scholarly journals Naturalistic audit of NICE criteria for the use of cholinesterase inhibitors

2005 ◽  
Vol 29 (11) ◽  
pp. 410-412 ◽  
Author(s):  
Steve Simpson ◽  
Diane Beavis ◽  
Adrian Leddy ◽  
Sue Ball ◽  
Ian Johnson
Keyword(s):  
Old Age ◽  
Cholinesterase Inhibitors ◽  
Mmse Score ◽  
Clinical Excellence ◽  
Adverse Outcomes ◽  
Response To Treatment ◽  
Health Authorities ◽  
Antidementia Drugs ◽  
Nice Guidance ◽  
State Examination

Aims and MethodIn 2001 the National Institute for Clinical Excellence (NICE) produced guidance for the treatment of Alzheimer's disease. NICE encourages the withdrawal of medication when the Mini-Mental State Examination (MMSE) score reaches 12 and advises against the treatment of patients with cholinesterase inhibitors if the MMSE score is below 12. Most health authorities have rigorously enforced these guidelines, which has put old age psychiatrists in a difficult position. Our prospective 12 week audit of consecutive patients examines the response to treatment of patients treated both in accordance with and outside of NICE criteria. We also investigated the effect of stopping the medication according to NICE's recommendation.ResultsOur results suggest that patients outside the NICE criteria respond better than those within the criteria. More disturbingly, when the medication was stopped owing to the MMSE score falling below 12, we found a very high mortality rate (5 out of 25, 20%) or acute deterioration (12 out of 25, 48%). This suggests that the medication is beneficial in the later stages and should not be stopped purely because of the stage of dementia.Clinical ImplicationsIf we are to prevent unnecessary suffering, greater freedom is needed by old age psychiatrists in the use of these antidementia drugs. Patients with severe dementia may benefit from acute treatment. The withdrawal of medication in line with NICE guidance is poor clinical practice and likely to have adverse outcomes in a large proportion of cases.

Clinical audit on nice guidance on anticholinesterases in a memory clinic

2011 ◽  
Vol 26 (S2) ◽  
pp. 829-829
Author(s):  
S. Bangar ◽  
R. Powell
Keyword(s):  
Mental Health ◽  
Clinical Audit ◽  
Mmse Score ◽  
Clinical Excellence ◽  
Memory Clinic ◽  
Baseline Mmse Score ◽  
Nice Guidance

IntroductionThe National Institute for Clinical Excellence (NICE) has laid down certain guidelines for prescribing Anti-cholinesterases in patients with dementia. Keeping in mind the NICE guidance, an audit was conducted to see whether these were followed.Aims and objectivesTo ascertain the level of compliance to the NICE guidance and ensure they are adhered to.MethodThe data was collected from patients attending the memory clinic at Park Royal Centre for Mental Health in Central London over a six month period. Sixteen patients were randomly selected for this audit. The baseline MMSE score was recorded and also the medication prescribed.ResultsThe baseline MMSE score in all the 16 (100%) patients was above the recommended score of 12.The MMSE score was done in 12(75%) patients during follow up at 4–6 months.Of the 12 available MMSE scores at follow up, none were below 12 and hence continued treatment.In 2 (12.5%) patients there was an improvement, in 6 (37.5%) patients there was a fall and in 4 (25%) patients there was no change in the MMSE score at follow up.ConclusionIt was found that the NICE guidance was followed in most (75%) patients.

scholarly journals Has the referral of older adults with dementia changed since the availability of acetylcholinesterase inhibitors and the NICE guidelines?

2006 ◽  
Vol 30 (4) ◽  
pp. 131-134 ◽  
Author(s):  
Christopher O'Loughlin ◽  
Jon Darley
Keyword(s):  
Mini Mental State Examination ◽  
Mmse Score ◽  
Acetylcholinesterase Inhibitors ◽  
Clinical Excellence ◽  
Clinical Implications ◽  
Nice Guidelines ◽  
Specialist Services ◽  
Old Age Psychiatry ◽  
The Mean ◽  
State Examination

Aims and MethodTo investigate whether patients with dementia are referred to specialist services earlier in the disease since the launch of acetylcholinesterase inhibitors and the publication of the National Institute for Clinical Excellence (NICE) guidelines for the use of these drugs. All referrals to old age psychiatry services in two 6-month periods in 1996 and 2003 were surveyed retrospectively for diagnosis, Mini-Mental State Examination (MMSE) score and use of acetylcholinesterase inhibitors.ResultsThe mean MMSE score at referral increased from 18.8 to 21.5 (P=0.0005) between 1996 and 2003. Acetylcholinesterase inhibitors were prescribed for 35% of all patients and 58% of patients that would be suitable according to NICE guidelines in the 2003 group.Clinical ImplicationsThe earlier referral of patients with dementia to mental health services is encouraging.

