Risperidone treatment in elderly patients with dementia: relative risk of cerebrovascular events versus other antipsychotics

2005 ◽  
Vol 17 (4) ◽  
pp. 617-629 ◽  
Author(s):  
Sanford Finkel ◽  
Chris Kozma ◽  
Stacey Long ◽  
Andrew Greenspan ◽  
Ramy Mahmoud ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Atypical Antipsychotics ◽  
Reference Group ◽  
Wide Spectrum ◽  
Patient Characteristics ◽  
Antipsychotic Treatment ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Significant Difference ◽  
Treatment Alternatives

Background:The possibility that low-dose antipsychotic treatment is associated with increased risk of cerebrovascular events (CVEs) in elderly patients with dementia has been raised. The objective was to determine whether risperidone is associated with an increased risk of CVEs relative to other commonly considered alternative treatments.Methods:An analysis of Medicaid data from 1999 to 2002, representing approxi-mately 8 million enrollees from multiple states, was conducted. The primary outcome was the incidence of acute inpatient admission for a CVE within 3 months following initiation of treatment with atypical antipsychotics (risperidone, olanzapine, quetiapine, or ziprasidone), haloperidol, or benzo-diazepines.Results:Descriptive analyses found similar rates of incident CVEs across evaluated agents. Multivariate analyses found no differences in comparisons of risperidone with olanzapine or quetiapine. Risperidone and other antipsychotics as a group were also not associated with a higher odds ratio (OR) of incident CVE than either haloperidol or benzodiazepines. With risperidone as the reference group: olanzapine, OR=1.05, 95% CI 0.63–1.73; quetiapine, OR=0.66, 95% CI 0.23–1.87; haloperidol, OR=1.91, 95% CI 1.02–3.60; benzodiazepines, OR=1.97, 95% CI 1.30–2.98. With benzodiazepines as the reference group, the OR of incident CVE for all antipsychotics as a class was 0.49, 95%CI 0.35–0.69.Conclusions:This study found no significant difference in the incidence of CVEs between patients taking risperidone and those taking other atypical antipsychotics. Risperidone and all atypical antipsychotics were not associated with higher risk than two common treatment alternatives (haloperidol and benzodiazepines). These findings do not support the conclusion that risperidone is associated with a higher risk of CVE than other available treatment alternatives. The data also suggest that patient characteristics other than antipsychotic use are more significant predictors of CVEs. Given the relatively low rates of incident CVEs, a larger sample of patients with groups closely balanced on a wide spectrum of potential risk factors could provide a more precise assessment of risk.

scholarly journals Comparing Patient Characteristics, Clinical Outcomes, and Biomarkers of Severe Asthma Patients in Taiwan

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 764
Author(s):  
Shih-Lung Cheng ◽  
Kuo-Chin Chiu ◽  
Hsin-Kuo Ko ◽  
Diahn-Warng Perng ◽  
Hao-Chien Wang ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Clinical Characteristics ◽  
Linear Models ◽  
Patient Characteristics ◽  
Emergency Department Visits ◽  
Receiver Operating Characteristic Curves ◽  
Increased Risk ◽  
Significant Difference ◽  
Asthma Patients ◽  
Patients At Risk

Purpose: To understand the association between biomarkers and exacerbations of severe asthma in adult patients in Taiwan. Materials and Methods: Demographic, clinical characteristics and biomarkers were retrospectively collected from the medical charts of severe asthma patients in six hospitals in Taiwan. Exacerbations were defined as those requiring asthma-specific emergency department visits/hospitalizations, or systemic steroids. Enrolled patients were divided into: (1) those with no exacerbations (non-exacerbators) and (2) those with one or more exacerbations (exacerbators). Receiver operating characteristic curves were used to determine the optimal cut-off value for biomarkers. Generalized linear models evaluated the association between exacerbation and biomarkers. Results: 132 patients were enrolled in the study with 80 non-exacerbators and 52 exacerbators. There was no significant difference in demographic and clinical characteristics between the two groups. Exacerbators had significantly higher eosinophils (EOS) counts (367.8 ± 357.18 vs. 210.05 ± 175.24, p = 0.0043) compared to non-exacerbators. The optimal cut-off values were 292 for EOS counts and 19 for the Fractional exhaled Nitric Oxide (FeNO) measure. Patients with an EOS count ≥ 300 (RR = 1.88; 95% CI, 1.26–2.81; p = 0.002) or FeNO measure ≥ 20 (RR = 2.10; 95% CI, 1.05–4.18; p = 0.0356) had a significantly higher risk of exacerbation. Moreover, patients with both an EOS count ≥ 300 and FeNO measure ≥ 20 had a significantly higher risk of exacerbation than those with lower EOS count or lower FeNO measure (RR = 2.16; 95% CI, 1.47–3.18; p = < 0.0001). Conclusions: Higher EOS counts and FeNO measures were associated with increased risk of exacerbation. These biomarkers may help physicians identify patients at risk of exacerbations and personalize treatment for asthma patients.

