Patients with dementia and their carers.

Clinical guidelines for general practitioners' care of patients with dementia still living in the community (not in hostels or nursing homes) were used in an educational program for general practitioners. At the same time information was obtained about the current health status, needs, and management of such patients and their carers. Eight general practitioners audited a total of 25 patients. Carer questionnaires were returned from 30 carers recruited by the general practitioners and 77 recruited by Alzheimer's Australia NSW. Many of the audit results are as expected, but some raise important issues. The diagnosis was not fully established for 20% of patients and the MMSE score not known by the general practitioner for 56%. Home safety had not been assessed for 44%. Legal matters such as driving or guardianship had not been considered for more than half. Most carers felt supported by their general practitioner in their role as carer, but services that would have been useful were not available to 23%, and most felt that being a carer had affected their own health. The small number of participants means that the audit results come from too few general practitioners to be reliably representative, but they do provide an indication of likely general results, and indicate priority areas for improved care.

The heritability of antinociception II: pharmacogenetic mediation of three over-the-counter analgesics in mice.

Chromosomal loci containing genes affecting antinociceptive sensitivity to morphine have been identified, but virtually nothing is known about the genetic mediation of sensitivity to over-the-counter analgesics. Such knowledge would be of great clinical interest, as prodigious interindividual variability has been noted in the efficacy of these ubiquitously used drugs. In the present study, we assessed heritability and genetic correlations among three over-the-counter analgesics in mice of 12 inbred mouse strains on the 0.9% acetic acid (i.p.) writhing test. Analgesics included the centrally acting analgesic, acetaminophen (150 mg/kg, s.c.), and the nonsteroidal anti-inflammatory drugs (NSAIDs), indomethacin (40 mg/kg, s.c.) and lysine-acetylsalicylic acid (800 mg/kg, s.c.). Significant strain differences in sensitivity to each of the drugs were observed, with narrow-sense heritability estimates ranging from 23 to 45%. Similar strains were sensitive and resistant, respectively, to the two NSAIDs (r(s) = 0.64). In contrast, a completely different pattern of sensitivities was observed for acetaminophen, implying genetic dissociation (r(s) = 0.29 and 0.02) compared with the NSAIDs. Additional experiments were performed on two strains, C57BL/6 and DBA/2, with extreme sensitivities to acetaminophen. Plasma acetaminophen levels in these strains were not significantly different during the time of antinociception assessment, suggesting the existence of genetic factors affecting acetaminophen pharmacodynamics rather than pharmacokinetics.