Predictors of the Placement of Cognitively Impaired Residents on Special Care Units

Riter, Robert N.; Fries, Brant E.

doi:10.1093/geront/32.2.184

Cited by 29 publications

(13 citation statements)

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“…AD patients often express feelings of incompetence, loss of control and frustration, while caregivers must cope with the patient's functional debilities and related emotional and psychological outcomes [40]. Deterioration in functional abilities is a critical predictor of patient institutionalization [41,42]. Given that a decline in the ability to perform instrumental and basic ADLs profoundly impacts patient independence and caregiver burden [40], the effects of metrifonate in significantly delaying the loss of these abilities may prolong a patient's independent functioning and decrease caregiver burden.…”

Section: Discussionmentioning

confidence: 99%

Metrifonate Therapy in Alzheimer’s Disease: A Pooled Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

Farlow

Cyrus

2000

Dement Geriatr Cogn Disord

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This retrospective analysis assessed the efficacy of metrifonate in the treatment of mild to moderate Alzheimer’s disease (AD). Those four studies meeting Food and Drug Administration guidelines for establishing the efficacy of an AD therapeutic agent were pooled for further analysis. Data were included from all patients valid for the intent-to-treat analyses (last observation carried forward). Patients received once daily placebo (n = 550), metrifonate 30–60 mg (by weight, n = 769) or 60/80 mg (by weight, n = 197). Metrifonate 60/80 mg significantly improved the cognitive abilities [AD Assessment Scale – Cognitive Subscale (ADAS-Cog), p = 0.0001; Mini Mental State Examination (MMSE), p = 0.0001], psychiatric and behavioral disturbances (Neuropsychiatric Inventory, p = 0.039; ADAS – Noncognitive Subscale, p = 0.0001), performance of instrumental and basic activities of daily living (Disability Assessment for Dementia, p = 0.0002) and global status (Clinician’s Interview-Based Impression of Change with Caregiver Input, p = 0.0001) of AD patients when compared with placebo. Metrifonate effects across these domains were dose related. Metrifonate 60/80 mg significantly improved the cognitive performance relative to both placebo and to baseline as evaluated by both the ADAS-Cog and the MMSE. Metrifonate is the first cholinesterase inhibitor consistently shown under prospective, placebo-controlled conditions to improve significantly behavior in addition to cognition, function in activities of daily living and global functional status of patients with mild to moderate AD.

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Section: Discussionmentioning

confidence: 99%

Metrifonate Therapy in Alzheimer’s Disease: A Pooled Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

Farlow

Cyrus

2000

Dement Geriatr Cogn Disord

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“…18 Given the loss of nicotinic receptors that accompanies the impairment of presynaptic cholinergic function in Alzheimer's disease,19 20 and their role in memory and learning11 21 maintaining nicotinic activity may have therapeutic value 15. Galantamine binds to an allosteric binding site on nicotinic receptors, thereby potentiating the response of these receptors to the natural agonist, acetylcholine 15.…”

mentioning

confidence: 99%

Effects of a flexible galantamine dose in Alzheimer's disease: a randomised, controlled trial

Rockwood

2001

Journal of Neurology, Neurosurgery &Amp; Psychiatry

249

173

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Objective-To assess the eYcacy and safety of galantamine in Alzheimer's disease at 3 months using flexible dose escalation. Methods-A randomised, double blind, placebo controlled trial in 43 centres in the United States, Canada, Great Britain, South Africa, Australia, and New Zealand. Patients with probable Alzheimer's disease (n=386; 171 women) with a score of 11-24 on the mini mental state examination, and a score>12 on the cognitive subscale of the Alzheimer's disease assessment scale (ADAS-cog) were randomised to placebo, or galantamine escalated over 4 weeks to a maintenance dose of 24 or 32 mg/day. The primary outcome measures were the change in ADAS-cog score and the clinician's interview based impression of change plus caregiver input (CIBIC-plus) score. Activities of daily living (ADL) and behavioural symptoms were secondary outcomes. To compare the eVects of highest levels of dosing, an observed cases (OC) analysis was undertaken, with classic intention to treat (ITT) and ITT with last observation carried forward (LOCF) as confirmatory analyses. Results-At 3 months, galantamine (24-32 mg/day) produced a significantly better outcome on cognitive function than placebo (treatment diVerence=1.9 points on ADAS-cog, p=0.002) and a significantly better global response than placebo, as measured by CIBIC-plus (deterioration in 21% of patients on galantamine v 37% on placebo; p<0.001). Galantamine produced significant benefits on basic and instrumental ADL. Behavioural symptoms did not change significantly from baseline levels in either group. Adverse events (primarily gastrointestinal) were of mild to moderate intensity. There were no important diVerences between the OC, ITT, and ITT/LOCF analyses. Most patients (82%) who were maintained on the higher dose of galantamine completed the study. Conclusions-Patients on galantamine, compared with those on placebo, experienced benefits in cognitive function and instrumental and basic activities of daily living. Flexible dose escalation of galantamine was well tolerated. (J Neurol Neurosurg Psychiatry 2001;71:589-595)

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“…3 They affect people in different ways depending on their previous lifestyle, but are often the cause of patients requiring full-time care in a nursing home. 4 Neuropsychiatric symptoms in AD include:…”

Section: Alzheimer's Diseasementioning

confidence: 99%

Clinical, neuropathological and neuroimaging features of Alzheimer's disease and dementia with Lewy bodies

Hancock

2011

Rev. Clin. Gerontol.

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Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are the two most common types of degenerative dementia. It has been questioned whether they are totally separate conditions, or whether they are in fact both part of a spectrum of a more general neurodegenerative disease. Fluctuating cognition and parkinsonism are key features of DLB, but atypical in AD which is characterized by progressive amnesia, aphasia, agnosia and apraxia. Neuropsychiatric disturbances also seem to be more common in DLB. The main neuropathological features of DLB are Lewy bodies, and in AD are senile plaques and neurofibrillary tangles, though some overlap has been found. A key finding of neuroimaging studies is that there is relative preservation of brain volume in DLB patients compared with AD patients, particularly of temporal lobe structures. There are also profound reductions in striatal dopamine transport in DLB, demonstrated by single photon emission computerized tomography (SPECT) imaging. Whilst there are some distinct differences between AD and DLB, further research is needed to greater define the distinctions between these two conditions.

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Predictors of the Placement of Cognitively Impaired Residents on Special Care Units

Cited by 29 publications

References 0 publications

Metrifonate Therapy in Alzheimer’s Disease: A Pooled Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

Metrifonate Therapy in Alzheimer’s Disease: A Pooled Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

Effects of a flexible galantamine dose in Alzheimer's disease: a randomised, controlled trial

Clinical, neuropathological and neuroimaging features of Alzheimer's disease and dementia with Lewy bodies

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