Berberine for prevention of dementia associated with diabetes and its comorbidities: A systematic review
ConclusionBerberine could impede the development of dementia via multiple mechanisms: preventing brain damages and enhancing cognition directly in the brain, and indirectly through alleviating risk factors such as metabolic dysfunction, and cardiovascular, kidney and liver diseases. This study provided evidence to support the value of berberine in the prevention of dementia associated with MetS.
Parkinson ’s Disease is a condition characterized by degeneration of the nigrostriatal pathways resulting in marked bradykinesia. Studies have reported that nearly 25% of Medicare beneficiaries with Parkinson’s Disease reside in long-term care facilities (LTCFs). Residents of LTCFs are older and may also have other age-related mobility disorders. It is important for providers to know that Parkinsonism symptoms can also occur as a result of natural aging and will not respond to standard therapy for Parkinson’s Disease.
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with dementia and anxiety disorder had chest pain; the diagnosis was unexpected.
Antipsychotic medications are a vital part of controlling psychosis in schizophrenic patients. However, when those patients live in nursing facilities, we are obligated by CMS to undertake gradual dose reductions of antipsychotic medication if possible. Sometimes, these efforts are successful and sometimes they fail. Antipsychotic medications have many side effects, including sedation, diabetes, hyperlipidemia, weight gain, motor rigidity, impaired gait, and falls. Monitoring of blood glucose, lipids, and extrapyramidal symptoms is mandatory.
Psychotropic medications are often prescribed to manage behavioral and psychological symptoms of dementia (BPSD) in nursing home (NH) residents, although these medications may lack efficacy for BPSD and can have adverse effects. NHs can receive a deficiency of care citation for inappropriate psychotropic medication use (F-758 tag). To promote more effective dementia care, some states specify dementia-specific training requirements for NH nursing staff. The occurrence of F-758 citations related to care of residents with dementia was examined in relation to the presence of state-level dementia-specific in-service training re...
Many older adults do not plan for their LTSS needs. When older adults experience a health crisis (e.g. hospitalization, worsening dementia), family members must often react to the crisis. With PCORI funding, we developed PlanYourLifespan.org (PYL.org) as a national, free, publicly available website that enables older adults and families to understand future needs and plan for what they will need as they age. Different than end-of-life planning, PYL.org focuses on what LTSS people will need when they are in their 80 ’s, 90’s, and 100’s.
Most behaviour assessment tools used in long-term care (LTC) involve retrospective reports. These assessments are prone to errors in recall and provide little opportunity to identify the context of behaviours. Furthermore, these assessments are often underused, prone to incomplete and inaccurate data collection, and the results can be difficult to analyze. To address these problems, we developed a Dementia Observations (DObs) mobile application for direct observation of behaviour symptoms. Direct observation of behaviour provides more detail about the frequency, duration, precipitants, and patterns.
Up to 38% of individuals with advanced dementia experience clinical depression. Although studies demonstrate lower rates of clinical depression as dementia advances, this may be attributed to the difficulty of assessment at this stage. Clinical interviews are thorough in assessing depression, though they are time- and resource-contingent. As such, healthcare providers often turn to screening tools or scales. However, conventional tools for assessing depression have problems with validity in this population.
Symptoms of delirium are common in the post-acute care setting, particularly in patients who have dementia or are approaching the end of life. When behavioral measures fail to adequately manage symptoms, there are few alternative options. Antipsychotic medications have long been the mainstay of pharmacologic treatment for delirium, despite a paucity of evidence for efficacy and newer data suggestive of possible harms. Moreover, the use of a new antipsychotic medication in veterans admitted to a short-term rehabilitation center is seen as potentially inappropriate and negatively affects the CMS/Medicare Quality Indicator (QI) profile.
At San Francisco Veterans Affairs Health Care System (SFVA) Community Living Center (CLC), most veterans have dementia plus co-occurring mental illness. Many demonstrate distressed behavior that interferes with care. CLC restorative care and mental health staff identified the need to improve engagement of veterans with dementia or behavioral challenges, and improve care partner training. Along with researchers at SFVA, they implemented PLI É, a novel integrative group exercise program for people with dementia.
Management of diabetes in post-acute settings needs special considerations. Hypoglycemia in the skilled nursing and rehabilitation facilities can lead to readmissions and complications including falls. Current EHR care-sets may not make a distinction between hospital and post-acute settings regarding diabetes management. The current diabetes management care-set in the EHR of our large healthcare system includes checking the blood sugar QID/AC/HS (before breakfast, lunch and dinner, and bedtime).