A randomized clinical trial of high-dosage coenzyme Q10 in early Parkinson disease: no evidence of benefit.

Importance: Coenzyme Q10 (CoQ10), an antioxidant that supports mitochondrial function, has been shown in preclinical Parkinson disease (PD) models to reduce the loss of dopamine neurons, and was safe and well tolerated in early-phase human studies. A previous phase II study suggested possible clinical benefit.

Objective: To examine whether CoQ10 could slow disease progression in early PD.

Alzheimer's disease, sleep apnea, and positive pressure therapy.

Numerous lines of evidence converge in suggesting that sleep apnea may play a causal role in severe cognitive impairment, most likely Alzheimer's Disease (AD) but also including vascular dementia. Until recently, most of these studies have been based on small samples of clinic patients or population-based, descriptive studies of sleep apnea and cognition. Although randomized clinical trials have been completed for treating sleep apnea in middle-aged cognitively intact patients with sleep apnea using continuous positive airway pressure (CPAP), systematic intervention studies in well-characterized AD patients are very rare and have been published from only a single research group.

Incident sleep disordered breathing in old age.

Background: Little is known about progression of and risk factors for sleep disordered breathing (SDB) in old age. We prospectively examined elderly volunteers to understand how changes in body weight are related to SDB for a period of 20-30 years.

Methods: Participants were 30 surviving members of a community-based cohort (mean entry age = 57.

Nocturia and disturbed sleep in the elderly.

Background: Nocturnal urination (nocturia) is such a commonplace occurrence in the lives of many older adults that it is frequently overlooked as a potential cause of sleep disturbance.

Methods: We examined the prevalence of nocturia and examined its role in self-reported insomnia and poor sleep quality in a survey of 1424 elderly individuals, ages 55-84. Data were derived from a 2003 National Sleep Foundation telephone poll conducted in a representative sample of the United States population who underwent a 20-min structured telephone interview.

Quality improvement initiatives for urinary incontinence in nursing homes.

Clinical practice guidelines based on research data and expert opinion provide more than adequate guidance for NHs to implement an incontinence quality improvement initiative that will meet the expectations laid out in the federal surveyor guidance for Tag F 315. All quality improvement initiatives take time, effort, leadership support, and coordination by a champion who is dedicated to program success. Simple policies, procedures, and documentation tools can be of critical value in improving the quality of incontinence care.

Effect of supine knee position on obstructive sleep apnea.

We previously reported a case of a middle-aged man whose obstructive sleep apnea (OSA) was virtually eliminated when he slept in the supine "knees up" position. In this study, we attempt to replicate this phenomenon in a group of volunteers with previously diagnosed OSA. Results indicated no significant improvement in OSA when sleeping supine knees up.

Polysomnographic correlates of spontaneous nocturnal wetness episodes in incontinent geriatric patients.

Study Objective: To examine polysomnographic correlates of spontaneously occurring nocturnal wetness episodes (NWEs) in incontinent geriatric patients.

Design: Cross-sectional, descriptive study.

Setting And Participants: Subjects were 27 long-term nursing home residents known to be incontinent at night who were studied polysomnographically for 1 (n = 22) or 2 (n = 5) nights in their own rooms.

Implementation of a nursing home urinary incontinence management program with and without tolterodine.

Objective: To evaluate the implementation of a nursing home urinary incontinence management program.

Design: A prospective field trial of the program incorporating practice guidelines and principles of continuous quality improvement.

Setting: Five nursing homes in New York, Virginia, and Georgia

Participants: One hundred fifty-one residents identified as being incontinent of urine and who met inclusion criteria for ongoing participation in the program.

Quality care indicators and staffing levels in a nursing facility subacute unit.

Objective: To determine whether admissions to a subacute unit in a university-affiliated nursing facility received equivalent care on weekdays as opposed to on weekends with regard to certified nursing assistant (CNA) and licensed nurse staffing levels.

