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[show abstract]
[hide abstract]
ABSTRACT: ObjectiveTo investigate the extent that baseline cognitive impairment and intake adherence affected the 13-item Alzheimer’s Disease
Assessment Scale — cognitive subscale (ADAS-cog) intervention response of a medical food in Alzheimer’s Disease (AD) patients.
Desigrt/setting/participants /intervention/measurementsThis analysis was performed on data from a proof-of-concept study, consisting of a 12-week, double-blind, randomized, controlled,
multicenter trial, followed by a similarly designed 12-week extension study. Patients with mild AD (Mini-Mental State Examination
[MMSE] score of 20–26) were randomized to receive active or control product as a 125 ml daily drink. One of the co-primary
outcome measures was the 13-item ADAS-cog. In this analysis, the study population was divided into two subgroups: patients
with ‘low’ baseline ADAS-cog scores (<25.0) and patients with ‘high baseline ADAS-cog scores (≥25.0). Repeated Measures Models
(RMM) were used to determine the relationship between ADAS-cog score and intervention.
ResultsA significant treatment effect (F[1,319]=4.0, p=0.046) was shown in patients with ‘high baseline ADAS-cog, but not in patients
with ‘low’ baseline ADAS-cog (F[1,250]= 1.25, p=0.265). Overall, intake adherence was significantly correlated with ADAS-cog
improvement in the active product group (correlation coefficient=−0.260; p=0.019), but not the control group.
ConclusionThese data indicate that baseline ADAS-cog significantly influenced the effect of Souvenaid intervention on ADAS-cog outcome.
A higher intake of active study product was also associated with greater cognitive benefit. These findings highlight the potential
benefits of Souvenaid in AD patients and warrant confirmation in larger, controlled studies.
Key wordsAlzheimer’s disease–cognition–treatment outcome–nutrition
The Journal of Nutrition Health and Aging 04/2012; 15(8):720-724. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: ObjectivesTo investigate the effect of a medical food (Souvenaid) on body mass index (BMI) and functional abilities in patients with
mild Alzheimer’s disease (AD).
Design/setting/participants/intervention /measurementsThese analyses were performed on data from a 12-week, double-blind, randomized, controlled, multicenter, proof-of-concept
study with a similarly designed and exploratory 12-week extension period. Patients with mild AD (Mini-Mental State Examination
score of 20–26) were randomized to receive either the active product or an iso-caloric control product While primary outcomes
included measures of cognition, the 23-item Alzheimer’s Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale
was included as a secondary outcome. Both ADCS-ADL and BMI were assessed at baseline and Weeks 6, 12 and 24. Data were analyzed
using a repeated-measures mixed model.
ResultsOverall, data suggested an increased BMI in the active versus the control group at Week 24 (ITT: p = 0.07; PP: p = 0.03),
but no treatment effect on ADCS-ADL was observed. However, baseline BMI was found to be a significant treatment effect modifier
(ITT: p = 0.04; PP: p = 0.05), and an increase in ADCS-ADL was observed at Week 12 in patients with a ‘low’ baseline BMI (ITT:
p = 0.02; PP: p = 0.04).
ConclusionsThese data indicate that baseline BMI significantly impacts the effect of Souvenaid on functional abilities. In addition,
there was a suggestion that Souvenaid increased BMI.
Key wordsAlzheimer’s disease–activities of daily living–treatment outcome–nutrition–BMI
The Journal of Nutrition Health and Aging 04/2012; 15(8):672-676. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Patiënten en hun familie wijten cognitieve achteruitgang vaak aan het ouder worden. De huisarts kan meestal een diagnose stellen.
Door het niet stellen en bespreken van de diagnose krijgen patiënten en familie niet de meest passende behandeling en uitleg
over het ziektebeeld. Ook is de zorg onvoldoende aangepast en anticiperend. Vanwege de verwevenheid van de klachten ‘geen
fut of zin meer’, met de differentiële diagnose delier/dementie/depressie, kan het antwoord nooit direct een simpelweg ‘ja
dat mag’ zijn. Dit artikel geeft een handreiking voor de probleemverheldering bij cognitieve stoornissen en de diagnostiek
en het beleid bij verdenking op delier, depressie en dementie.
delier-dementie-depressie-cognitieve achteruitgang
04/2012; 23(1):33-40.
