Hospitalization Poses Danger To Some Alzheimer's Patients; Nicotine Treatment Improves Memory In Patients With Mild Cognitive Impairment
A study conducted by researchers at the Beth Israel Deaconess Medical Center, VA Boston Healthcare System, and the Aging Brain Center at Hebrew SeniorLife, found that Alzheimer's disease patients who experienced delirium during hospitalization faced higher incidence of adverse outcomes.
The researchers examined rates of hospitalization in 741 AD patients aged 65 and older who were enrolled in the Massachusetts Alzheimer's Disease Research Center Patient Registry from 1991-2006. Medical records for all hospitalizations were obtained and reviewed for occurrence of delirium using a validated method. The researchers then examined the associations of hospitalization and delirium with three adverse outcomes -- cognitive decline, institutionalization, and death.
Approximately 46% of AD patients in the study were hospitalized, and delirium occurred in 52% of those hospitalizations. One in seven was found to experience at least one of the three adverse outcomes studied. Any hospitalization increased the risk of institutionalization and death, and hospitalizations in which AD patients suffered delirium were associated with the highest risk of cognitive decline (22%), institutionalization (15%), and death (12%).
"Patients with Alzheimer's disease are frequently hospitalized and when hospitalized develop delirium more than half the time" said Edward Marcantonio, MD, of Beth Deaconess Medical Center and Harvard Medical School and one of the study authors. "Given the adverse outcomes associated with these events, developing new strategies to lower the rates of hospitalization in AD patients and to prevent delirium in this population could substantially improve overall outcomes and perhaps slow the inevitable decline AD patients face."
Nicotine: Improves Cognitive Function
In a multicenter randomized controlled trial of 74 non-smoking volunteers with mild cognitive impairment (MCI), the use of nicotine treatment produced statistically significant improvement in paragraph recall, delayed word recall accuracy, speed of memory, and choice reaction time accuracy.
The six-month study, conducted by researchers at Duke University, University of Vermont, Georgetown University, and Cognitive Drug Research Ltd., with funding from the National Institute on Aging, also showed a trend for a greater proportion of patients on nicotine to be rated as improved compared to the placebo group.
Volunteers received either transdermal nicotine in doses that ranged from 5-15 milligrams or placebo over a six-month period. Both groups had similar adverse events rates and there were no effects secondary to the nicotine. There were also no significant adverse effects for nicotine other than a decrease in weight.
"Transdermal nicotine is a promising treatment for patients with early cognitive deficits and warrants further studies, said Heidi K. White, MD, of Duke University and lead author of the study. "It is safe, effective, and tolerable and could improve quality of life for patients with MCI and their families."
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