scholarly journals P.019 Trends in medication use over eleven years in patients presenting to a rural and remote memory clinic

2016 ◽  
Vol 43 (S2) ◽  
pp. S25-S26
Author(s):  
R Verity ◽  
A Kirk
Keyword(s):  
Medication Use ◽  
Significant Decline ◽  
Remote Memory ◽  
Anticholinergic Medication ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Anticholinergic Medications ◽  
To Come ◽  
Spearman’S Correlation ◽  
Over Time

Background: Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients presenting to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed. Methods: The first 445 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient’s initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman’s Correlation) was conducted to examine trends in medication use over time. Results: Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a statistically significant decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the eleven years of this study (Spearman’s correlation coefficient=-0.64, p=0.035). Conclusions: The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.

scholarly journals Trends in Medication Use Over 11 Years in Patients Presenting to a Rural and Remote Memory Clinic

2016 ◽  
Vol 43 (6) ◽  
pp. 815-818 ◽  
Author(s):  
Ryan Verity ◽  
Andrew Kirk ◽  
Debra Morgan ◽  
Chandima Karunanayake
Keyword(s):  
Medication Use ◽  
Remote Memory ◽  
Anticholinergic Medication ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Anticholinergic Medications ◽  
The Central Nervous System ◽  
To Come ◽  
Spearman’S Correlation ◽  
Over Time

AbstractBackground: Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients at initial presentation to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed. Methods: The first 444 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient’s initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman’s correlation) was conducted to examine trends in medication use over time. Results: Patients were on a mean of 5.18 medications (standard deviation, 3.46). Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the 11 years of this study (Spearman’s correlation coefficient =−0.64, p=0.035). The prevalence of drugs acting on the central nervous system trended toward an increase, but this was not statistically significant. Sixty-three patients (14.2%) presented to the RRMC already taking a cholinesterase inhibitor. Conclusions: The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.

scholarly journals Medication Use in Patients Presenting to a Rural and Remote Memory Clinic

2008 ◽  
Vol 35 (5) ◽  
pp. 669-671 ◽  
Author(s):  
Trevor A Steve ◽  
Andrew Kirk ◽  
Margaret Crossley ◽  
Debra Morgan ◽  
Carl D'Arcy ◽  
...  
Keyword(s):  
Medication Use ◽  
Remote Memory ◽  
Memory Clinic ◽  
Rural And Remote

Anticholinergic Medication Use, Dopaminergic Genotype, and Recurrent Falls

2021 ◽  
Author(s):  
Andrea L Rosso ◽  
Zachary A Marcum ◽  
Xiaonan Zhu ◽  
Nicolaas Bohnen ◽  
Caterina Rosano
Keyword(s):  
Fall Risk ◽  
Medication Use ◽  
Effect Modification ◽  
Anticholinergic Medication ◽  
Anticholinergic Medications ◽  
Recurrent Falls ◽  
Health Aging ◽  
Dopamine Signaling

Abstract Background Anticholinergic medications are associated with fall risk. Higher dopaminergic signaling may provide resilience to these effects. We tested interactions between anticholinergic medication use and dopaminergic genotype on risk for recurrent falls over 10 years. Methods Participants in the Health, Aging, and Body Composition (Health ABC) study (n = 2 372, mean age = 73.6; 47.8% men; 60.0% White) without disability or anticholinergic use at baseline were followed for up to 10 years for falls. Medication use was documented in 7 of 10 years. Highly anticholinergic medications were defined by Beers criteria, 2019. Recurrent falls were defined as ≥2 in the 12 months following medication assessment. Generalized estimating equations tested the association of anticholinergic use with recurrent falls in the following 12 months, adjusted for demographics, health characteristics, and anticholinergic use indicators. Effect modification by dopaminergic genotype (catechol-O-methyltransferase [COMT]; Met/Met, higher dopamine signaling, n = 454 vs Val carriers, lower dopamine signaling, n = 1 918) was tested and analyses repeated stratified by genotype. Results During follow-up, 841 people reported recurrent falls. Anticholinergic use doubled the odds of recurrent falls (adjusted odds ratio [OR] [95% CI] = 2.09 [1.45, 3.03]), with suggested effect modification by COMT (p = .1). The association was present in Val carriers (adjusted OR [95% CI] = 2.16 [1.44, 3.23]), but not in Met/Met genotype (adjusted OR [95% CI] = 1.70 [0.66, 4.41]). Effect sizes were stronger when excluding baseline recurrent fallers. Conclusion Higher dopaminergic signaling may provide protection against increased 12-month fall risk from anticholinergic use. Assessing vulnerability to the adverse effects of anticholinergic medications could help in determination of risk/benefit ratio for prescribing and deprescribing anticholinergics in older adults.