scholarly journals Antipsychotics in dementia: are they being appropriately prescribed?

2010 ◽  
Vol 22 (3) ◽  
pp. 501-502 ◽  
Author(s):  
Fozia Roked ◽  
Asha Omar ◽  
Fayaz Roked ◽  
Ridwan Ahmed ◽  
Abdul Patel
Keyword(s):  
Adverse Effects ◽  
Atypical Antipsychotics ◽  
The Elderly ◽  
Qt Prolongation ◽  
Patient Organizations ◽  
People With Dementia ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Excessive Sedation ◽  
Typical And Atypical Antipsychotics

In 2007, the U.K.'s All-Party Parliamentary Group on Dementia (APPG) undertook an inquiry into the prescription of antipsychotics for people with dementia on account of concerns expressed by carers, patient organizations and academics about the appropriateness and safety of these drugs (All-Party Parliamentary Group on Dementia, 2008). It has been estimated that 32% of patients with dementia in care homes are prescribed antipsychotics (Alldred et al., 2007). Both typical and atypical antipsychotics are associated with QT prolongation, which can lead to arrhythmias and sudden death (Joint Formulary Committee, 2009). They are also associated with an increased risk of cerebrovascular events. Adverse effects in the elderly include excessive sedation and dizziness, which can lead to falls and therefore accelerated cognitive decline.

P5323HDL-C and all-cause mortality in a high-risk population: impact of LDL-C

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Dhindsa ◽  
P B Sandesara ◽  
C Liu ◽  
M Topel ◽  
A Mehta ◽  
...  
Keyword(s):  
Enzyme Inhibitor ◽  
Reference Group ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Model ◽  
High Risk Population ◽  
Angiotensin Ii Receptor Blocker ◽  
Risk Population ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background Previous studies have shown increased cardiovascular (CV) risk with both high (>60mg/dl) and low concentrations of high-density lipoprotein cholesterol (HDL-C). The effect of elevated HDL-C levels (>60mg/dL) at differing LDL-C concentrations on outcomes is unknown. Purpose To study the relationship between elevated HDL-C levels (>60mg/dl) in relation to LDL-C concentration (greater vs less than 70mg/dL) and adverse CV outcomes in an at-risk population. Methods Participants included 5,746 individuals (mean age 63.3±12.4 years, 35% female, 23% African American) enrolled in the cardiovascular biobank. Individuals were stratified by HDL-C categories (<30, 31–40, 41–50, 51–60 and ≥60 mg/dL) and LDL-C categories (≥70 and <70 mg/dL). A Cox proportional hazards model was used to examine the association between HDL-C and adverse outcomes, with HDL-C 41–50 mg/dL as the reference group. All models were adjusted for age, race, sex, body mass index, hypertension, smoking, triglycerides, heart failure history, myocardial infarction (MI) history, diabetes, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use, beta blocker use, statin use, aspirin use, estimated glomerular filtration rate, obstructive coronary artery disease. Results Over a median follow-up of 6.2 years (25th-75th percentiles = 3.3–8.0 years), a total of 286 MIs, 691 CV deaths and 1,093 all-cause deaths occurred. Individuals with HDL-C ≥60 mg/dL (n=632) had an increased risk of all-cause mortality with an LDL-C ≥70mgdL (HR 1.59; 95% CI=1.10–2.29, p=0.013) after adjustment for the aforementioned variables. This association was not statistically significant with LDL-C <70mg/dL (HR 1.16; 95% CI 0.60–1.21, p=0.66). There was no statistically significant difference for CV death or MI at elevated HDL-C in either group. Conclusion Elevated HDL-C levels is associated with increased all-cause mortality with an LDL-C ≥70mg/dL, though does not appear to be associated with worse outcomes when LDL-C is <70mg/dL.