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[show abstract]
[hide abstract]
ABSTRACT: It is unknown how often choking occurs in geriatric wards and in nursing homes and what the treatment and outcomes are in
regular practice.
A questionnaire was sent to Dutch geriatricians (N=130), nursing home physicians (N=130), and trainees for these disciplines
(N = 215), in order to gain information about the experience, practice and competence of physicians in choking in geriatric
and nursing home patients. We also analysed to what extent geriatric and nursing home wards were prepared for accurate handling
of choking.
The response rate was 30%. More than half of the responders had experienced an episode of food choking at least once in the
past five years. The mortality rate in the reported cases was high (30%). The majority of the patients who died of choking
had not received the Heimlich-manoeuvre. Physicians who had attended resuscitation training long ago felt as competent to
manage a choking episode as physicians that had recently attended resuscitation training. Of all geriatric wards and nursing
homes, the majority lacked a guideline on how to handle in acute food choking. Geriatric wards and nursing homes do not seem
to be well prepared for acute food choking in several aspects. Despite methodological shortcomings of this study, the results
underline the necessity of clarification of the terms used, and development and implementation of guidelines for this important
problem.
In de praktijk en in de literatuur bestaat veel verwarring over de gewenste handelwijze bij verstikking. Door middel van een
enquête onder verpleeghuisartsen (N=130), klinisch geriaters (N=130) en artsen in opleiding voor deze specialismen (N=215)
werd gepoogd meer inzicht te verkrijgen in het voorkomen, de handelwijze en het competentiegevoel van artsen bij een acute
dreigende verstikking in voedsel bij klinisch geriatrische en verpleeghuispatiënten. Ook werd geïnventariseerd in hoeverre
afdelingen en artsen voorbereid zijn op verstikking.
Door ongeveer één op de drie aangeschreven werd gerespondeerd. Meer dan de helft van de respondenten had de afgelopen vijf
jaar tenminste één maal een acute dreigende verstikking meegemaakt.
Bij de gerapporteerde casus (N = 72) was het overlijdenspercentage 31%. Bij de meerderheid van de patiënten die overleden
waren, was de Heimlich-methode niet toegepast. Artsen die langer geleden een reanimatiescholing gevolgd hadden voelden zich
even competent om te handelen als artsen die recent een reanimatiescholing hadden gevolgd. Bij verreweg de meeste respondenten
was geen richtlijn of protocol ‘acute dreigende verstikking door corpora aliena’ op de afdeling aanwezig.
Verpleeghuisafdelingen en afdelingen klinische geriatrie bleken op een aantal gebieden niet goed voorbereid op verstikking
bij ouderen. Ondanks methodologische beperkingen van deze studie, wordt duidelijk dat begripsverheldering, richtlijnontwikkeling
en -implementatie zeer wenselijk is.
verstikking-aspiratie-resuscitatie-Heimlich-methode-geriatrie-verpleeghuisgeneeskunde
Tijdschrift voor gerontologie en geriatrie 04/2012; 37(4):163-167.
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[show abstract]
[hide abstract]
ABSTRACT: Twee patiënten presenteerden zich met cognitieve stoornissen en parkinsonisme-achtige verschijnselen tijdens de behandeling
met valproïnezuur. Bij beide patiënten was er sprake van progressieve cognitieve stoornissen en mobiliteitsproblemen. Na het
staken van de valproïnezuur waren beide syndromen grotendeels of zelfs volledig reversibel. Er is een toenemende prevalentie
en incidentie van epilepsie bij ouderen boven de 60 jaar en een groot gedeelte van deze patiënten wordt behandeld met valproïnezuur.
Alle klinici die oudere patiënten behandelen dienen op de hoogte te zijn van het feit dat deze behandeling reversible cognitieve
stoornissen en parkinsonisme kan veroorzaken, mogelijk door verminderde activiteit van mitochondrieel complex I functie.
Het staken van valproïnezuur wordt sterk aanbevolen bij alle patiënten die tijdens de behandeling cognitieve stoornissen,
parkinsonisme of beide ontwikkelen.
