prognosis. Theoretical interpretations of apathy implicate alterations of connections amongst fronto-striatal and limbic regions. Objective: To test the association between presence of apathy and patterns of brain functional connectivity in patients with clinically-established AD. Methods: Seventy AD patients were included. Thirty-five patients experienced apathy as defined by the screening question of the Neuropsychiatric Inventory, and thirty-five did not. All patients agreed to undergo an MRI protocol inclusive of resting-state acquisitions. The hemodynamic-dependent signal was extracted bilaterally from five regions of interest: ventromedial prefrontal cortices, anterior cingulate cortices, dorsolateral prefrontal cortices, insulae and amygdalae. t tests were run to compare connectivity maps of apathetic and nonapathetic patients. Age, education, Mini Mental State Examination score, gray matter volumes and gray matter fractions served as covariates. Results: At a pFWE < 0.05 threshold, apathetic patients had reduced connectivity between the left insula and right superior parietal cortex. Apathetic patients had also increased connectivity between the right dorsolateral prefrontal seed and the right superior parietal cortex. Patients with apathy were significantly more likely to experience other psychiatric symptoms. Conclusion: Our findings support a role of frontal and insular connections in coordinating value-based decisions in AD. Both down-regulation and maladaptive up-regulation mechanisms appear to be at play in these regions.

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