Long-term therapy with thiazolidinediones and the risk of bladder cancer: A cohort study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1503-1503 ◽  
Author(s):  
Ronac Mamtani ◽  
Kevin Haynes ◽  
Warren B. Bilker ◽  
David J. Vaughn ◽  
Brian L. Strom ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cohort Study ◽  
Cancer Risk ◽  
Reference Group ◽  
Health Improvement ◽  
Term Therapy ◽  
Bladder Cancer Risk ◽  
Increased Risk ◽  
Significant Difference

1503 Background: The US Food and Drug Administration and other regulatory agencies recently warned prescribers that use of pioglitazone, a thiazolidinedione (TZD), may increase the risk of bladder cancer. France and Germany removed the drug from their markets, although the rest of Europe did not. However, no information was available about the risk from alternative TZDs. We aimed to compare bladder cancer risk over time with use of TZDs relative to sulfonylureas (SUs), and between pioglitazone and rosiglitazone. Methods: We conducted a cohort study of patients with type 2 diabetes who initiated treatment with a TZD or SU using The Health Improvement Network (2000-2010), a UK general practitioner medical record database. Incident cancers within the database were identified. We computed hazard ratios (HRs) of bladder cancer for TZDs in comparison to the reference group of SU users. Results: There were 60 incident diagnoses of bladder cancer in the TZD cohort (n=18,459) and 137 in the SU cohort (n=41,396). There was no significant difference in bladder cancer risk between the cohorts (HR 0·93, [95% CI 0·68-1·29]), but most use was short-term use. In contrast, the risk of bladder cancer increased with increasing time since initiation of TZD versus SU therapy (HRs 1·15, 1·40, and 1·72 for 3-4, 4-5, and ≥ 5 years, respectively; P-trend=0·033). Bladder cancer risk also increased with increasing time since initiation of pioglitazone (P-trend<0·001) and rosiglitazone (P-trend=0·006). Direct comparison of pioglitazone to rosiglitazone did not demonstrate significant differences in cancer risk with increasing time since initiation (P-trend=0·12) or duration of therapy (P-trend=0·75). Conclusions: Long-term TZD therapy is associated with an increased risk of bladder cancer, which appears to be a class effect.

Treatment Outcomes of Head and Neck Cancer Patients in the Elderly Receiving Different Chemoradiation Combinations: A Single-Center Experience

2021 ◽  
pp. 1-7
Author(s):  
Vidhya Karivedu ◽  
Marcelo Bonomi ◽  
Majd Issa ◽  
Adriana Blakaj ◽  
Brett G. Klamer ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Head And Neck ◽  
Chemotherapy Regimen ◽  
Single Agent ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
The Elderly ◽  
Increased Risk ◽  
Significant Difference ◽  
Weekly Cisplatin

<b><i>Objectives:</i></b> This study aimed to assess the effect of definitive or adjuvant concurrent chemoradiation (CRT) among elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC). <b><i>Materials and Methods:</i></b> We retrospectively analyzed 150 elderly LA HNSCC patients (age ≥70) at a single institution. Demographics, disease control outcomes, and toxicities with different chemotherapy regimens were reviewed. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) estimates. <b><i>Results:</i></b> Median age at diagnosis was 74 years (range 70–88). Of the cohort, 98 (65.3%) patients received definitive and 52 (34.7%) received adjuvant CRT; 44 (29.3%) patients received weekly carboplatin and paclitaxel, 43 (28.7%) weekly cetuximab, 33 (22%) weekly carboplatin, and 30 (20%) weekly cisplatin. The OS at 2 years was 70% (95% confidence interval [CI]: 63–79%), and PFS at 2 years was 61% (95% CI: 53–70%). There was no significant difference in OS or PFS between definitive and adjuvant CRT (<i>p</i> = 0.867 and <i>p</i> = 0.475, respectively). Type of chemotherapy regimen (single-agent carboplatin vs. others) (95% CI: 1.1–3.9; <i>p</i> = 0.009) was a key prognostic factor in predicting OS in multivariable analysis. Concurrent use of cetuximab was associated with increased risk of PEG tube dependence at 6 months (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Management of LA HNSCC in the elderly is a challenging scenario. Our study shows that CRT is a feasible treatment modality for elderly patients with LA HNSCC. We recommend CRT with weekly cisplatin or weekly carboplatin and paclitaxel. A chemotherapy regimen should be carefully selected in this difficult to treat population.

