Elderly age associated with poor functional outcome after rupture of anterior communicating artery aneurysms

The effect of age on patient outcomes after rupture of the anterior communicating artery (Acom) aneurysms is not well-defined. We performed a retrospective cohort study of patients presenting to our institution with a ruptured Acom aneurysm between 2003 and 2012. Patients were divided into two groups on the basis of age at presentation, with patients 65 years and older categorized as the elderly group. The effect of elderly age on patient outcomes was then evaluated using multivariate logistic regression analysis. There were 147 patients presenting with a ruptured Acom aneurysm. Of these, 41 (27.9%) were 65 years or older. Patients in the elderly group were more likely to be female (68.3% vs. 40.6%, p = 0.0026), and less likely to be active smokers (22.0% vs. 60.4%, p < 0.0001) or to abuse alcohol (7.3% vs. 21.7%, p = 0.0404). Elderly patients were more likely to have a history of hypertension (70.7% vs. 52.8%, p = 0.0487) and coronary artery disease (19.5% vs. 2.8%, p = 0.0006). Elderly patients were more likely to require a ventriculostomy (61.0% vs. 37.7%, p = 0.0109) and ultimately to require permanent cerebrospinal fluid diversion (36.6% vs. 17.0%, p = 0.0106). On adjusted analysis, age 65 years or older was associated with a greater likelihood of poor outcome at last follow-up within 1 year of aneurysmal subarachnoid hemorrhage (odds ratio = 3.76, 95% confidence interval: 1.30–11.78, p = 0.0144). Our results suggest that elderly age is an independent risk factor for poor functional outcome after rupture of an Acom aneurysm.     

Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population

ObjectivesThe impact of sleep-related breathing disorders on the incidence of arterial hypertension (AHT) in the older adults is not well-established. The aim of our study was to test the link between severe obstructive sleep apnea (OSA) and the occurrence of hypertension in older subjects after 3 years.Methods372 normotensive subjects with a mean age of 68.2 years were included in our longitudinal study. All participants had a ventilatory polygraphic recording and an ambulatory blood pressure (BP) monitoring at baseline and after 3 years. Severe OSA was defined by an apnea–hypopnea index (AHI) of ⩾30 per hour. A new onset of hypertension was defined according to a mean 24-hour value >140 mmHg for systolic BP and >85 mmHg for diastolic BP or the use of antihypertensive medication.ResultsThe baseline factors significantly associated with an increased risk for new-onset hypertension were male gender, obesity, diabetes mellitus (DM), dyslipidemia, and OSA. Multiple logistic regression analyses showed that an AHI ⩾ 30 per hour was independently associated with incident hypertension after 3 years (P = .02; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1–2.8).ConclusionsThe presence of severe OSA is associated with new-onset AHT in normotensive elderly (mean age, 68.2 y) subjects.     

L’effet de l’âge et de la durée d’incarcération sur la santé mentale des détenus âgés

Inmate aging is considered to start at the age of 50, which is early in relation to aging in the general population. The aging of the criminal population in France poses a real public health problem. There is very little research on the mental health (mental and cognitive disorders) of older inmates.ObjectivesThe objective of this study was to evaluate the effect of age and time spent in prison on mental disorders and cognitive performance of elderly prison inmates. We put forward the hypothesis that age and amount of time spent in prison are associated with the deterioration of older inmates’ mental health, that is, an increase in the prevalence of psychiatric disorders and a decrease in cognitive performance.MethodsWe recruited 138 men aged 50 and over in seven French prisons. The research protocol included a semi-directive interview, the Mini International Neuropsychiatric Interview (MINI DSM-IV) for the assessment of mental disorders, as well as the Rapid Battery for Frontal Efficiency (BREF) and the Mini Mental State Examination (MMSE) for the evaluation of cognitive performance.ResultsThe average age of the inmates (N = 138) was 59.7 years (range 50–84, SD = 8.02). The average sentence was approximately 13.5 years (SD = 7) and the average time spent in prison was 6.9 years (SD = 5.9). The results showed a very high prevalence of mental disorders, notably depression and anxiety, and cognitive disorders. However, the probability of occurrence of certain psychiatric diagnoses decreases with age (major depressive episode, agoraphobia, post-traumatic stress disorder and generalized anxiety). In addition, logistic regression estimates showed no significant relationship between time spent in prison and mental disorders. However, there is a significant link between time spent in prison and cognitive impairment.ConclusionOur hypothesis is partially validated. Indeed, age is not associated with mental or cognitive disorders. However, the amount of time spent in prison has an effect on the deterioration of certain cognitive functions. It appears that after the age of 50, it is not chronological age but environmental factors that mainly explain cognitive decline. Our study shows that the longer the detention period, the greater the inmate's cognitive decline. These results highlight the very high vulnerability of elderly prisoners in terms of mental health and emphasize the importance of implementing appropriate detection and care measures to address the needs of this segment of the criminal population. Routine screening for cognitive impairment in all older prisoners should be carried out by caregivers in penitentiary institutions. Furthermore, better follow-up and cognitive assessment of prisoners aged 50 or more and whose length of incarceration exceeds five years could make it possible to detect subjects at risk and to propose appropriate activities to reduce and/or delay the effects of aging in detention.     

