scholarly journals Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review

2021 ◽  
Author(s):  
Martina Rekatsina ◽  
Antonella Paladini ◽  
Dariusz Myrcik ◽  
Omar Viswanath ◽  
Ivan Urits ◽  
...  
Keyword(s):  
Nervous System ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Pain Assessment ◽  
Full Text ◽  
Pain Perception ◽  
The Elderly ◽  
Clinical Approach ◽  
Advanced Dementia ◽  
Opioid Prescription

Background: Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in central nervous system along with changes in the peripheral nervous system due to aging have a significant impact in pain perception. Often clinicians decide to prescribe opioids in order to relief pain, also without a clear indication. Aim: This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods: A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles which were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. Results: This review discuss the complex physiological and pharmacological changes in elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer’s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in elderly. Information regarding opioid prescription in nursing homes as well as recorded indications for opioids use, type and dosing of opioid and compliance of treatment in advanced dementia are also provided. Conclusions: Opioid prescription in elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients, need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.

scholarly journals Assessing Steroid Toxicity in the Elderly with Multiple Myeloma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5557-5557
Author(s):  
Vidhya Nair ◽  
Hadi Mohammed ◽  
Sharmeen Mahmood ◽  
Pushpinderdeep Singh Kahlon ◽  
Philip Kuriakose
Keyword(s):  
Central Nervous System ◽  
Multiple Myeloma ◽  
Nervous System ◽  
Adverse Effects ◽  
Elderly Patients ◽  
Dose Reduction ◽  
The Elderly ◽  
High Dose ◽  
Full Dose ◽  
Starting Dose

Background The mainstay of treatment for Multiple Myeloma (MM) includes various combinations of chemotherapy, which generally includes high dose steroids. The median age at diagnosis for MM is above 60 years. Patients above the age of 70 may not be considered for an auto peripheral blood transplant, resulting in being treated with chemotherapy alone. This often leads to a relatively long period of steroid exposure. Increasing age is a risk factor for decreased tolerance to steroids, and increased drug toxicity. As such, the steroid dose (usually Dexamethasone) is often considered for reduction in patients above a certain age. However, there are no clear guidelines regarding a standard dose to use in the elderly, nor is there uniformity among clinicians in the way doses are chosen. Purpose To assess a) the starting dose of Dexamethasone (dex) in the elderly, b) frequency of dose reduction of dexamethasone, c) adverse effects of dex treatment in the elderly with MM, and d) average time after dose reduction. Methods We performed a 10 year retrospective chart review on patients, age 70 or greater treated at Henry Ford Health System with a diagnosis of MM from 2000-2015. Patients were grouped by age 70-75 years, 76-80 years, and greater than 80 years based on when treatment was initiated. We investigated the starting treatment dose of dex, ranging from 1-20 mg weekly and 21-40 mg weekly. Secondly, we assessed for the occurrence of dose reduction; and, if present, the length of time to reducing the dose. Lastly, the types of adverse effects to dex leading to dose reduction were grouped by system, such as, central nervous system, musculoskeletal, endocrine, gastrointestinal and psychiatric. Data collected was categorical, thus, no statistical tests were performed as this was a descriptive study. Results A total of 150 patients were reviewed and 91 patients met the inclusion criteria. Of these patients, 8 (8.8%) were started at doses between 1-20 mg and majority (62.5%) were ages 70-75, thus, there was no relation between lower starting dose and age. Of the 91 patients, 24 (26.4%) had a dose reduction and 11 (12.1%) had both chemotherapy and dex discontinued prior to therapy completion. Majority (87.5%) of patients that had a dose reduction were initially started at 40 mg. The reasons for dose reduction included adverse effects grouped by musculoskeletal (29.17%), psychiatric (16.67%), endocrine (12.3%), central nervous system (4.17%), and gastrointestinal (4.17%). Of note, 8 patients (33.3%) had dose reductions as result of their clinical trial requirement. The average length of dex therapy before dose reduction was 17.2 months. Conclusion The majority of elderly patients (age 70 or above) with MM tolerated full doses of dex without adverse effects. Secondly, there was no relation between lower starting dose for dex and advanced age. However, since there were limited patients (n=8) who started at a low dose, other than those on clinical trials, we were not able to do a comparison of starting doses. But we were able to show that the majority of patients tolerated full dose, despite their age. The most frequent cause of steroid toxicity was musculoskeletal, such as leg swelling. On average, elderly patients were able to tolerate full dose of dex for over 1 year prior to requiring a dose reduction. Summary Our data demonstrates no correlation between advanced age in MM and lack of tolerability of high dose steroids. In conclusion, current findings do not justify reduced doses solely based on age alone. Future studies could include investigating statistical analysis on steroid exposure and survivorship. Disclosures Kuriakose: Alexion: Consultancy, Honoraria, Speakers Bureau; Bayer: Consultancy.