scholarly journals Does Day Length Affect Cognitive Performance in Memory Clinic Patients?

2011 ◽  
Vol 38 (3) ◽  
pp. 461-464 ◽  
Author(s):  
Catherine Lacny ◽  
Andrew Kirk ◽  
Debra G. Morgan ◽  
Chandima Karunanayake
Keyword(s):  
Cognitive Performance ◽  
Daily Temperature ◽  
Day Length ◽  
Remote Memory ◽  
Initial Assessment ◽  
Memory Clinic ◽  
Rural And Remote ◽  
The Mean ◽  
The Relationship

Objective:To determine whether day length affects cognitive performance in rural and remote memory clinic patients.Methods:A rural and remote memory clinic in Saskatoon, Saskatchewan provided an opportunity to examine how cognitive performance on the Mini-Mental State Exam (MMSE) is influenced by day length. Saskatchewan is an ideal location to test this association as day length varies greatly both seasonally and geographically. Following an initial assessment by the Rural and Remote Memory Clinic (RRMC) team in Saskatoon, patient follow-up appointments were performed either in-person or via telehealth videoconference. At each follow-up appointment the clinic neurologist administered the MMSE. The relationship between day length and MMSE scores at the sixweek follow-up appointment was analyzed in 154 patients. The mean daily temperature was controlled for in the analysis. Bivariate correlate and linear regression analyses were conducted.Results:There was no significant association between MMSE scores and either minutes of day length or mean daily temperature.Conclusion:Day length does not appear to have significant effect on cognitive performance of rural and remote memory clinic patients.

scholarly journals Characteristics of Young-Onset and Late-Onset Dementia Patients at a Remote Memory Clinic

2020 ◽  
Vol 47 (3) ◽  
pp. 320-327
Author(s):  
Jennifer F. W. Wong ◽  
Andrew Kirk ◽  
Landon Perlett ◽  
Chandima Karunanayake ◽  
Debra Morgan ◽  
...  
Keyword(s):  
Late Onset ◽  
Remote Memory ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Caregiver Support ◽  
Young Onset ◽  
Highly Educated ◽  
Dementia Patients ◽  
Patient Groups ◽  
Late Onset Dementia

ABSTRACT:Background:Young-onset dementia (YOD) is defined as the onset of dementia symptoms before the age of 65 years and accounts for 2–8% of dementia. YOD patients and their caregivers face unique challenges in diagnosis and management. We aimed to compare the characteristics of rural YOD and late-onset dementia (LOD) patients at a rural and remote memory clinic in Western Canada.Methods:A total of 333 consecutive patients (YOD = 61, LOD = 272) at a rural and remote memory clinic between March 2004 and July 2016 were included in this study. Each patient had neuropsychological assessment. Health, mood, function, behaviour and social factors were also measured. Both groups were compared using χ2 tests and independent sample tests.Results:YOD patients were more likely to be married, employed, current smokers and highly educated. They reported fewer cognitive symptoms, but had more depressive symptoms. YOD patients were less likely to live alone and use homecare services. YOD caregivers were also more likely to be a spouse and had higher levels of distress than LOD caregivers. Both YOD and LOD patient groups were equally likely to have a driver’s licence.Conclusions:Our findings indicate YOD and LOD patients have distinct characteristics and services must be modified to better meet YOD patient needs. In particular, the use of homecare services and caregiver support may alleviate the higher levels of distress found in YOD patients and their caregivers. Additional research should be directed to addressing YOD patient depression, caregiver distress and barriers to services.