Prescripciones inconvenientes en el tratamiento del paciente con deterioro cognitivo

IntroductionSome treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review.DevelopmentBenzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol < 40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases.ConclusionsPolypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population.     

National trends of psychotropic medication use among patients diagnosed with anxiety disorders: Results from Medical Expenditure Panel Survey 2004–2009

Data from the 2004 to 2009 Medical Expenditure Panel Survey (MEPS) were used to: (1) characterize changes in utilization and (2) identify factors associated with the use of psychotropic medication among patients with anxiety disorders. We calculated the prevalence, compared the use patterns for each year and drug class, and used logistic regression to identify the factors associated with psychotropic medication use. Patients ever using a psychotropic medication for anxiety grew from 57.4% in 2004 to 63.8% in 2009 (p < 0.01). From 2004 to 2009, use of benzodiazepines (22.7–30.5%, p < 0.01) and atypical antipsychotics (2.3–3.9%, p < 0.01) increased. A high prevalence in the use of benzodiazepines (41.8% in 2004 to 48.8% in 2009) was observed among older adults. Older age, having insurance coverage, and poor health status were significantly associated with self-reported psychotropic medication use. An increase of psychotropic medication use from 2004 to 2009 was observed. A high prevalence and increasing trend in the use of benzodiazepines may warrant further attention given safety concerns in older adults.     

Paroxysmal nonepileptic events in pediatric patients

ObjectivesParoxysmal nonepileptic events (PNEs) are frequently encountered phenomena in children. Although frequencies and types of PNEs have been extensively studied in adult populations, the data available for children and adolescents are limited, especially in patients without underlying neurologic disorders. In this study, we evaluated and compared the characteristics of PNEs between age groups and according to the presence of neurologic deficits to improve early detection and diagnosis of PNEs.MethodsWe retrospectively reviewed 887 pediatric patients who were admitted to the epilepsy monitoring unit at the Samsung Medical Center between December 2001 and July 2014. One hundred and forty-one patients (15.9%) were diagnosed as having PNEs on the basis of their clinical history and long-term video-electroencephalography (EEG) monitoring (VEM).ResultsChildren with PNEs were divided into three groups by age: 1) the infant, toddler, and preschool group (< 6 years, N = 50, 35.5%); 2) the school-age group (6–< 12 years, N = 30, 21.3%); and 3) the adolescent group (12–< 18 years, N = 61, 43.3%). Physiologic disorders, such as normal infant behavior, sleep movement, and staring, were more common in patients younger than 6 years of age, whereas psychogenic nonepileptic seizures were predominant in patients older than 6 years. Vasogenic syncope was also frequently observed in the adolescent group and was confirmed by the head-up tilt test. There was no significant difference in specific PNE types between the groups of patients with or without neurologic deficits.ConclusionsPhysiologic symptoms were predominant in the younger age group, whereas psychogenic nonepileptic seizures were observed in older age groups more often. Clinical pattern recognition by age plays an important role in clinical practice, because pediatric patients present various types of PNEs with age-specific patterns. Considering various and inconsistent presentations and the importance of correct diagnosis, long-term VEM can be helpful in diagnosing normal infant behavior and psychogenic nonepileptic seizures.     

