Medications in Patients with Dementia and Behavioral Disturbance

Background: Behavioral disturbance (BD) is common in dementia patients, with no FDA approved medications for this condition. Little data exists on the real-world medication use in this population. Objective: To describe real-world medications use in this population. Methods: A cross-sectional study was conducted using the MarketScan database for outpatient medications and the Cerner database for inpatient medications. The study period was Oct 2015–Jun 2018. Patients with dementia and BD were identified through ICD-10-CM. We examined outpatient medications prescribed during 6-month before or after BD event date, and inpatient medications during inpatient visits, especially on central nervous systems (CNS) drugs including antidementia drugs, antidepressants, antipsychotics, anxiolytics, and anticonvulsants. Results: A total of 56,544 outpatients and 34,245 patient hospitalizations were assessed separately. Among outpatients, patients filled more medications after a BD event. The use of the five CNS drug classes generally increased after a BD event, and the largest increase was seen in antipsychotics (23%to 33%). Among inpatients, the median number of medications used in each hospitalization was 14. The use of antipsychotics was particularly high (64%), followed by anxiolytics (51%). A list of 60 unique medications were suggested to be the commonly used drugs in dementia patients with BD. Conclusion: In dementia patients with BD, anti-dementia medications, antidepressants, anticonvulsants, hypnotics and antipsychotics were the most used drug classes. Antidepressants and antipsychotics use were more frequent after a BD event, which suggests a need for safe drugs targeting BD in dementia patients.

A Modeling Comparison of the Potential Effects on Marine Mammals from Sounds Produced by Marine Vibroseis and Air Gun Seismic Sources

Concerns about the potential environmental impacts of geophysical surveys using air gun sources, coupled with advances in geophysical surveying technology and data processing, are driving research and development of commercially viable alternative technologies such as marine vibroseis (MV). MV systems produce controllable acoustic signals through volume displacement of water using a vibrating plate or shell. MV sources generally produce lower acoustic pressure and reduced bandwidth (spectral content) compared to air gun sources, but to be effective sources for geophysical surveys they typically produce longer duration signals with short inter-signal periods. Few studies have evaluated the potential effects of MV system use on marine fauna. In this desktop study, potential acoustic exposure of marine mammals was estimated for MV and air gun arrays by modeling the source signal, sound propagation, and animal movement in representative survey scenarios. In the scenarios, few marine mammals could be expected to be exposed to potentially injurious sound levels for either source type, but fewer were predicted for MV arrays than air gun arrays. The estimated number of marine mammals exposed to sound levels associated with behavioral disturbance depended on the selection of evaluation criteria. More behavioral disturbance was predicted for MV arrays compared to air gun arrays using a single threshold sound pressure level (SPL), while the opposite result was found when using frequency-weighted sound fields and a multiple-step, probabilistic, threshold function.