Adverse drug reactions in patients with Alzheimer's disease and related dementia in France: a national multicentre cross-sectional study.

PURPOSE: To assess the prevalence of adverse drug reactions (ADRs) occurring in patients with Alzheimer's disease (AD) or other dementia in France. METHODS: A cross-sectional multicentre study was conducted by the French network of the 31 regional pharmacovigilance centres on a given day. The subjects were selected by random draw to be a representative sample of French patients with dementia: consultations of dementia clinics, nursing-homes, acute and long care geriatric units, rehabilitation care geriatric units. The staff of each medical structure together with that of the pharmacovigilance centre defined a day for including the patients. Socio-demographic data, history, ADR and drugs given were registered. RESULTS: There were 1332 subjects included, 51.1% living at home, 48.8% in institutions, aged 82.0 ± 8.0 years (46-108); 61.3% suffered from AD. Mean number of drugs was 6.3 ± 3.1. Anti-dementia drugs were given to 66.4% subjects. ADR prevalence was 5.0% (95% CI: 3.9-6.2) without a significant difference between at home and institutionalized patients. ADR consisted of gastro-intestinal (23.2%), central nervous system (17.4%) and psychiatric disorders (8.7%). Of the ADR, 31.9% were serious, and 47.8% preventable. The drugs most often involved were anti-dementia (28.9%), cardio-vascular (28.9%) and psychotropic drugs (26.4%, anxiolytics, hypnotics, antidepressants, neuroleptics). CONCLUSION: This national scale study showed that iatrogenesis in patients with AD and related dementia can at times be serious and preventable. Therefore, special attention is required when prescribing psychotropic and anti-dementia drugs, as they are frequently used and induce half of the ADR in this population.

Usefulness of the short IQCODE for predicting postoperative delirium in elderly patients undergoing hip and knee replacement surgery.

BACKGROUND/OBJECTIVE: The prevalence of postoperative delirium in elderly patients is >30%. The objective of this prospective study was to determine the usefulness of the short form of the Informant Questionnaire on COgnitive Decline in the Elderly (short IQCODE) to predict the occurrence of postoperative delirium after elective hip and knee arthroplasty in the elderly. METHODS: Consecutive patients, 60 years and older, who were admitted for elective hip or knee arthroplasty were included. The preoperative cognitive status was determined using the Mini-Mental State Examination (MMSE) and the short IQCODE. Postoperative delirium was diagnosed using the Confusion Assessment Method. Logistic regression was used to analyze the links between the preoperative test scores and the outcome of postoperative delirium. RESULTS: One hundred and one patients completed the study (mean age 73.6 +/- 6.6 years). The mean +/- SD MMSE score was 26 +/- 3, and the mean short IQCODE score was 50.7 +/- 6.2. Postoperative delirium developed in 15 patients (14.8%). A short IQCODE score >50 was significantly associated with postoperative delirium (OR 12.7, 95% CI 1.4-115.5; p = 0.02). CONCLUSIONS: The short IQCODE appears to be a useful tool to predict the risk of postoperative delirium in elderly patients undergoing elective surgery. Detecting this complication could be of great interest to improve the postoperative survey of elderly patients.

[Automobile driving among patients with dementia. Survey in the Poitou-Charentes region]. / Conduite automobile des patients déments. Enquête en Poitou-Charentes.

OBJECTIVES: To determine the characteristics of drivers with dementia and analyze their driving habits. METHODS: The study was conducted among neurologists and geriatricians in the Poitou-Charentes region. We asked 75 physicians to question (according to a structured questionnaire) the patients they saw in January 2004 who were known to suffer from dementia, defined by a Folstein Mini-Mental State (MMS) score pound 25. We compared the epidemiologic characteristics of drivers and nondrivers and described their driving habits. RESULTS: Of the 75 practitioners asked to participate, 27 (36%) accepted and interviewed 146 patients, 74 women and 72 men. Their mean MMS score was 17.6 +/- 5.6 [0-25]. In all, 52 were still driving at the time of the interview, and 48 had stopped, 9 because of motor vehicle accidents. Logistic regression analysis revealed 3 significant variables that differed between the drivers and the nondrivers: drivers were mainly male (p=0.0002), younger (p=0.001) and more recently diagnosed (p=0.003). Half those still driving drove only occasionally (< or =3 times a week), usually during daylight and for short distances. One driver was involved in an accident the year before. DISCUSSION: Patients appeared to be aware of the dangers of driving and avoided taking risks. The MMS score predicted driving status. It is essential to develop simple tests to assess driving ability as objectively as possible.