Design/setting: A 6-month prospective analytical study conducted from January to July 2000. All subacute unit residents admitted to this unit were monitored for the presence of specific outcome measures that were correlated to CNA and licensed nurse staffing levels during the day shift.

Computer simulation as a basis for pharmacy reengineering.

Using computer simulation can enhance the management decision-making process. Simulations can predict the effects on cost and quality of services. This article discusses the use of computer simulation to assist in planning the reengineering process to change a hospital's drug distribution from a decentralized pharmacy satellite system to a centralized robotic drug dispensing system.

E-learning. A practical solution for training and tracking in patient-care settings.

E-learning, online computer (Web)-based educational training, may be the solution to keeping health care staff abreast of new technologies, information, and regulations. Compared with traditional classroom teaching, e-learning can deliver content faster to the entire staff, be individualized to meet pace, language, and reading level. Additionally, an e-learning system provides accurate and automatic tracking.

Donepezil HCl (E2020) maintains functional brain activity in patients with Alzheimer disease: results of a 24-week, double-blind, placebo-controlled study.

Objective: The authors evaluated the effects of donepezil (10 mg/day) versus placebo on brain glucose metabolism.

Methods: This was a randomized, double-blind, parallel-group, 24-week pilot study in 28 patients with mild-to-moderate Alzheimer disease (AD). Functional brain activity was quantified by measuring average glucose metabolism in an axial brain slice and regional brain glucose metabolism using positron emission tomography.

Geriatric considerations in the diagnosis and management of overactive bladder.

Numerous considerations affect the diagnosis and management of overactive bladder (OAB) in older patients, including neurologic and cardiovascular disorders, musculoskeletal conditions, diabetes, and psychiatric disorders. Older patients are commonly prescribed multiple medications, and many medications can contribute to OAB symptoms and/or interact with drug treatment for OAB. In addition to chronic illnesses and related medications, several factors outside the lower urinary tract can play an important part in managing OAB in older patients.

Intractable incontinence in the elderly.

The number of people living into extreme old age is rising exponentially in the USA, Europe and other developed countries. Urinary incontinence is prevalent in this population. While many very old (age > 75 years) incontinent individuals are relatively healthy and respond well to various treatments, a substantial proportion has impaired cognitive function and impaired mobility.

Infections in residents of long-term care facilities: an agenda for research. Report of an expert panel.

The number of frail, older residents of long-term care facilities (LTCFs) will increase dramatically over the next 30 years. Improving the quality of health care provided in LTCFs is an important national and international priority. Improving the prevention and management of infections in LTCFs is a critical component of efforts to improve quality of care and poses unique challenges.

Cognitive outcome after mild and moderate traumatic brain injury in older adults.

This paper presents findings on the cognitive outcome of older adults sustaining mild traumatic brain injury (TBI). Results indicate that mild TBI patients who are 50 years or older, unlike those with moderate TBI, exhibit cognitive functioning that is comparable to noninjured controls by 1-2-months postinjury. However, these patients continue to report significant anxiety, depression, and somatic preoccupation despite their improvement on objective neuropsychological measures.

Risperidone for the treatment of behavioral and psychological symptoms of dementia.

Risperidone offers physicians the unique combination of extensive, published clinical experience and a good safety profile for treating patients with dementia who have symptoms of aggression, agitation, and psychosis. Numerous open-label and, more recently, placebo-controlled trials have documented the efficacy of risperidone in the management of behavioral and psychological symptoms of dementia. These trials also show that risperidone is better tolerated than conventional neuroleptic agents.

Anticholinergic effects of medication in elderly patients.

Anticholinergic toxicity is a common problem in the elderly. It has many effects ranging from dry mouth, constipation, and visual impairments to confusion, delirium, and severe cognitive decline. The toxicity is often the result of the cumulative anticholinergic burden of multiple prescription medications and metabolites rather than of a single compound.