Serotonin Syndrome in Elderly Patients Treated for Psychotic Depression with Atypical Antipsychotics and Antidepressants: Two Case Reports

CNS Spectrums ◽  
2007 ◽  
Vol 12 (8) ◽  
pp. 596-598 ◽  
Author(s):  
Izchak Kohen ◽  
Marc L. Gordon ◽  
Peter Manu
Keyword(s):  
Elderly Patients ◽  
Atypical Antipsychotic ◽  
Mental Status ◽  
Atypical Antipsychotics ◽  
Serotonin Syndrome ◽  
Case Reports ◽  
Antipsychotic Treatment ◽  
Psychotic Depression ◽  
Medical Inpatient ◽  
First Case

ABSTRACTWe report two cases of serotonin syndrome in elderly patients during treatment of psychotic depression with atypical antipsychotics and antidepressants. The first case is a 69-year-old man who was admitted for depression with psychosis and treated with trazodone, risperidone, and sertraline. Subsequently, he developed myoclonus, tremor, cogwheel rigidity, and diaphoresis. The second case is a 72-year-old female initially admitted to a medical inpatient unit for a change in mental status that presented as increased confusion, lethargy, slurred speech, and a fever of 101.5°. She had been on phenelzine and quetiapine. In both cases, all symptoms resolved within 24 hours of the psychotropics being stopped. In both cases, we believe that serotonin syndrome was produced by a combination of an antidepressant and an atypical antipsychotic. There have been several case reports of serotonin syndrome from similar combinations of antidepressant and atypical antipsychotic treatment. Clinicians treating elderly patients with a combination of serotonergic antidepressants and atypical antipsychotics for psychotic depression should be aware of the potential for serotonin syndrome.

scholarly journals Predictors of Mortality in Elder Patients With Proximal Humeral Fracture

2017 ◽  
Vol 9 ◽  
pp. 215145851772815 ◽  
Author(s):  
Chad M. Myeroff ◽  
Jeffrey P. Anderson ◽  
Daniel S. Sveom ◽  
Julie A. Switzer
Keyword(s):  
Elderly Patients ◽  
Proximal Humerus ◽  
Humeral Fracture ◽  
Patient Characteristics ◽  
Treatment Method ◽  
Shoulder Function ◽  
Predictors Of Mortality ◽  
Inpatient Ward ◽  
Increased Risk ◽  
American Society

Background: Known possible consequences of proximal humerus fractures include impaired shoulder function, decreased independence, and increased risk for mortality. The purpose of this report is to describe the survival and independence of elderly patients with fractures of the proximal humerus, treated in our institution, relative to patient characteristics and treatment method. Methods: Retrospective cohort study from 2006 to 2012. Setting: Community-based hospital with level 1 designation. Patients/Participants: Three hundred nineteen patients ≥60 years who presented to the emergency department with an isolated fracture of the proximal humerus were either admitted to the inpatient ward for the organization and provision of immediate definitive care or discharged with the expectation of coordination of their care as an outpatient. Treatment was nonoperative or operative. Outcome Measures: One- and 2-year mortality. Results: Significant predictors of mortality at 1 year included Charlson Comorbidity Index (CCI; continuous, hazard ratio [HR] = 1.40; 95% confidence interval [CI]: 1.06-1.86), body mass index (BMI; <25 vs ≥25; HR = 3.43; 95% CI: 1.45-8.14), and American Society of Anesthesiologists (ASA) disease severity score (3-4 vs 1-2; HR = 4.48; 95% CI: 1.21-16.55). In addition to CCI and BMI, reliance on a cane/walker/wheelchair at the time of fracture predicted mortality at 2 years (vs unassisted ambulation; HR = 3.13; 95% CI: 1.59-5.88). Although the Neer classification of fracture severity significantly correlated with inpatient admission ( P < .001), it was not significantly associated with mortality or with loss of living or ambulatory independence. Among admitted patients, 64% were discharged to a facility with a higher level of care than their prefracture living facility. Twenty percent of study patients experienced a loss in ambulatory status by at least 1 level at 1 year postfracture. Conclusion: In a cohort of elderly patients with fractures of the proximal humerus, patient characteristics including comorbidities, ASA classification, and lower BMI were associated with increased mortality. Specifically, those admitted at the time of fracture and treated nonoperatively had the highest mortality rate and, likely, represent the frailest cohort. Those initially treated as outpatients and later treated operatively had the lowest mortality and, likely, represent the healthiest cohort. These data are inherently biased by prefracture comorbidities but help stratify our patients’ mortality risk at the time of injury.

