The impact of anticholinergic burden in Alzheimer's dementia-the LASER-AD study.

Objective: to examine the effect of medications with anticholinergic effects on cognitive impairment and deterioration in Alzheimer's dementia (AD).

Methods: cognitive function was measured at baseline and at 6- and 18-month follow-up using the Mini-Mental State Exam (MMSE), the Severe Impairment Battery (SIB) and the Alzheimer's Disease Assessment Battery, Cognitive subsection (ADAS-COG) in a cohort study of 224 participants with AD. Baseline anticholinergic Burden score (ABS) was measured using the Anticholinergic Burden scale and included all prescribed and over the counter medication.

How do the PHQ-2, the PHQ-9 perform in aging services clients with cognitive impairment?

Objective: To examine the performance of the Patient Health Questionnaire-2 (PHQ-2) and the PHQ-9 in detecting current major depressive episode (MDE) in aging services care management clients who screen positive for cognitive impairment (CI).

Methods: Cross-sectional observational study of 236 care management clients ages ≥60 years recruited from an Upstate NY aging services agency. The test characteristics of the PHQ-2 and PHQ-9 to screen for depression were calculated using the Structured Clinical Interview for DSM-IV (SCID) to identify MDE (gold standard).

Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study.

Objectives: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative.

Design: A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993.

Setting: Community-dwelling and institutionalized participants.

Improving delirium care in the intensive care unit: the design of a pragmatic study.

Background: Delirium prevalence in the intensive care unit (ICU) is high. Numerous psychotropic agents are used to manage delirium in the ICU with limited data regarding their efficacy or harms.

Methods/design: This is a randomized controlled trial of 428 patients aged 18 and older suffering from delirium and admitted to the ICU of Wishard Memorial Hospital in Indianapolis.

Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD) trial.

Background: Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood.

Time-motion analysis of health care workers' contact with patients and workers' hand hygiene: open vs closed units.

Background: The effects of open (care provided by general medicine teams with a pulmonary intensivist consultant) vs closed (care provided by a dedicated critical care team) intensive care units on health care workers' contact with patients and their hand hygiene is uncertain.

Objective: To determine if closed intensive care units have fewer visits of patients by health care providers and greater hand-washing compliance among providers than do open units.

Methods: Time-motion analysis was used to observe 2 rooms in a medical intensive care unit at a teaching hospital affiliated with Indiana University School of Medicine, Indianapolis, for 96 hours before and after closure of the unit.

Monitoring quality of care for nursing home residents with behavioral and psychological symptoms related to dementia.

Background: Behavioral and psychological symptoms associated with dementia are common in nursing home residents. Quality indicators (QI) assessing quality of care for these residents are minimally risk adjusted and can provide inaccurate information regarding the quality of care provided by the facility.

Objective: Evaluate the performance of a new QI for the incidence of worsening behaviors in nursing home residents with behavioral and psychological symptoms association with dementia.

Caregiver and noncaregiver attitudes toward dementia screening.

Objectives: To compare attitudes toward dementia screening of older adults with and without an experience of dementia caregiving.

Design: A cross-sectional study.

Setting: Primary care clinics in Indianapolis, Indiana.

Implementing innovative models of dementia care: The Healthy Aging Brain Center.

Background: Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both the patients suffering from dementia and their informal caregivers.

Objective: To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis.

Methods: We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC).

Pilot study of a nonpharmacological intervention for delirium superimposed on dementia.

Delirium is a common neuropsychiatric syndrome that occurs most frequently in older adults with dementia and is referred to as delirium superimposed on dementia (DSD). Our aim in this pilot project was to demonstrate that implementation of cognitively stimulating activities is clinically feasible and has potential to reduce delirium severity and duration and functional loss in post-acute care settings. We randomized newly admitted participants with DSD to treatment (n = 11) and control (n = 5) conditions and conducted daily blinded assessments of delirium, delirium severity, and functional status for up to 30 days.

Implementing dementia care models in primary care settings: The Aging Brain Care Medical Home.

Objectives: The purpose of this article is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression.

Methods: Capitalizing on the substantial interest in the US on the patient-centered medical home concept, the Aging Brain Care Medical Home targets older adults with dementia and/or late-life depression in the primary care setting. We describe a structured set of activities that laid the foundation for a new partnership with the primary care practice and the lessons learned in implementing this new care model.