Two patients presented with progressive cognitive impairment and parkinsonism related symptoms while being treated with sodium
valproate. Both patients suffered from progressive cognitive decline and mobility disorders with an insidious onset over a
period of months to years. After discontinuation of sodium valproate both debilitating symptoms resolved nearly completely.
There is a growing prevalence and incidence of epilepsy above the age of 60 and a great number of these patients are on sodium
valproate treatment. All clinicians treating elderly patients should be aware of the fact that this treatment can cause reversible
cognitive decline and parkinsonism probably due to impairment of mitochondrial complex I function. Discontinuation of sodium
valproate is strongly recommended in all patients with development of cognitive impairment or parkinsonism or both during
sodium valproate treatment.
Valproate-parkinsonism-cognitive impairment
Tijdschrift voor gerontologie en geriatrie 04/2012; 40(1):29-33.
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[show abstract]
[hide abstract]
ABSTRACT: Doel: Nagaan middels een pilotstudy hoe vaak angst om te vallen voorkomt bij ouderen die een valpolikliniek bezoeken en welke
kenmerken en gevolgen deze valangst heeft.
Opzet: Retrospectief status onderzoek.
Methode: Een willekeurige selectie (N=100) uit de dossiers van geriatrische patiënten van de valpolikliniek in het Jeroen Bosch Ziekenhuis
te Den Bosch werd systematisch geanalyseerd.
Resultaten: De patiënten hadden een gemiddelde leeftijd van 79,8 en de mediane duur van de valhistorie was 34,6 maanden. Voordat zij
de valpolikliniek bezochten, bezocht 62% van hen reeds eerder het ziekenhuis in verband met de gevolgen van het vallen. Op
de valpolikliniek werden bij het multi-disciplinair onderzoek gemiddeld 2,5 oorzaken voor het vallen herkent.
In dit onderzoek komt angst voor vallen bij 31% van de patiënten voor. De demografische karakteristieken en de oorzaken van
vallen bij de patiënten met en zonder angst voor vallen blijken in dit onderzoek niet goed van elkaar te onderscheiden. Van
patiënten met angst voor vallen bleek 26% een heupprothese te hebben, terwijl dit voorkwam bij 7% van de patiënten zonder
een heupprothese (P<0,05). Bij patiënten met angst voor vallen wordt in 90% van de gevallen nadere diagnostiek uitgevoerd,
terwijl dit bij 53% van de patiënten zonder angst voor vallen het geval is (P<0,01). Bovendien krijgen patiënten met angst
voor vallen 1,8 maal vaker fysiotherapeutische behandelingen (P<0,01).
Conclusie: Angst om te vallen komt veel voor bij geriatrische patiënten na een val. In deze pilotstudy konden geen determinanten voor
het ontstaan van angst voor vallen worden gevonden. Wel bleek angst voor vallen geassocieerd met het hebben van een heupprothese
en aannemelijk dat angst voor vallen leidt tot een hogere medische consumptie. Zowel in de medische praktijk als in wetenschappelijk
onderzoek vraagt angst voor vallen meer aandacht.
Fear of falling in a fall clinic for geriatric patients: a pilot study
Objective. In this pilot study we wantto determine how often fear of falling occurs in geriatric patients visiting a fall clinic and
to study the characteristics of fear of falling and its consequences.
Design. Retrospective study of patient’s records.
Method. A random sample of 100 medical records of geriatric patients of the fall clinic of the Jeroen Bosch Ziekenhuis in Den Bosch
was systematical examined.
Results. The mean age of the patients was 79.8 ± 6 years. Before visiting the fall clinic, the patients had a history of falling
during 34.6 months, and 62% of them visited a hospital due to the consequences of falling. In the fall clinic a mean number
of 2.5 probable causes per fall was diagnosed.
In this study 31% of the patients had fear of falling. The demographic characteristics and the causes of falling of the patients
with or without fear of falling, were almost the same. Patients with fear of falling had a hip prothesis in 26%, whereas patients
without fear of falling only in 7% had a hip prothesis (P<0.05). In patients with fear of falling, in 90% extra diagnostic
investigation was needed, whereas in patients without fear of falling extra diagnostic investigation only occurred in 53%
(P<0.01). Finally, patients with fear of falling needed 1.8 more times physical therapy compared to patients without fear
of falling (P<0.01).