scholarly journals Social Assistant Humanoid Robots for Dementia of the Elderly: A Scoping Review

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Xiangyu Liu
Keyword(s):  
Qualitative Research ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Older People ◽  
Research Method ◽  
The Elderly ◽  
Humanoid Robots ◽  
Future Research ◽  
Future Studies ◽  
Method Analysis

In recent years, many cognitive care robots have been developed. There is also a form of the companion pet, and there are also robots that can be personified and talk with the elderly. Also, some telecommunications equipment can be replaced to help older people connect to the telecommunications community. However, the need for such robots is still unclear in the focus of this area of being able to interact, talk to, and connect with family and society. Although many studies in the existing literature that tell how to research to verify their efficacy, methods of defining effects can pave the way for future studies. This is what this article will show. The article included qualitative research searches and screenings, effect summaries, and research method analysis. The problem to be solved in this article is how to use and measure the effectiveness of conversational humanoids in nursing elderly patients with cognitive impairment. We also hope to provide some guidance for future research on cognitive impairment.

scholarly journals A systematic review: comparative analysis of the effects of propofol and sevoflurane on postoperative cognitive function in elderly patients with lung cancer

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haitao Sun ◽  
Guohua Zhang ◽  
Bolun Ai ◽  
Huimin Zhang ◽  
Xiangyi Kong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Adverse Effect ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Meta Analysis ◽  
The Elderly ◽  
Independent Effect ◽  
Related Phenomenon

Abstract Background The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patients. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate, as is the number and amounts of drugs used and the “depth of anesthesia.” So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer. Methods This study is a systematic review and meta-analysis for controlled clinical studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 h after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed-effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6 h (11 studies; SMD -1.391, 95% CI -2.024, − 0.757; p < 0.001), MMSE 24 h (14 studies; SMD -1.106, 95% CI -1.588, − 0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, − 0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, − 0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

scholarly journals Blueberry Extracts Supplementation Improves Cognitive Function in Elderly Patients with Mild Cognitive Impairment (P14-013-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Yugang Jiang ◽  
Shoudan Sun
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Natural Science ◽  
Intervention Study ◽  
The Elderly ◽  
The State ◽  
Control Group ◽  
Cognitive Aptitude

Abstract Objectives An intervention study was performed to determine if supplement containing blueberry extracts could improve cognitive function in the elderly patients with mild cognitive impairment (MCI). Methods Forty six MCI patients participated in the intervention study were paired based on their age, education level and initial the basic cognitive aptitude test (BCAT) scores and then randomly assigned to the intervention group (n = 23, which received 1.0 g/day of blueberry extracts) or blank control group (n = 23) . The endpoint was the improvement in cognitive function as evaluated by BCATs. All parameters were measured before and after the treatment period of 12 weeks. Results After 12 weeks of intervention, we observed significant improvement in their total BCAT score, space imagery efficiency, working memory and recognition memory of subjects in patients with blueberry extracts supplementation comparing to those in the control group (P = 0.006, 0.023, 0.000, 0.005, respectively). However the levels of inflammatory factors (IL-6 and TNF-α in serum) showed no significant changes after intervention. Conclusions The data indicated that blueberry has a beneficial effect on cognitive function of the elderly MCI patients, which might provide therapeutic potential for Alzheimer's disease. Funding Sources This work was supported by the State Key Program of National Natural Science Foundation of China and the State Key Program of National Natural Science Foundation of Tianjin. Supporting Tables, Images and/or Graphs

scholarly journals Comparative Analysis of the Effects of Propofol and Sevoflurane on Postoperative Cognitive Function in Elderly Patients with Lung Cancer