Acceptability of dementia screening in primary care patients.

Objectives: To determine the acceptability of dementia screening in two populations of older adults in different primary care settings.

Methods: Cross-sectional study of consecutive patients presenting for primary care appointments in the Duke University Health System (n = 152) or Durham VA Medical Center (n = 193) were evaluated face to face using the Dementia Screening and Perceived Harms (SAPH) questionnaire.

Results: Overall, 81% of primary care patients indicated that they would want to be screened to determine if they are developing dementia.

Use of anticholinergics and the risk of cognitive impairment in an African American population.

Background: Anticholinergic properties of certain medications often go unrecognized, and are frequently used by the elderly population. Few studies have yet defined the long-term impact of these medications on the incidence of cognitive impairment.

Methods: We report a 6-year longitudinal, observational study, evaluating 1,652 community-dwelling African American subjects over the age of 70 years who were enrolled in the Indianapolis-Ibadan Dementia Project between 2001 and 2007 and who had normal cognitive function at baseline.

Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system.

Complexity science suggests that our current health care delivery system acts as a complex adaptive system (CAS). Such systems represent a dynamic and flexible network of individuals who can coevolve with their ever changing environment. The CAS performance fluctuates and its members' interactions continuously change over time in response to the stress generated by its surrounding environment.

A randomized pilot study of the Engaging Moms Program for family drug court.

In response to the need for effective drug court interventions, the effectiveness of the Engaging Moms Program (EMP) versus Intensive Case Management Services (ICMS) on multiple outcomes for mothers enrolled in family drug court was investigated. In this intent-to-treat study, mothers (N = 62) were randomly assigned to either usual drug court care or the Engaging Moms drug court program. Mothers were assessed at intake and 3, 6, 12, and 18 months following intake.

Integrating care for older adults with cognitive impairment.

The number of older adults with Alzheimer's disease and related disorders is expected to triple over the next 50 years. While we may be on the cusp of important therapeutic advances, such advances will not alter the disease course for millions of persons already affected. Hoping for technology to spare the health care system from the need to care for older adults with dementia is no longer tenable.

Treatment of dementia: where is it going?

Global levels of dementia are escalating but alongside this new innovations and service models are developing to improve outcome and the patient journey. This article describes some of the current and horizon issues in dementia care.

The cognitive impact of anticholinergics: a clinical review.

Context: The cognitive side effects of medications with anticholinergic activity have been documented among older adults in a variety of clinical settings. However, there has been no systematic confirmation that acute or chronic prescribing of such medications lead to transient or permanent adverse cognitive outcomes.

Objective: Evaluate the existing evidence regarding the effects of anticholinergic medications on cognition in older adults.

A preliminary study of anticholinergic burden and relationship to a quality of life indicator, engagement in activities, in nursing home residents with dementia.

Objectives: (1) To describe the anticholinergic burden experienced by nursing home residents with dementia using the Anticholinergic Cognitive Burden (ACB) Scale; and (2) to determine the association of anticholinergic burden and engagement in activity.

Design: Cross-sectional, using baseline data from an ongoing clinical trial.

Setting: Nine nursing homes in Pennsylvania.

Pharmacological management of delirium in hospitalized adults--a systematic evidence review.

Background And Objectives: Despite the significant burden of delirium among hospitalized adults, there is no approved pharmacologic intervention for delirium. This systematic review evaluates the efficacy and safety of pharmacologic interventions targeting either prevention or management of delirium.

Data Sources: We searched Medline, PubMed, the Cochrane Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to October 2008.

Aggression in persons with dementia: use of nursing theory to guide clinical practice.

With approximately four million people in the United States today diagnosed with dementia, one of the most devastating problems faced by caregivers and patients is dealing with aggressive behavior. Aggression occurs in half of persons diagnosed with dementia and is associated with more rapid cognitive decline, increased risk of abuse, and caregiver burden. This paper uses the Need-driven Dementia-compromised Behavior (NDB) model to explain aggression and discusses therapeutic approaches to care that combines non-pharmacological and pharmacological interventions targeting both the management of aggression crisis and preventing its future recurrence.

Patients' attitudes of dementia screening across the Atlantic.

Background: Dementia is a common and growing global public health problem. It leads to a high burden of suffering for society with an annual cost of $100 billion in the US and $10 billion in the UK. New strategies for both treatment and prevention of dementia are currently being developed.