Conclusion. After a fall, fear of falling occurs often in geriatric patients. In this study, no causes for fear of falling could be
determinated, although hip prothesis are associated with fear of falling. In patients with fear of falling more medical consumption
occurs. In medical practice as in science fear of falling needs more attention.
valpolikliniek-angst voor vallen-risicofactoren
Tijdschrift voor gerontologie en geriatrie 04/2012; 36(4):156-163.
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Els J. Meeuwsen,
R. J. F. Melis,
E. M. Adang,
G. A. Golüke-Willemse,
P. F. Krabbe,
B. J. De Leest,
F. H. J. M. Van Raak,
C. J. M. Schölzel-Dorenbos,
M. C. Visser,
C. A. Wolfs,
S. Vliek, M. G. M. Olde Rikkert
[show abstract]
[hide abstract]
ABSTRACT: BackgroundWith the rising number of dementia patients with associated costs and the recognition that there is room for improvement in
the provision of dementia care, the question arises on how to efficiently provide high quality dementia care.
ObjectiveTo describe the design of a study to determine multidisciplinary memory clinics’ (MMC) effectiveness and cost-effectiveness
in post-diagnosis treatment and care-coordination of dementia patients and their caregivers compared to the post-diagnosis
treatment and care-coordination by general practitioners (GP). Next, this article provides the theoretical background of pragmatic
trials, often needed in complex interventions, with the AD- Euro study as an example of such a pragmatic approach in a clinical
trial.
MethodThe study is a pragmatic multicentre, randomised clinical trial with an economic evaluation alongside, which aims to recruit
220 independently living patients with a new dementia diagnosis and their informal caregivers. After baseline measurements,
patient and caregiver are allocated to the treatment arm MMC or GP and are visited for follow up measurements at 6 and 12
months. Primary outcome measures are Health Related Quality of Life of the patient as rated by the caregiver using the Quality
of Life in Alzheimer’s Disease instrument (Qol-AD) and self-perceived caregiving burden of the informal caregiver measured
using the Sense of Competence Questionnaire (SCQ). To establish cost-effectiveness a cost-utility analysis using utilities
generated by the EuroQol instrument (EQ-5D) will be conducted from a societal perspective. Analyses will be done in an intention-to-treat
fashion.
ResultsThe inclusion period started in January 2008 and will commence until at least December 2008. After finalising follow up the
results of the study are expected to be available halfway through 2010.
DiscussionThe study will provide an answer to whether follow-up of dementia patients can best be done in specialised outpatient memory
clinics or in primary care settings with regard to quality and costs. It will enable decision making on how to provide good
and efficient health care services in dementia.
Trial registrationClinicalTrials.gov Identifier NCT00554047
The Journal of Nutrition Health and Aging 04/2012; 13(3):242-248. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Assessment of complex geriatric health problems by nurses is important for diagnosis, especially assessment of cognitive functioning
through daily observations. However, it is unclear which Dutch observation scales are available to assess cognitive abilities.
In this study, we present an overview of these scales. A systematic review was performed. Beforehand we determined criteria
for inclusion of scales and we searched through Dutch and English databases up till May 2005.
Thirteen behavioural observation scales were found. The number of dimensions of cognitive functioning assessed in the scales
varied greatly, from two to eight in number. Memory and psychomotor behaviour were always included; consciousness and thinking
were frequently included, while alertness, perception, executive functions and language were least included. Extensive assessment
of cognitive functioning is highly relevant for a geriatric hospital ward in which patients are admitted for diagnosis. Of
all scales that we traced, the A-one is the most extensive: all eight dimensions are included. Little is known about the potential
for using the A-one scale in nursing practice; further exploration is indicated. For now, nurses should become acquainted
with the different dimensions of cognitive functioning and start to integrate observations in these dimensions in their reporting.