scholarly journals 368 Perioperative Outcomes in Open versus Laparoscopic Surgery in Elderly Patients Undergoing Right Hemicolectomy

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Y Lim ◽  
R Wang ◽  
D J H Tan ◽  
Y H Chin ◽  
C H Ng ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Bowel Function ◽  
Right Hemicolectomy ◽  
Perioperative Outcomes ◽  
Postoperative Stay ◽  
Increased Risk ◽  
Significant Difference

Abstract Introduction With the global aging population, elderly patients are increasingly undergoing colorectal surgery. This study aims to evaluate postoperative outcomes in open (OS) and laparoscopic surgery (LS) for right hemicolectomy in elderly patients. Method We retrospectively reviewed patients aged 70 and above undergoing right hemicolectomy for malignancies at our institution. Additionally, Embase and Medline databases were reviewed, and comparative meta-analysis was conducted. Results 84 patients were included in our cohort (OS = 34; LS = 50). No significant difference in anastomotic leak (AL) (OS = 4; LS = 2; p = 0.176), surgical site infection (SSI) (OS = 4; LS = 2; p = 0.216), and ileus (OS = 10; LS = 16; p = 0.801) was observed. LS was associated with decreased postoperative stay (p = 0.001). Additionally, LS had faster return of bowel function (ROBF) (p = 0.068) and resumption of diet (p = 0.147), albeit without significance. Overall survival (p = 0.062), and disease-free survival (p = 0.067) did not significantly differ between LS and OS. Pooled analysis of 463 patients yielded no significant difference in AL (OR:1.15; 95%CI: 0.17-8.01; p = 0.89), SSI (OR:0.88; 95%CI: 0.44-1.76; p = 0.71), and ileus (OR:1.42; 95%CI: 0.69 – 2.92; p = 0.35). Postoperative stay (WMD:1.90 days; 95%CI: -1.81–5.61 days; p = 0.31), and ROBF (WMD:14.49 hours; 95%CI: -4.07–33.05 hours; p = 0.13) were shortened in LS, although without significance. Conclusions LS is associated with improved functional outcomes without an increased risk of postoperative morbidity or mortality.

scholarly journals Early initiation of PD therapy in elderly patients is associated with increased risk of death

2020 ◽  
Author(s):  
Yuan Peng ◽  
Hongjian Ye ◽  
Chunyan Yi ◽  
Xi Xiao ◽  
Xuan Huang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Age Groups ◽  
Young Patients ◽  
Early Initiation ◽  
Elderly Age ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Late Initiation ◽  
Late Start

Abstract Background The effect of early initiation of dialysis on outcomes of patients with end-stage renal disease (ESRD) remains controversial. We conducted this study to investigate the association between the timing of peritoneal dialysis (PD) initiation and mortality in different age groups. Methods In this single-centre cohort study, incident patients receiving PD from 1 January 2006 to 31 December 2016 were enrolled. Patients were categorized into three groups according to the estimated glomerular filtration rate (eGFR) at the initiation of PD, with early, mid and late initiation of PD defined as eGFR ≥7.5, 5–7.5 and &lt;5 mL/min/1.73 m2, respectively. Results A total of 2133 incident patients receiving PD were enrolled with a mean age of 47.1 years, 59.6% male and 25.3% with diabetes, of whom 1803 were young (age &lt;65 years) and 330 were elderly (age ≥65 years). After multivariable adjustment, the overall and cardiovascular (CV) mortality risks for young patients receiving PD were not significantly different between these three groups. However, for elderly patients, early initiation of PD therapy was associated with increased risks of all-cause {hazard ratio [HR} 1.54 [95% confidence interval (CI) 1.06–2.25]} and CV [HR 2.07 (95% CI 1.24–3.48)] mortality compared with late initiation of PD, while no significant difference was observed in overall or CV mortality between the mid- and late-start groups. Conclusions No significant difference in mortality risk was found among the three levels of eGFR at PD therapy initiation in young patients, while early initiation of PD was associated with a higher risk of overall and CV mortality among elderly patients.

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