scholarly journals Treatment of patients with Alzheimer's disease: a national survey following release of the NICE guidance

2003 ◽  
Vol 27 (1) ◽  
pp. 11-13 ◽  
Author(s):  
Claire M. Connolly ◽  
Roger Bullock
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Old Age ◽  
Overall Response Rate ◽  
Response Rate ◽  
Clinical Excellence ◽  
Postal Survey ◽  
Mild Disease ◽  
Annual Expenditure ◽  
Nice Guidance

Aims and MethodThe National Institute for Clinical Excellence (NICE) has issued guidance regarding the treatment of Alzheimer's disease. A postal survey of old age psychiatrists, geriatricians and neurologists was conducted to establish working practice pre-NICE and investigate expectations about the effect of this guidance.ResultsThe overall response rate was 26.3%. Old age psychiatrists prescribe the majority of drugs for the treatment of Alzheimer's disease. There was variation in the annual expenditure on such treatment. The main reason for non-prescription was a lack of funding. Over 80% of doctors thought that patients with mild disease should now be targeted for treatment.Clinical ImplicationsIn order to implement the guidance it will be necessary to address the issue of funding and have clear role allocation between local services.

scholarly journals Study of cognitive functions in major idiopathic interstitial pneumonias

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Mohamed W. Zakaria ◽  
Reem I. El-Korashy ◽  
Mostafa O. Shaheen ◽  
Samah Selim ◽  
Kwashi J. Amum
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cognitive Dysfunction ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Control Group ◽  
Healthy Individuals ◽  
Co Morbidity ◽  
Impaired Lung Function ◽  
State Examination

Abstract Background Cognitive dysfunction in idiopathic interstitial pneumonia (IIP) is an important clinical co-morbidity that is associated with impaired lung function. The aim of the work is to assess cognitive function in major IIP and to find out the relation between cognitive dysfunction and the oxygenation parameters. Results Fifty individuals were involved in the study; 30 patients with major IIP and 20 healthy individuals. Patients with IIP had significantly lower mini mental state examination (MMSE) score compared to the control group (P < 0.001). Wechsler Deterioration Index (WDI) revealed that 33.3% (n = 10) of the patients with IIP had sure cognitive impairment and 26.6% (n = 8) had ongoing cognitive deterioration. Patients with idiopathic pulmonary fibrosis (IPF) had lower cognitive function than other IIP. Conclusion There is an impairment of cognitive function in patients with major IIP, particularly in IPF, as measured by WDI and MMSE. Further large studies are needed to assess the possible predictors of cognitive impairment and their effects on the patients’ outcome.

Disruptive Vocalization and Depression in Older Nursing Home Residents

2000 ◽  
Vol 12 (4) ◽  
pp. 463-471 ◽  
Author(s):  
Michael Dwyer ◽  
Gerard J. A. Byrne
Keyword(s):  
Nursing Home ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Nursing Home Residents ◽  
Confounding Variables ◽  
The Relationship ◽  
State Examination ◽  
Age And Sex

Screaming and other types of disruptive vocalization are commonly observed among nursing home residents. Depressive symptoms are also frequently seen in this group, although the relationship between disruptive vocalization and depressive symptoms is unclear. Accordingly, we sought to examine this relationship in older nursing home residents. We undertook a controlled comparison of 41 vocally disruptive nursing home residents and 43 non-vocally-disruptive nursing home residents. All participants were selected to have Mini-Mental State Examination (MMSE) scores of at least 10. Participants had a mean age of 81.0 years (range 63-97 years) and had a mean MMSE score of 17.8 (range 10-29). Nurse ratings of disruptive vocalization according to a semioperationalized definition were validated against the noisy behavior subscale of the Cohen-Mansfield Agitation Inventory. Subjects were independently rated for depressive symptoms by a psychiatrist using the Dementia Mood Assessment Scale, the Cornell Scale for Depression in Dementia, and the Depressive Signs Scale. Vocally disruptive nursing home residents scored significantly higher than controls on each of these three depresion-in-dementia scales. These differences remained significant when the effects of possible confounding variables of cognitive impairment, age, and sex were removed. We conclude that depressive symptoms are associated with disruptive vocalization and may have an etiological role in the generation of disruptive vocalization behaviors in elderly nursing home residents.

scholarly journals Efficacy of SSRIs on cognition of Alzheimer's disease patients treated with cholinesterase inhibitors