Verpleegkundige diagnostiek door middel van observeren is essentieel voor de analyse van de complexe gezondheidsproblemen
van geriatrische patiënten. Het is echter onduidelijk welke (vertaalde) Nederlandstalige instrumenten beschikbaar zijn die
door middel van observeren het cognitief functioneren kunnen beoordelen. Met deze studie geven we hiervan een overzicht.
We hebben een systematische literatuurstudie verricht, waarbij er gezocht is tot mei 2005 in Engels- en Nederlandstalige databases.
De zoektocht leverde dertien (sub)schalen op. Inhoudelijk varieerden de schalen van het inventariseren van twee tot acht domeinen
van het cognitief functioneren. Het geheugen en de psychomotoriek worden bijna altijd geobserveerd, het bewustzijn en het
denken/begrijpen minder vaak en de domeinen aandacht en concentratie, waarnemen, executieve functies en taal worden beduidend
minder geïnventariseerd. Voor een verpleegafdeling Klinische Geriatrie is het in het kader van diagnostiek interessant om
het cognitief functioneren zo uitgebreid mogelijk te inventariseren. Het blijkt dat de A-one, een observatielijst voor ergotherapeuten
het meest uitgebreid is. Het is interessant om te onderzoeken of hiervan een verpleegkundige variant gemaakt kan worden. Verpleegkundigen
kunnen meer kennis opdoen over het cognitief functioneren vanuit de neuropsychologie. De verpleegkundige rapportages kunnen
voorlopig in vrije tekst beschreven worden aan de hand van de acht domeinen.
cognitie-observatieschaal-review-geriatrie-verpleegkundige
Tijdschrift voor gerontologie en geriatrie 04/2012; 37(5):242-252.
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[show abstract]
[hide abstract]
ABSTRACT: Slikproblemen komen bij ouderen veel voor en hebben vaak belangrijke gevolgen voor het dagelijks functioneren en de zelfredzaamheid.
Bij oudere patiënten met slikstoornissen is naast lokaal onderzoek ook een algemeen neurologisch onderzoek en een onderzoek
van de voedingstoestand aangewezen. In de diagnostische fase moet men erop bedacht zijn dat het slikprobleem meestal niet
één maar meerdere oorzaken heeft. Bij duidelijke signalen van een slikstoornis moet overleg of verwijzing worden overwogen.
De eerste klinische en poliklinische ervaringen met multidisciplinaire slikteams zijn immer gunstig.slikstoornissen
voedingsstoornissen
ouderen
logopedie
04/2012; 21(7):303-306.
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[show abstract]
[hide abstract]
ABSTRACT: Regelmatig is ‘acute verwardheid’ de diagnose van het psychisch functioneren van ouderen met plotselinge gedragsstoornissen.
Dit begrip maakt echter niet duidelijk of er sprake is van stoornissen in bewustzijn, aandacht en concentratie of cognitie,
of van combinaties hiervan. In dit artikel wordt aan de hand van twee casus duidelijk gemaakt dat beoordeling en benoeming
van aandacht en bewustzijn, samen met het uitvoeren van een volledig lichamelijk onderzoek (corpus), het ABC vormen voor een goede analyse van acute
verwardheid bij ouderen. Alleen op deze wijze kan men betrouwbaar de diagnose delier stellen, de belangrijkste oorzaak van
acute verwardheid bij ouderen. Vroegtijdig herkenning van het delier is van groot belang, omdat dit snelle behandeling van
de altijd aanwezige lichamelijke stoornissen mogelijk maakt en de kans op cognitieve restschade verlaagd. Enkele eenvoudige
diagnostische instrumenten kunnen de huisarts goede diensten bewijzen.
acute aandoeningen-bewustzijnsverlies-delier-ouderen-psychiatrie
Huisarts en wetenschap 04/2012; 44(7):454-459.
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[show abstract]
[hide abstract]
ABSTRACT: The third revision of the Dutch College of General Practitioners' practice guideline 'Dementia' is a major improvement and stimulates the general practitioner by providing concrete advice on stepped care in dementia diagnostics and organizing care management in order to obtain improvement in the quality and realization of dementia care in the primary care setting. However, this practice guideline does not address more effective and efficient dementia care by collaboration between primary and secondary care as it discourages the prescription of cholinesterase inhibitors and recommends limiting further diagnostic procedures to patients in whom a treatable condition is likely. Although, this new practice guideline strengthens the central role of the general practitioner in Dutch dementia care, this role would be further reinforced if general practitioners were to adopt integrated diagnostics of dementia and relevant additional diseases burden as the starting point.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(49):A5554.