scholarly journals Feasibility of remote Memory Clinics using the plan, do, study, act (PDSA) cycle

2021 ◽  
Author(s):  
Jemima T Collins ◽  
Biju Mohamed ◽  
Antony Bayer
Keyword(s):  
Remote Memory ◽  
Service Improvement ◽  
Attendance Rate ◽  
Memory Clinic ◽  
Improvement Project ◽  
Face To Face ◽  
Pdsa Cycle ◽  
Diagnosis Of Dementia ◽  
Memory Clinics ◽  
To Come

Abstract Introduction A timely diagnosis of dementia is crucial for initiating and maintaining support for people living with dementia. The coronavirus disease (COVID) pandemic temporarily halted Memory Clinics, where this is organised, and rate of dementia diagnosis has fallen. Despite increasing use of alternatives to face-to-face (F2F) consultations in other departments, it is unclear whether this is feasible within the traditional Memory Clinic model. Aims The main aim of this service improvement project performed during the pandemic was to explore feasibility of telephone (TC) and videoconference (VC) Memory Clinic consultations. Methods Consecutive patients on the Memory Clinic waiting list were telephoned and offered an initial appointment by VC or TC. Data extracted included: age, internet-enabled device ownership, reason for and choice of Memory Clinic assessment. We noted Montreal Cognitive Assessment-Blind (TC) and Addenbrooke’s Cognitive Examination-III (VC via Attend Anywhere) scores, and feasibility of consultation. Results Out of 100 patients, 12 had a home assessment, moved away, been hospitalised, or died. 45, 21 and 6 preferred F2F, VC and TC assessments respectively. 16 were not contactable and offered a F2F appointment. The main reason for preferring F2F was non-ownership, or inability to use an internet-enabled device (80%). VC and TC preference reasons were unwillingness to come to hospital (59%), and convenience (41%). Attendance rate was 100% for VC and TC, but 77% for F2F. Feasibility (successful consultations) was seen in 90% (VC) and 67% (TC) patients. Conclusion For able and willing patients, remote Memory Consultations can be both feasible and beneficial. This has implications for future planning in dementia services.

scholarly journals P.002 Quality of life across types of dementia in rural and remote memory clinic patients

2019 ◽  
Vol 46 (s1) ◽  
pp. S14
Author(s):  
M Kushneriuk ◽  
A Kirk ◽  
C Karunanayake ◽  
DG Morgan ◽  
ME O’Connell
Keyword(s):  
Quality Of Life ◽  
Lewy Body Dementia ◽  
Remote Memory ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Patient Demographics ◽  
Included Patient ◽  
Patient Variables ◽  
One Way Anova

Background: Quality of life (QOL) is of great importance in dementia. We examined QOL across types of dementia in patients presenting to a rural and remote memory clinic (RRMC). Methods: This analysis included 343 RRMC patients seen between 2004 and 2016. Patients were diagnosed with mild cognitive impairment (MCI, n=74), frontotemporal dementia (FTD, n=42), Alzheimer’s disease (AD, n=187), vascular dementia (VD, n=22), or Lewy Body dementia (DLB, n=18). Patients and caregivers completed questionnaires at their initial visit. Data collection included patient-rated patient QOL (QOL-PT), caregiver-rated patient QOL (QOL-CG), MMSE score, age, and other patient demographics. Statistical analysis assessed patient variables and differences in QOL across types of dementia using one-way ANOVA, χ2 tests, and t-tests. Results: QOL-PT did not differ by diagnosis, whereas QOL-CG did. QOL-CG was significantly higher in MCI (34.6±7.1) compared to FTD (30.9±5.2) and AD (31.7±5.9). QOL-PT and QOL-CG differed in certain dementia types. QOL-PT was significantly higher than QOL-CG in MCI (QOL-PT=37.3±5.0, QOL-CG=35.3±7.3), FTD (QOL-PT=37.2±6.1, QOL-CG=31.7±5.5), and AD (QOL-PT=37.0±9.7, QOL-CG=32.1±5.9). Conclusions: We found that QOL-PT does not differ across dementia types, QOL-CG is higher in MCI compared to FTD and AD, and patients rate their own QOL higher than their caregivers do in MCI, FTD, and AD.