Risky use and misuse of alcohol and cigarettes in psychiatric inpatients: a screening questionnaire study

BackgroundMental disorders are associated with an increased prevalence of substance use disorders (SUDs). Despite this comorbidity being firmly established, alcohol and nicotine risky use and misuse are not routinely and systematically assessed in clinical practice.ObjectiveThe aim of this study is to examine the prevalence of risky use of alcohol, alcohol use disorder (AUD), smoking, and nicotine use disorder in people with psychiatric diagnoses and their association with age, gender, and occupational functioning.MethodParticipants were 210 patients from an inpatient psychiatric ward. Three self-reporting questionnaires were used: the Alcohol Use Disorders Identification Test (AUDIT), the Lübeck Alcoholism Screening Test (LAST), and the Fagerström Test for Nicotine Dependence (FTND).ResultsRisky alcohol use or AUD was found in more than one third of patients and was more common in males than in females (p < 0.01) and in young people as compared to older adults (p = 0.04). Current nicotine consumption concerned over a half participants and was significantly associated with risky alcohol use and AUD (p < 0.01). Patients with current SUD had the highest prevalence of both smoking (80%) and alcohol misuse (80%). Low occupational functioning was associated with both alcohol use (p = 0.02) and concurrent alcohol and SUDs (p = 0.03).ConclusionsBoth alcohol and nicotine risky use and misuse are highly prevalent in people with psychiatric disorders and their concurrent abuse is common. The simultaneous use of different screening questionnaires allows the identification not only of people with frank use disorders, but also those with harmful use, facilitating early detection of people at risk.     

Effect of a multi-domain intervention on the quality of life in older adults with major neurocognitive disorder: A pilot study

PurposeMajor neurocognitive disorders (MND) have multiple negative consequences on patients’ lives and on their caregivers’ health. Occupational therapy and cognitive stimulation have failed to show any significant efficacy on quality of life (QoL), cognitive functioning and behavioural symptoms. Bretonneau Hospital's Day Care Unit offers personalized and structured multi-domain interventions to cognitively impaired older patients on a weekly basis, for a 3-month period.ObjectivesOur objective was to determine whether a specific rehabilitation day care unit (RDCU) could influence the QoL of cognitively impaired community-dwelling elderly patients. We also aimed to better understand the characteristics of patients who had the most benefited from the RDCU.MethodsRetrospective study based on a sample of outpatients participating in RDCU during three months. All patients underwent a cognitive (MMS), functional (IADl, ADL) and behavioral (NPI) assessment. We compared QoL using the QoL-Alzheimer's Disease (QoL-AD) scale before and after RDCU.ResultsOverall, we included 60 outpatients in our study (mean age 83.3 ± 5.8; women = 70%). We found a statistically significant improvement of QoL-AD scores after RDCU (31.8 ± 4.9 to 32.9 ± 5.2, P = 0.008). Patients who benefitted the most from RDCU were older (P = 0.01) and had lower baseline QoL (P = 0.04). We did not find any other characteristics associated with QoL-AD score improvement in our population.ConclusionRDCU showed positive effects on QoL in this uncontrolled pilot study of older adults with MND. These findings should be confirmed in a future randomized controlled trial to corroborate the potential benefits of RDCU on QoL in older cognitively impaired patients.     

Utilization patterns of antidepressants between 1991 and 2011 in a population-based cohort of middle-aged and elderly

BackgroundIn middle-aged and older patients in whom antidepressant use increased in last decades, patterns of use might be of concern The objective of this study was to investigate the patterns of prevalence, incidence and duration of antidepressant use in an ageing population.MethodsAll participants (aged > 45 years) from the population-based Rotterdam Study were followed from January 1st 1991 until death, loss to follow-up, or end of the study period (December 31st 2011). Antidepressant drug dispensing, based on pharmacy records, were subdivided into Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs) and other antidepressants. One-year prevalence, 5-year incidence and duration of antidepressant use were calculated.ResultsYearly prevalence of antidepressant use increased from 3.9% in 1991 to 8.3% of the population in 2011. The increase in SSRI use was 5.8-fold, whereas use of other antidepressants doubled and TCA use remained stable over time. Incidence of all antidepressants decreased from 23.9 to 14.2 per 1000 person-years between 1992 and 2011. The duration of a first treatment episode increased over time.ConclusionDespite the prevalence of antidepressant use increased over time, incidence did not, which is most likely explained by a longer treatment duration and recurrent episodes.     

Comorbidity,age of onset and suicidality in obsessive–compulsive disorder (OCD): An international collaboration