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[show abstract]
[hide abstract]
ABSTRACT: This is the first meta-analysis focusing on elderly patients with mobility problems, physical disability and/or multi-morbidity. The aim of this study is to assess the effect of physical exercise therapy on mobility, physical functioning, physical activity and quality of life. A broad systematic literature search was performed in the databases PubMed, CINAHL, Embase, PEDro and The Cochrane Library. Relevant study characteristics were reviewed and meta-analyses using standardized mean differences (SMDs) were performed. The results show that physical exercise therapy has a positive effect on mobility (SMD final value: 0.18; 95% CI: 0.05, 0.30; SMD change value: 0.82; 95% CI: 0.54, 1.10) and physical functioning (SMD final value: 0.27; 95% CI: 0.08, 0.46; SMD change value: 2.93; 95% CI: 2.50, 3.36). High-intensity exercise interventions seem to be somewhat more effective in improving physical functioning than low-intensity exercise interventions (SMD final value: 0.22; 95% CI: -0.17, 0.62; SMD change value: 0.38; 95% CI: -0.48, 1.25). These positive effects are of great value for older adults who are already physically impaired. The effect on physical activity and quality of life was not evident and no definite conclusions on the most effective type of physical exercise therapy intervention can be drawn.
Ageing research reviews 11/2011; 11(1):136-49. · 5.62 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: To investigate the extent that baseline cognitive impairment and intake adherence affected the 13-item Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-cog) intervention response of a medical food in Alzheimer's Disease (AD) patients. DESIGN/SETTING/PARTICIPANTS /INTERVENTION/MEASUREMENTS: This analysis was performed on data from a proof-of-concept study, consisting of a 12-week, double-blind, randomized, controlled, multicenter trial, followed by a similarly designed 12-week extension study. Patients with mild AD (Mini-Mental State Examination [MMSE] score of 20-26) were randomized to receive active or control product as a 125 ml daily drink. One of the co-primary outcome measures was the 13-item ADAS-cog. In this analysis, the study population was divided into two subgroups: patients with 'low' baseline ADAS-cog scores (<25.0) and patients with 'high' baseline ADAS-cog scores (≥25.0). Repeated Measures Models (RMM) were used to determine the relationship between ADAS-cog score and intervention.
A significant treatment effect (F[1,319]=4.0, p=0.046) was shown in patients with 'high' baseline ADAS-cog, but not in patients with 'low' baseline ADAS-cog (F[1,250]=1.25, p=0.265). Overall, intake adherence was significantly correlated with ADAS-cog improvement in the active product group (correlation coefficient=-0.260; p=0.019), but not the control group.
These data indicate that baseline ADAS-cog significantly influenced the effect of Souvenaid intervention on ADAS-cog outcome. A higher intake of active study product was also associated with greater cognitive benefit. These findings highlight the potential benefits of Souvenaid in AD patients and warrant confirmation in larger, controlled studies.
The Journal of Nutrition Health and Aging 08/2011; 15(8):720-4. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: To investigate the effect of a medical food (Souvenaid) on body mass index (BMI) and functional abilities in patients with mild Alzheimer's disease (AD). DESIGN/SETTING/PARTICIPANTS/INTERVENTION /MEASUREMENTS: These analyses were performed on data from a 12-week, double-blind, randomized, controlled, multicenter, proof-of-concept study with a similarly designed and exploratory 12-week extension period. Patients with mild AD (Mini-Mental State Examination score of 20-26) were randomized to receive either the active product or an iso-caloric control product. While primary outcomes included measures of cognition, the 23-item Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale was included as a secondary outcome. Both ADCS-ADL and BMI were assessed at baseline and Weeks 6, 12 and 24. Data were analyzed using a repeated-measures mixed model.
