Popular drug for mild Alzheimer's largely a flop - Health - Alzheimer's Disease - msnbc.com

A drug frequently prescribed to treat people with mild Alzheimer's disease does not appear to be an effective therapy for many of these patients, according to a new study.

The results show the drug, memantine, is no better than a dummy pill when it comes to ameliorating disease symptoms, including the decline of mental abilities, the researchers say. There is also meager evidence that the drug works for patients with moderate Alzheimer's, the researchers say.

Memantine is approved by the Food and Drug Administration to treat patients with moderate and severe Alzheimer's. However, physicians often prescribe it off-label to those with mild forms of the disease.  About 19 percent of U.S. patients with mild Alzheimer's disease take the drug, the researchers say. The drug is intended to improve cognitive functions and make it easier for patients to perform daily activities.

via msnbc.msn.com

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Online tool can help seniors determine risk for dementia | Johns Hopkins University - The Gazette

A quick online assessment tool developed by Johns Hopkins researchers can help worried seniors find out if they are at risk of developing dementia and determine whether they should seek a comprehensive, face-to-face diagnosis from a physician, according to a new study.

The tool, which is being refined and validated, is not meant to replace a full evaluation from a doctor that includes a physical exam, blood work, imaging studies and more. Instead, this assessment provides a scientific way to help a person educate himself about a disease that doctors now believe is best managed if caught early.

“As the population ages and dementia becomes more prevalent, it’s important to get people diagnosed early,” said Jason Brandt, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and the leader of the study appearing online in the journal Alzheimer’s & Dementia. “Alzheimer’s disease and other types of dementia don’t just creep up on you. They’re incubating for decades in the brain. This tool is potentially very useful in determining who is at risk.”

Among the questions asked on the Dementia Risk Assessment are whether a person has a history of high blood pressure, depression, diabetes, high cholesterol or head injury, all of which are considered well-documented risk factors for dementia. The assessment also includes a simple memory test that could point to a subtle cognitive decline, Brandt says.

The study analyzed responses from 357 people over the age of 50 who took the assessment at www.alzcast.org. Those who scored lowest on the memory test were significantly older and were more likely to be men, have hypertension and report severe memory problems. And while only 9 percent of respondents reported they had severe memory problems, more than one-third said they had a first-degree relative with dementia or severe memory loss—a major risk factor for the condition.

The assessment takes just five to 10 minutes to complete online, and the questions have been borrowed from other scientifically valid assessments.

via gazette.jhu.edu

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Mass. aims to cut drug overuse for dementia - The Boston Globe

State regulators and the Massachusetts nursing home industry are launching a campaign today to reduce the inappropriate use of antipsychotic medications for residents with dementia — a practice that endangers lives and is more common here than in most other states.

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During the next year, a team of specialists will identify nursing homes with successful methods for avoiding overuse of antipsychotics and determine which homes need help cutting back. Nursing home staff will be taught how to deal with aggressive and difficult behaviors, often displayed by dementia patients, without resorting to antipsychotics to sedate them.

In 2009, 22 percent of Massachusetts nursing home residents who received antipsychotic medications did not have a diagnosis for which the drugs were recommended — the 12th highest rate of inappropriate antipsychotic use in the nation, the Globe re ported earlier this year.

Twice in the past five years, federal regulators have issued nationwide alerts about troubling and sometimes fatal side effects when antipsychotics are taken by people with dementia, often Alzheimer’s patients.

Specialists say that understaffing sometimes prompts overuse of these medications to help control dementia patients’ behavior, but that inappropriate use can also be traced to lack of training in alternative approaches.

“There is a knowledge gap between the front-line workers — the nurses — and the black-box warnings on these medications,’’ said Laurie Herndon, a geriatric nurse practitioner who is leading the initiative for Massachusetts Senior Care, the trade group representing the state’s 430 nursing homes. A black-box warning is the most serious type of caution used in prescription drug labeling.

“We wanted to avoid talking at them, and instead provide educational material they can use,’’ Herndon said.

Campaign details will be unveiled at the association’s annual meeting today in Worcester, which is expected to draw about 900 people.

Alice Bonner, the state’s top nursing home regulator, said she appointed a task force to study the overuse of antipsychotics in nursing homes and develop alternative approaches after the Globe highlighted the problem in Massachusetts earlier this year. The task force includes nursing home physicians, nurses, social workers, and pharmacists, along with elder advocates, researchers, and state surveyors who monitor the quality of the facilities.

Bonner, director of the Bureau of Health Care Safety and Quality in the Department of Public Health, said the state, given its budget problems, does not have new resources to devote to the campaign, but is working with legislators and the Patrick administration to get new funding in the next state budget. The trade association intends to apply for grants from nonprofit groups to fund the initiative.

“No one is going to plunk a whole lot of money in our laps,’’ Herndon said, “but that shouldn’t stop us.’’

Bonner said that the task force has already identified low-cost approaches used by some nursing homes. One approach involves more careful screening of patients when they are admitted, which includes gathering more detailed information from families about the patient’s personality before the onset of illness. This, Bonner said, helps staffers tailor care and activities to each patient.

“They get a good sense of who a person was before they began to suffer with dementia, what kinds of things they like to do, and what kinds of things their family can tell us makes them calm or gets them engaged,’’ Bonner said.

“When you see a nursing home with a low rate of antipsychotics, very often you will see these programs,’’ she said.

Bonner also said that nursing homes that give workers consistent schedules that allow them to work with the same patients have also been successful.

“That helps reduce difficult behaviors with patients with dementia because staff knows the patients so well, they pick up on early signs of trouble and prevent a catastrophic event, so they can intervene early,’’ she said. Consistent schedules have the side benefit of helping nursing homes retain their workers longer, Bonner said. “Once this is in place, it turns out it is less expensive because staff turnover is expensive,’’ she said.

The education campaign will draw on the work of Dr. Susan Wehry, a geriatric psychiatrist and associate professor of psychiatry at the University of Vermont College of Medicine. Wehry recently concluded an intensive, nine-month pilot project in four Vermont nursing homes that taught all staffers, from housekeepers to medical directors, alternative approaches, such as using music and massage, to manage difficult patient behaviors.

The program, she said, helped identify which alternatives work, which don’t, and how challenging the mission can be.

Wehry is still analyzing the results but said preliminary findings showed that in one of the homes where the administrator made all of the training sessions mandatory for staff, antipsychotic use was dramatically reduced. A third of the patients with dementia had been prescribed antipsychotics before the program, and not one was on them by the end, she said.

“They were much improved in terms of staff-resident interactions and level of alertness,’’ Wehry said. “And they looked happier.’’

Data from another home that did not make all of the training mandatory showed no change in the number of dementia patients given the medications. Wehry said a more troubling trend also emerged there — one of the physicians switched from giving antipsychotics to prescribing antianxiety medications.

“If all we do is shift the burden, then all we have done is create a different set of problems,’’ Wehry said. “Our goal is not to just reduce our reliance on antipsychotics, but to change [patient] behaviors.’’

Kay Lazar can be reached at klazar@globe.com

via boston.com

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