2019 ◽  
Author(s):  
Haitao Sun ◽  
Guohua Zhang ◽  
Bolun Ai ◽  
Huimin Zhang ◽  
xiangyi kong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Effect ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Fixed Effects ◽  
Meta Analysis ◽  
The Elderly ◽  
Independent Effect ◽  
Related Phenomenon

Abstract Background The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patient. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate as is the number and amounts of drugs used and the "depth of anesthesia". So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer. Methods This study is a meta-analysis for controlled-clinical-studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 hours after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6h (11 studies; SMD -1.391, 95% CI -2.024, -0.757; p < 0.001), MMSE 24h (14 studies; SMD -1.106, 95% CI -1.588, -0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, -0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, -0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

scholarly journals Comparative Analysis of the Effects of Propofol and Sevoflurane on Postoperative Cognitive Function in Elderly Patients with Lung Cancer

2019 ◽  
Author(s):  
Tao Yan ◽  
Bolun Ai ◽  
Huimin Zhang ◽  
Xiangyi Kong ◽  
Wan-Ting Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Effect ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Fixed Effects ◽  
Meta Analysis ◽  
The Elderly ◽  
Independent Effect ◽  
Related Phenomenon

Abstract Background The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patient. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate as is the number and amounts of drugs used and the "depth of anesthesia". So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer. Methods This study is a systematic review and meta-analysis for controlled clinical studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 hours after surgery. SMDs along with 95% CIs were extracted and analyzed using random or fixed effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6h (11 studies; SMD -1.391, 95% CI -2.024, -0.757; p < 0.001), MMSE 24h (14 studies; SMD -1.106, 95% CI -1.588, -0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, -0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, -0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

scholarly journals A Systematic review: Comparative Analysis of the Effects of Propofol and Sevoflurane on Postoperative Cognitive Function in Elderly Patients with Lung Cancer

2019 ◽  
Author(s):  
Haitao Sun ◽  
Guohua Zhang ◽  
Bolun Ai ◽  
Huimin Zhang ◽  
xiangyi kong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Effect ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Fixed Effects ◽  
Meta Analysis ◽  
The Elderly ◽  
Independent Effect ◽  
Related Phenomenon

Abstract Background The potential risk for cognitive-impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patient. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate as is the number and amounts of drugs used and the "depth of anesthesia". So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung-cancer. Methods This study is a meta-analysis for controlled-clinical-studies. Public - available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 hours after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6h (11 studies; SMD -1.391, 95% CI -2.024, -0.757; p < 0.001), MMSE 24h (14 studies; SMD -1.106, 95% CI -1.588, -0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, -0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, -0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

scholarly journals REVIEW ON ELECTROENCEPHALOGRAPHIC FINDINGS IN PATIENTS WITH ALZHEIMER'S DISEASE

2021 ◽  
Vol 27 (1) ◽  
pp. 3529-3533
Author(s):  
Ivan Todorov ◽  
◽  
Kosta Kostov ◽  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Central Nervous System ◽  
Nervous System ◽  
Cognitive Impairment ◽  
Low Cost ◽  
The Elderly ◽  
Pathological Process ◽  
The Central Nervous System ◽  
Progressive Cognitive Impairment

Nowadays, with the constant enhancement of the longevity of the human population, the spreading of dementia is in steady rising. Among the many different sources of progressive cognitive impairment, Alzheimer's disease plays a major role being the most common reason for mental decline in the elderly population. Alzheimer's disease is a neurodegenerative disease of the central nervous system that leads to progressive cognitive impairment and has severe health, social and economic tolls. The lack of effective treatment and the problems of the daily living that the disease creates for the patients and their families raises many important issues in modern times. Due to the effect on the individuals and the need for a permanent caregiver, it is of high importance to have accessible tools for early diagnostic and assessment of the ongoing treatment. Electroencephalography is a noninvasive, easily reproductive diagnostic method with low cost that can be performed in different stages of the diseases of the central nervous system and give input on the current condition. This review presents the current achievements in the field of the usage of electroencephalography and its specific findings in patients with Alzheimer's disease and the qualitative and quantitative changes that appears and are important for early diagnosis, differential diagnostic, prediction of acceleration of the pathological process, distinguishing of co-existing conditions and follow-up of the effect of the administered treatment.

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