Overall, data suggested an increased BMI in the active versus the control group at Week 24 (ITT: p = 0.07; PP: p = 0.03), but no treatment effect on ADCS-ADL was observed. However, baseline BMI was found to be a significant treatment effect modifier (ITT: p = 0.04; PP: p = 0.05), and an increase in ADCS-ADL was observed at Week 12 in patients with a 'low' baseline BMI (ITT: p = 0.02; PP: p = 0.04).
These data indicate that baseline BMI significantly impacts the effect of Souvenaid on functional abilities. In addition, there was a suggestion that Souvenaid increased BMI.
The Journal of Nutrition Health and Aging 08/2011; 15(8):672-6. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Evidence on cerebrospinal fluid (CSF) analysis to demonstrate Alzheimer's disease has not yet been implemented in diagnostic guidelines.
We investigated the use of CSF analysis in a survey amongst all known memory clinics in the Netherlands, of which 85 of 113 (75.2%) responded.
Sixty per cent of respondents used CSF analysis in 5% (median) of patients. The analysis almost always confirmed the working diagnosis in 68.4% and sometimes changed it in 28.2%. Complications occurred very infrequently (0%, median) and were mild. Reasons not to perform CSF analysis included the lack of clear recommendations in diagnostic guidelines.
These results ask for a guideline update to clarify the use of CSF analysis as an add-on diagnostic method.
European Journal of Neurology 07/2011; 18(7):1014-6. · 3.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Worldwide, the number of people aged 60 years and older steadily grows to a predicted 2 billion in 2050. Online interventions increasingly target lifestyle risk factors to promote healthy aging. The objective of this systematic review is to evaluate whether Internet mediated lifestyle interventions can successfully change lifestyle in people aged 50 and older. A PubMed search was conducted resulting in twelve articles, based on ten studies. The studies focused on physical activity, weight loss, nutrition, and diabetes. Nine studies used feasible interventions, with an average small to moderate effect size. The most important result is that there are multiple studies reporting positive lifestyle changes in an older population. On average, complex interventions, whether they present tailored or generic information, and online or offline comparison, are more effective than interventions with only one component. Internet mediated interventions hold great potential in implementing effective lifestyle programs, capable of reaching large populations of older persons at very low costs.
Ageing research reviews 05/2011; 10(4):487-97. · 5.62 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to explore the value of a daily observation scale in the assessment of patients' memory function by nurses on a geriatric ward.
An observational study of 50 geriatric inpatients was carried out. The relationship between the memory items of the Nurses' Behavioral Rating Scale for Geriatric Inpatients (GIP) and four types of neuropsychological memory tests was examined: visual paired-associate learning (Visual Association Test, VAT), word-list learning (Eight Word Test, 8WT from the Amsterdam Dementia Screening, ADS), and the subtests Route Recall and Story Recall from the Rivermead Behavioural Memory Test (RBMT). Correlations with the overall measures assessing level of dementia such as the Mini-mental State Examination (MMSE), Clinical Dementia Rating scale (CDR) and the 15-item Geriatric Depression Scale (GDS-15) were examined as well.
The Pearson's correlation coefficients between GIP and the four memory tests were between 0.45 and 0.71 (p < 0.01). The GIP correlations with the MMSE and CDR were 0.63 and 0.46, respectively (p < 0.01). No significant correlation was found with the GDS-15. Statistically significant differences in GIP memory scores between patients with dementia and non-demented patients were found (p < 0.01).
Results indicate that an observation scale of memory function may have value for providing information about the underlying memory impairment. The results of nurses' observations may be used in triage contributing to the diagnostic process by selecting patients requiring further neuropsychological assessment.
International Psychogeriatrics 02/2011; 23(1):102-6. · 2.24 Impact Factor
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ABSTRACT: Frailty is one of the greatest challenges for healthcare professionals. The level of frailty depends on several interrelated factors and can change over time while different interventions seem to be able to influence the level of frailty. Therefore, an outcome instrument to measure frailty with sound clinimetric properties is needed. A systematic review on evaluative measures of frailty was performed in the databases PubMed, EMBASE, Cinahl and Cochrane. The results show numerous instruments that measure the level of frailty. This article gives a clear overview of the content of these frailty instruments and describes their clinimetric properties. Frailty instruments, however, are often developed as prognostic instruments and have also been validated as such. The clinimetric properties of these instruments as evaluative outcome measures are unclear.