2009 ◽  
Vol 22 (1) ◽  
pp. 114-119 ◽  
Author(s):  
Luca Rozzini ◽  
Barbara Vicini Chilovi ◽  
Marta Conti ◽  
Erik Bertoletti ◽  
Marina Zanetti ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cholinesterase Inhibitors ◽  
Mmse Score ◽  
Joint Effect ◽  
Negative Effects ◽  
Multidimensional Assessment ◽  
Degree Of Protection ◽  
Depressed Patients ◽  
The Mean

ABSTRACTBackground: This study examines the joint effect on cognition of selective serotonin re-uptake inhibitors (SSRIs) and cholinesterase inhibitors (AChEIs) in depressed patients affected by Alzheimer's disease (AD) living at home.Methods: The study was conducted in two different outpatient neurological clinics. 338 patients with probable AD were treated with ChEis (donepezil, rivastigmine and galantamine) as per the clinician's judgment and were observed for nine months. At study entry, participants underwent a multidimensional assessment evaluating cognitive, functional and psychobehavioral domains. All patients were evaluated at baseline, after one (T1), three (T2) and nine months (T3). Patients were grouped in three different categories (patients not depressed and not treated with SSRIs, patients depressed and treated with SSRIs, and patients depressed but not treated with SSRIs).Results: At baseline 182 were diagnosed as not depressed and not treated with SSRIs, 66 as depressed and treated with SSRIs, and 90 as depressed but not treated with SSRIs. The mean change in MMSE score from baseline to nine months showed that depressed patients not treated worsened in comparison with those not depressed and not treated with SSRIs (mean change −0.8 ± 2.3 vs 0.04 ± 2.9; p = 0.02) and patients depressed and treated with SSRI (mean change −0.8 ± 2.3 vs 0.1 ± 2.5; p = 0.03).Conclusions: In AD patients treated with AChEIs, SSRIs may exert some degree of protection against the negative effects of depression on cognition.

scholarly journals Back to basics – getting involved in public education

2008 ◽  
Vol 32 (4) ◽  
pp. 149-150
Author(s):  
Mona Freeman ◽  
James Stoddart
Keyword(s):  
Public Education ◽  
Clinical Excellence ◽  
The Public ◽  
Clinical Exam ◽  
Nice Guidance ◽  
Treatment Plans

Being a doctor nowadays is not a role which automatically raises one's status and brings one respect. Our treatment plans and advice are no longer accepted without discussion and/or often compromise. Our patients are now familiar with technical jargon and often come to appointments armed with the ‘latest research’ or up-to-date National Institute of Health and Clinical Excellence (NICE) guidance, which can make such consultations feel more like flashbacks to the Part 2 clinical exam. With an increasingly informed and sometimes critical public regarding all aspects of health and medicine, it is imperative that we, as psychiatrists, are at the forefront of providing information about the illnesses and conditions we treat. Essentially, such information for the public must be easy to understand, accurate and unbiased.

Apolipoprotein E, Cognitive Function, and Dementia in a General Population Aged 85 Years and Over

2000 ◽  
Vol 12 (3) ◽  
pp. 379-387 ◽  
Author(s):  
Kati Juva ◽  
Auli Verkkoniemi ◽  
Petteri Viramo ◽  
Tuomo Polvikoski ◽  
Katariina Kainulainen ◽  
...  
Keyword(s):  
Mini Mental State Examination ◽  
Mmse Score ◽  
Reference Population ◽  
Apo E ◽  
Diagnosis Of Dementia ◽  
Ε4 Allele ◽  
Very Old Age ◽  
The Mean ◽  
Apo E Genotype ◽  
State Examination

We examined 510 subjects representing 83.2% of all citizens of a Finnish city aged 85 years or over. Mini-Mental State Examination (MMSE) scores, diagnosis of dementia by DSM-III-R criteria, and Apo-E genotype were determined. The prevalence of dementia was 38.6%. The odds ratio (OR) of the Apo-E ε4 carriers (with the reference population of people with the genotype ε3/ε3) for dementia was 2.36 (95% CI 1.58–3.58). There was a significant sex difference: The OR in women was 3.23 (95% CI 2.02–5.17) whereas among men it was insignificant. The mean MMSE score (± SD) among the Apo-E ε4 carriers (15.0 ± 10.0) and noncarriers (18.7 ± 8.6) (p < .001) differed among the whole population, but not within the demented or nondemented subjects analyzed separately. This study does not support the hypothesis that the Apo-E ε4 allele impairs cognitive functions of nondemented elderly, at least in those surviving to very old age.

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