ObjectivesTo collate data from multiple obsessive–compulsive disorder (OCD) treatment centers across seven countries and five continents, and to report findings in relation to OCD comorbidity, age of onset of OCD and comorbid disorders, and suicidality, in a large clinical and ethnically diverse sample, with the aim of investigating cultural variation and the utility of the psychiatric diagnostic classification of obsessive–compulsive and related disorders.MethodsResearchers in the field of OCD were invited to contribute summary statistics on current and lifetime psychiatric comorbidity, age of onset of OCD and comorbid disorders and suicidality in their patients with OCD.ResultsData from 3711 adult patients with primary OCD came from Brazil (n = 955), India (n = 802), Italy (n = 750), South Africa (n = 565), Japan (n = 322), Australia (n = 219), and Spain (n = 98). The most common current comorbid disorders were major depressive disorder (28.4%; n = 1055), obsessive–compulsive personality disorder (24.5%, n = 478), generalized anxiety disorder (19.3%, n = 716), specific phobia (19.2%, n = 714) and social phobia (18.5%, n = 686). Major depression was also the most commonly co-occurring lifetime diagnosis, with a rate of 50.5% (n = 1874). OCD generally had an age of onset in late adolescence (mean = 17.9 years, SD = 1.9). Social phobia, specific phobia and body dysmorphic disorder also had an early age of onset. Co-occurring major depressive disorder, generalized anxiety disorder and psychotic disorders tended to have a later age of onset than OCD. Suicidal ideation within the last month was reported by 6.4% (n = 200) of patients with OCD and 9.0% (n = 314) reported a lifetime history of suicide attempt.ConclusionsIn this large cross-continental study, comorbidity in OCD was common. The high rates of comorbid major depression and anxiety disorders emphasize the need for clinicians to assess and monitor for these disorders. Earlier ages of onset of OCD, specific phobia and social phobia may indicate some relatedness between these disorders, but this requires further study. Although there do not appear to be significant cultural variations in rates or patterns of comorbidity and suicidality, further research using similar recruitment strategies and controlling for demographic and clinical variables may help to determine whether any sociocultural factors protect against suicidal ideation or psychiatric comorbidity in patients with OCD.     

Prevalence of mood-altering and opioid medication use among spine surgery candidates and relationship with hospital cost

Depression is the most common psychiatric illness in the USA and is commonly diagnosed in patients with chronic back pain. We investigated the use of mood-altering medications among spine surgery candidates and the relationship with opioid use and cost of care. We retrospectively reviewed the charts of 578 spine surgery patients who underwent surgery during 2005 to 2007 and their hospital charges. Patients were divided by type of spine surgery as follows: 154 lumbar microdiscectomies (LMD), 297 anterior cervical decompression and fusions (ACDF) and 127 lumbar decompression and fusions (LDF). We found that 25.4% of spine surgery candidates were on antidepressants, 9.3% on anxiolytics, and 41.3% on opioids were. More precisely, 26.6% of LMD, 24.6% of ACDF and 26% of LDF patients were on antidepressants; 9.1% of LMD, 7.1% of ACDF, and 15% of LDF patients were on anxiolytics; and 47.4% of LMD, 36% of ACDF, and 46.5% of LDF patients were on opioids. Of all patients, 16.8% were on two or three types of these medications. Significantly more antidepressants were used by females in the ACDF and LDF groups and more opioids were used by African Americans in the LDF group. There were significant differences (p < 0.05) in the length of stay and hospital cost between patients on antidepressants and those not on antidepressants in the LDF group, especially among females. Opioids are the most commonly used psychoactive drugs among chronic back pain and spine surgery candidates followed by antidepressants and anxiolytics. Screening for antidepressant use among spine surgery patients seems reasonable on the preoperative visit. This would help adjust antidepressant medications following surgery as depression might resolve in response to pain improvement. If antidepressant medications were initially prescribed to treat pain; they also might need to be tapered off postoperatively to correspond with new pain levels. The relationship of antidepressants with increased hospital charges in this category of patients requires further investigation.     

Psychiatric disorders among 165 patients with juvenile myoclonic epilepsy in India and association with clinical and sociodemographic variables

ObjectiveThe current study evaluated the association between clinical variables and psychiatric disorders (PDs) in patients with juvenile myoclonic epilepsy (JME).MethodsConsecutive patients with JME who had at least two years of regular follow-up from May 2011 to April 2014 formed the study population. The association between clinical and sociodemographic data with psychiatric evaluation on structured clinical interview and quality of life in epilepsy — 31 (QOLIE-31) was evaluated using logistic regression analysis.ResultsOut of 165 patients in the current study, 77 (46.6%) patients were diagnosed with PDs; while 50 were categorized to having anxiety disorders, 27 patients had depressive disorders. The mean age of the study population was 25.35 ± 7.6 years with 37.52% women. Patients with PDs had lower overall QOLIE score (55.84 ± 13.07 vs 68.70 ± 11.23, p < 0.001) and lower social function score (80.95 ± 19.22 vs 91.09 ± 14.74, p < 0.001). Being married was the strongest predictor of depressive disorders (β = 8.59; 95% CI, 1.44–51.28; p = 0.018); whereas, lower emotional well-being (β = 0.942; 95% CI, 0.907–0.978; p = 0.002) was the only variable associated with anxiety disorders. Patients with depressive disorders had longer duration of PDs (11.85 ± 8.68 years vs 7.75 ± 6.70 years, p = 0.039), and a majority of them were married (66.7% vs 26.0%, p = 0.001). Patients with depressive disorders scored low on emotional well-being (50.81 ± 14.62 vs 61.02 ± 13.05, p = 0.002), energy levels (52.78 ± 11.71 vs 62.80 ± 10.84, p < 0.001), and social function (70.96 ± 20.69 vs 86.34 ± 16.16, p = 0.001). Depressive disorders were more prevalent among married patients above 35 years of age (5.2% vs 36.8%, p = 0.042).SignificanceNearly half of the patients with JME had coexisting PDs. The psychological profile of anxiety disorders was different from depressive disorders in patients with JME. Depressive disorders were more prevalent among older patients with JME, and marriage was strongly associated with depressive disorders.     