Ageing research reviews 01/2011; 10(1):104-14. · 5.62 Impact Factor
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ABSTRACT: OBJECTIVE To study the potential differences in patient characteristics between two referral methods to a fall clinic, specifically: case-finding of patients admitted to an emergency department because of a fall, compared to direct referral to the fall clinic via the general practitioner.
Cross-sectional study.
Fall clinics in two university teaching hospitals in the Netherlands.
Three hundred community-dwelling older people aged 65 years or over currently attending the fall clinics in Nijmegen (Group 1, n=154) and in Amsterdam (Group 2, n=146).
Patients were referred by a general practitioner (Group 1) or were selected using the Carefall Triage Instrument (CTI) after visiting the emergency department (Group 2). In all patients, modifiable risk factors for recurrent falls were assessed.
Group 1 had less modifiable risk factors for falling (a mean of 4 (SD 1.6) vs. a mean of 5 (SD 1.5) in Group 2, p < 0.001). Compared to Group 2, Group 1 had more prevalent " recurrent falling (≥ 2 falls)" (p=0.001) and "assisted living in homes for the aged" (p=0.037). "Fear of falling", "mobility and balance problems", "home hazards" and "osteoporosis" were significantly less prevalent in Group 1.
This study suggests that patients referred to a multidisciplinary fall prevention clinic by their general practitioner have a different risk profile than those selected by case finding using the CTI. These differences have consequences for the reach of secondary care for fall-preventive interventions and will probably influence the effectiveness and efficiency of a fall prevention program.
The Journal of Nutrition Health and Aging 01/2011; 15(2):140-5. · 2.69 Impact Factor
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ABSTRACT: Amyloid beta(40) (Abeta(40)) is the most abundant Abeta peptide in the brain. The cerebrospinal fluid (CSF) level of Abeta(40) might therefore be considered to most closely reflect the total Abeta load in the brain. Both in Alzheimer's disease (AD) and in normal aging the Abeta load in the brain has a large inter-individual variability. Relating Abeta(42) to Abeta(40) levels might consequently provide a more valid measure for reflecting the change in Abeta metabolism in dementia patients than the CSF Abeta(42) concentrations alone. This measure may also improve differential diagnosis between AD and other dementia syndromes, such as vascular dementia (VaD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD).
To investigate the diagnostic value of the CSF Abeta(42)/Abeta(40) ratio in differentiating AD from controls, VaD, DLB and FTD.
We analysed the CSF Abeta(42)/Abeta(40) ratio, phosphorylated tau(181) and total tau in 69 patients with AD, 26 patients with VaD, 16 patients with DLB, 27 patients with FTD, and 47 controls.
Mean Abeta(40) levels were 2850 pg/ml in VaD and 2830 pg/ml in DLB patients, both significantly lower than in AD patients (3698 pg/ml; p<0.01). Abeta(40) levels in AD patients were not significantly different from those in controls (4035 pg/ml; p=0.384). The Abeta(42)/Abeta(40) ratio was significantly lower in AD patients than in all other groups (p <0.001, ANCOVA). Differentiating AD from VaD, DLB and non-AD dementia improved when the Abeta(42)/Abeta(40) ratio was used instead of Abeta(42) concentrations alone (p<0.01) The Abeta(42)/Abeta(40) ratio performed equally well as the combination of Abeta(42), phosphorylated tau(181) and total tau in differentiating AD from FTD and non-AD dementia. The diagnostic performance of the latter combination was not improved when the Abeta(42)/Abeta(40) ratio was used instead of Abeta(42) alone.
The CSF Abeta42/Abeta40 ratio improves differentiation of AD patients from VaD, DLB and non-AD dementia patients, when compared to Abeta42 alone, and is a more easily interpretable alternative to the combination of Abeta42, p-tau and t-tau when differentiating AD from either FTD or non-AD dementia.
Current Alzheimer research 08/2010; 7(5):470-6. · 4.97 Impact Factor
