digoxin and Cognition-Disorders

Older adults with advanced cognitive impairment have a limited life expectancy and the use of multiple drugs is of questionable benefit in this population. The aim of the present study was to assess if, in a sample of nursing home (NH) residents with advanced cognitive impairment, the effect of polypharmacy on mortality differs depending on estimated life expectancy.. Data were from the Services and Health for Elderly in Long TERm care (SHELTER) project, a study collecting information on residents admitted to 57 NHs in 8 European countries. Polypharmacy was defined as the concomitant use of 10 or more drugs. Limited life expectancy was estimated based on an Advanced Dementia Prognostic Tool (ADEPT) score of 13.5 or more. A Cognitive Performance Scale score of 5 or more was used to define advanced cognitive impairment. Participants were followed for 1 year.. Mean age of 822 residents with advanced cognitive impairment entering the study was 84.6 (SD 8.0) years, and 630 (86.6%) were women. Overall, 123 participants (15.0%) had an ADEPT score of 13.5 or more (indicating limited life expectancy) and 114 (13.9%) were on polypharmacy. Relative to residents with ADEPT score less than 13.5, those with ADEPT score of 13.5 or higher had a lower use of benzodiazepines, antidementia drugs, and statins but a higher use of beta-blockers, digoxin, and antibiotics. Polypharmacy was associated with increased mortality among residents with ADEPT score of 13.5 or more (adjusted hazard ratio [HR] 2.19, 95% confidence interval [CI]: 1.15-4.17), but not among those with ADEPT score less than 13.5 (adjusted HR 1.10, 95% CI: 0.71-1.71).. Polypharmacy is associated with increased mortality in NH residents with advanced cognitive impairment at the end of life.. These findings underline the need to assess life expectancy in older adults to improve the prescribing process and to simplify drug regimens.

Topics: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Anti-Bacterial Agents; Benzodiazepines; Cardiotonic Agents; Cognition Disorders; Digoxin; Drug Utilization; European Union; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Israel; Life Expectancy; Male; Nursing Homes; Polypharmacy

Topics: Atrial Fibrillation; Cognition Disorders; Dementia; Digoxin; France; Humans

Cognitive impairment or clinical signs of dementia in an old patient who receives digoxin, should suggest a digitalis intoxication. Symptoms can be present although a normal digoxin serum concentration. It is recommended to stop the treatment to obtain a regression of dementia symptoms.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Arrhythmia Agents; Cognition Disorders; Dementia; Digoxin; Female; Humans

To identify the current state of medication-taking practices of community-dwelling older adults on high-risk medications.. Telephone survey of older adults filling prescriptions for warfarin, digoxin, or phenytoin from May 2, 2002, through June 30, 2003.. The Pennsylvania Pharmacy Assistance Contract for the Elderly (PACE) Program, a state-run program providing prescription drug coverage for poor older adults.. PACE members.. Patients self-reported sources of information on current medications as well as home-based practices for organizing medication regimens.. Four thousand nine hundred fifty-five PACE members were interviewed. Thirty-two percent of the sample reported that they had not received any specific instructions about their medications, 35% reported that they received instructions from their primary care provider, and 46% indicated they received them from a pharmacist. Fifty-four percent of participants indicated that they used a pillbox for organizing their medications. Older adults prescribed warfarin were more likely to report receiving instructions than those prescribed digoxin or phenytoin.. A substantial proportion of older adults on high-risk medications do not recall receiving instructions for the use of their medications and do not take advantage of existing systems for organizing medication regimens. Improved patient education and delivery of medication organization systems are immediate opportunities to potentially reduce the risk of medication errors in older people.

Topics: Aged; Aged, 80 and over; Cognition Disorders; Cohort Studies; Digoxin; Female; Health Behavior; Health Services Accessibility; Health Status; Home Nursing; Humans; Male; Medication Errors; Patient Education as Topic; Pennsylvania; Phenytoin; Population Surveillance; Prospective Studies; Self Administration; Warfarin

Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke.. This was a cross-sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini-Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account.. All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (n=44) had lower mean adjusted cognitive z scores (-0.26+/-0.11) than men without atrial fibrillation (+0.14+/-0.03; P=0.0003). The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was -0.24+/-0.12 in the 36 men with atrial fibrillation and +0.17+/-0.03 in those without atrial fibrillation (P=0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (n=27) performed markedly better (-0.05+/-0.21) than those without treatment (n=9; -1.14+/-0.34; adjusted P=0.0005). Previous myocardial infarction was not associated with impaired cognitive results.. In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.

Topics: Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Cerebrovascular Disorders; Cognition; Cognition Disorders; Cohort Studies; Cross-Sectional Studies; Digoxin; Female; Humans; Male; Neuropsychological Tests; Risk Factors

To document the presence and treatment of selected vascular risk factors in patients with vascular cognitive impairment and elements affecting undertreatment of vascular risk factors.. Secondary analysis of the Canadian Study of Health and Aging database, which is a national, representative, cross-sectional study of the epidemiologic distribution of dementia in elderly people in Canada.. Survey.. Institutionalized and community-dwelling elderly people.. Vascular risk factors, dementia diagnosed by standard methods, and medication use.. Treatable vascular risk factors occurred significantly more often in patients with vascular cognitive impairment (with and without dementia) than in patients with probable Alzheimer disease or normal cognitive function. For example, 76% of patients with vascular dementia and 57% of those with vascular cognitive impairment without dementia had a history of stroke, compared with only 5% of those with probable Alzheimer disease and 7% of those with no cognitive loss. (For hypertension, the comparable figures are 55%, 48%, 24%, and 38%, respectively.) Potential undertreatment of vascular risk factors had little effect on mean control of vascular risk factors. For example, the mean (+/- SD) systolic blood pressure in those being treated was 144 +/- 26 mm Hg, compared with 142 +/- 25 mm Hg in those not receiving pharmacological treatment. In each group (treated vs untreated), the proportion of patients with a systolic blood pressure higher than 160 mm Hg was 20% and 16%, respectively. Potential undertreatment occurred most often in those with severe dementia and those living in nursing homes.. Vascular risk factors occurred more commonly in patients with vascular cognitive impairment compared with other patients, including those with other forms of dementia. When present, such risk factors were often treated pharmacologically, except in patients with severe dementia and those in long-term care institutions. Undertreatment does not, in general, result in worsened risk factor control.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Aspirin; Cognition Disorders; Dementia; Diabetes Complications; Diabetes Mellitus; Digoxin; Female; Humans; Hypertension; Male; Risk Factors; Vascular Diseases

Serum digoxin concentrations can mislead psychiatric consultants. Two patients with therapeutic digoxin concentrations were seen for neuropsychiatric disorders that cleared rapidly once digoxin was discontinued.

Topics: Aged; Cognition Disorders; Depression; Digoxin; Heart Failure; Humans; Male; Tachycardia, Paroxysmal

Topics: Aged; Arteriosclerosis; Cognition Disorders; Confusion; Digoxin; Humans

Topics: Aged; Brain; Cerebral Cortex; Cognition Disorders; Digitalis Glycosides; Digoxin; Electroencephalography; Female; Humans; Hyperventilation; Ouabain; Periodicity; Phenytoin; Unconsciousness