Potential herb-drug interactions in community-dwelling older adults in China: the Shanghai Aging Study.

BACKGROUND: Potential herb-drug interactions (pHDIs) often go unrecognized, and little is known about the prevalence of pHDIs in older adults. AIMS: This study aimed to investigate the prevalence of pHDIs in community-dwelling older adults in Shanghai and identify patterns and factors associated with pHDIs. METHODS: Baseline data from the Shanghai Aging Study, which was designed to establish a prospective community-based cohort of older adults in Shanghai, were analyzed regarding pHDIs with Lexi-Interact Online software. RESULTS: Among 1227 participants who used any combination of drug-herb or herb-herb, 43.3% were exposed to at least one pHDI. A total of 1641 different pHDIs were identified among the study samples. Only seven (0.4%) pHDIs were rated as risk category X, indicating that the combinations were contraindicated and should be avoided. Worryingly, 876 (53.4%) pHDIs were rated as risk category D, indicating that significant interactions may occur and therapeutic modification should be considered. Of particular concern is that 99.8% of pHDIs in risk category D involve herbs with anticoagulant/antiplatelet properties. Individuals with stroke (odds ratio [OR] 2.02), hyperlipidemia (OR 1.51) or heart diseases (OR 1.42) and the number of herbs (2.66), number of drugs (OR 1.21), and age (OR 1.02) were significantly associated with the risk of pHDIs. CONCLUSION: 43.3% of community-dwelling older adults who used any combination of drug-herb or herb-herb was exposed to pHDIs, and more than half of pHDIs were related to herbs with anticoagulant/antiplatelet properties. Awareness of the patterns and high-risk groups of these pHDIs may contribute to increased patient safety.

Inability to Smell Peppermint Is Related to Cognitive Decline: A Prospective Community-Based Study.

BACKGROUND: A few studies have demonstrated the association of poorer olfactory identification (OI) with poorer cognition in population-based cohorts. None of them considered the outcome associated with the inability to smell a certain odor. OBJECTIVE: To verify the hypothesis that at least one specific odor is associated with incident cognitive decline among older adults. METHODS: In the Shanghai Aging Study, a sub-cohort of 948 dementia-free participants who had baseline OI measurements were prospectively followed for 5 years. RESULTS: An inability to smell peppermint (ß = -0.44, p < 0.001), rose (ß = -0.14, p = 0.040), or coffee (ß = -0.37, p = 0.002) was inversely related to the annual rate of change in the Mini Mental State Examination score, and an inability to smell peppermint was associated with a higher risk for incident dementia (hazard ratio 2.67, 95% CI 1.44-4.96) after adjustment for confounders. CONCLUSION: Our study suggests that some odors, especially peppermint, might be considered as a potential predictor for dementia in older populations.

Auditory Verbal Learning Test is Superior to Rey-Osterrieth Complex Figure Memory for Predicting Mild Cognitive Impairment to Alzheimer's Disease.

OBJECTIVE: To carry out meaningful comparisons on results of different research studies on mild cognitive impairment (MCI), it is critical to select an appropriate objective memory test to examine memory deficit. We aim to refine the operational criteria of amnestic MCI (aMCI) on neuropsychological tests that optimally balance the sensitivity and specificity. METHODS: We focused on 206 non-demented subjects from memory clinic. We then classified each individual as having MCI or subjective cognitive decline (SCD) according to different neuropsychological criteria. By following them longitudinally, clinical outcomes were compared to evaluate the stability of MCI diagnoses and prediction of progression. RESULTS: The delayed recall of auditory verbal learning test (AVLT_DR) identified 116 subjects as MCI, resulted in the conversion rate as 44% over the roughly 30-month time interval, missed 7.8% incipient Alzheimer's disease (AD) patients in SCD group who eventually converted to dementia. The delayed recall of complex figure test (CFT_DR) identified fewer MCI patients (n=95) and misdiagnosed more preclinical AD patients (15.3%), in comparison with AVLT criterion. Criterion requiring deficits in both tests produced higher conversion rate (54.3%), but resulted in higher misdiagnosis rate (14.7%) simultaneously. The AVLT criterion had the largest area under the curve (0.7248, p<0.05). CONCLUSION: AVLT is superior to CFT in the stability of diagnoses and prediction of progression. In the clinical setting, the "one test" criterion AVLT has similar sensitivity to both-deficits methods, and is optimal in balancing sensitivity and specificity.