Differences between men and women referred to a rural and remote memory clinic

2017 ◽  
Vol 381 ◽  
pp. 671
Author(s):  
A. Kirk ◽  
O. Philippon ◽  
C. Karunanayake ◽  
D. Morgan
Keyword(s):  
Remote Memory ◽  
Memory Clinic ◽  
Rural And Remote ◽  
Men And Women

Anticholinergic medication use is associated with globus pharyngeus

2016 ◽  
Vol 130 (12) ◽  
pp. 1125-1129 ◽  
Author(s):  
S Haft ◽  
R M Carey ◽  
D Farquhar ◽  
N Mirza
Keyword(s):  
Medication Use ◽  
Cross Sectional Study ◽  
Anticholinergic Medication ◽  
Severity Scale ◽  
Cross Sectional ◽  
Globus Pharyngeus ◽  
Anticholinergic Medications ◽  
Considerable Portion ◽  
Previous Diagnosis ◽  
And Gender

AbstractBackground:Globus pharyngeus has been linked to salivary hypofunction. We hypothesise that a considerable portion of the globus experienced by patients is due to a drying effect secondary to anticholinergic medication use; this study aimed to determine their association.Methods:A cross-sectional study was conducted of 270 patients who presented to a laryngology practice over 6 months. Participants rated globus sensation on a 5-point severity scale, with those scoring 0 considered as controls (non-globus). Participants were excluded if they had a likely cause of globus. Scores were compared with participants’ medication lists, co-morbidities, age and gender, and evaluated using multivariate analysis, with significance set at p < 0.05.Results:Any participant taking at least 2 anticholinergic medications had a 3.52 increased odds (p = 0.02) of experiencing globus. A previous diagnosis of gastroesophageal reflux disease was also significantly associated with globus (p = 0.004), with an odds ratio of 3.75.Conclusion:A substantial portion of idiopathic globus may be due to anticholinergic use or reflux. The findings implicate medication use as a risk factor for globus. An awareness of these associations is invaluable for identifying cause and treating globus.

scholarly journals Anticholinergic Medication Use, Dopaminergic Genotype, and Recurrent Falls

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 756-756
Author(s):  
Andrea Rosso ◽  
Xiaonan Zhu ◽  
Zachary Marcum ◽  
Nico Bohnen ◽  
Briana Sprague ◽  
...  
Keyword(s):  
Generalized Estimating Equations ◽  
Fall Risk ◽  
Medication Use ◽  
Effect Modification ◽  
Anticholinergic Medication ◽  
Anticholinergic Medications ◽  
Recurrent Falls ◽  
Increase Risk ◽  
Dopamine Signaling

Abstract Anticholinergic medications (A-chol) increase risk for falls; higher dopaminergic signaling may provide resilience to these effects. In 2489 older adults (mean age=74; 52% women) with 10 years of data on medication use, falls, and dopaminergic genotype (catechol-O-methyltransferase (COMT)), we assessed the association of A-chol use with recurrent falls (≥2) over the subsequent 12 months using generalized estimating equations. Effect modification by COMT (met/met, higher dopamine signaling, n=473 vs val carriers, lower dopamine signaling, n=2016) was tested; analyses were then stratified by COMT and adjusted for demographics and A-chol use indicators. During follow-up, 843 people reported recurrent falls. A-chol use doubled the odds of recurrent falls (OR [95%CI]=2.13[1.74, 2.60]), with a suggested effect modification by COMT (p=0.1). The association was present in val carriers (adjusted OR [95%CI]=1.93[1.36, 2.73]) but not in met/met (adjusted OR [95%CI]=1.30[0.53, 3.22]). Higher dopaminergic signaling may provide protection against the effects of A-chol use on fall risk.

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