The course of depressive symptoms and prescribing patterns of antidepressants in schizophrenia in a one-year follow-up study

BackgroundAntidepressants are frequently prescribed in patients with psychotic disorders, but little is known about their effects in routine clinical practice. The objective was to investigate the prescribing patterns of antidepressants in relation to the course of depressive symptoms in patients with psychotic disorders.MethodsA cohort of 214 Dutch patients with psychotic disorders received two assessments of somatic and psychiatric health, including a clinician-rated screening for depressive symptoms, as part of annual routine outcome monitoring.ResultsDepressive symptoms were prevalent among 43% (93) of the patients. Antidepressants were prescribed for 40% (86) of the patients and the majority 83% (71) continued this therapy after one year. Multivariable analysis showed that patients with more severe psychopathology had a higher risk to develop depressive symptoms the following year (OR [95% CI] = 0.953 [0.912–0.995]). For patients with depressive symptoms at baseline, polypharmacy was a potential risk factor to keep having depressive symptoms (OR [95% CI] = 1.593 [1.123–2.261]). Antidepressant use was not an independent predictor in both analyses.ConclusionsRoutine outcome monitoring in patients with psychotic disorders revealed a high prevalence of depressive symptoms. Antidepressants were frequently prescribed and continued in routine clinical practice.     

Comparative levels of excessive daytime sleepiness in common medical disorders

IntroductionSleep restriction and sleep disorders are common causes of excessive daytime sleepiness (EDS). Medical disorders (MD) can also cause EDS, but previous studies have used non-standardized measures, selected samples, or have examined EDS in singular disorders. This study describes the relative degree of EDS associated with medical disorders to provide comparative data across a range of common medical conditions in a large unselected community-based sample.MethodsResponses of 2612 individuals (aged 18–65) were assessed after excluding those with suspected sleep disordered breathing, narcolepsy, and shift workers. Participants across a range of medical disorders were evaluated using the Epworth Sleepiness Scale (ESS) and patient reports of nocturnal sleep.ResultsSixty-seven percent of the sample reported a MD. The prevalence of EDS (ESS ? 10) was 31.4% in individuals with MD and increased as a function of a number of MD (0 MD = 29.4%, 1 MD = 28.4%, 2 MD = 31.0%, 3 MD = 35.3%, 4 MD = 38.4%). Disorders which were independent predictors of EDS were ulcers OR = 2.21 (95% CI = 1.35–3.61), migraines OR = 1.36 (95% CI = 1.08–1.72), and depression OR = 1.46 (95% CI = 1.16–1.83) after controlling for other conditions, age, gender, time in bed, caffeine, smoking and alcohol use. Participants with ulcers had the highest prevalence of sleepiness, 50.0%, as well as the highest level of problems falling asleep (40.8%) and awakenings during the night (62.5%).ConclusionsIndividuals with ulcers, migraines, and depression have independent and clinically significant levels of EDS relative to other common MD.     

Clinical characteristics and treatment responses in new-onset epilepsy in the elderly

PurposeEpidemiologic studies have shown that the incidence of epilepsy is the highest in the elderly population. Because the elderly constitutes the most rapidly growing population, epilepsy in this group is an important health issue worldwide. To identify the characteristics of epilepsy in the elderly, we reviewed our experience at a tertiary referral center in Japan.MethodsWe searched all electronic medical records of the past 6 years at the epilepsy clinic of the hospital affiliated to our University-affiliated hospital. We defined an elderly person as an individual aged 65 years and above. All patients underwent history and physical examinations, 3 T magnetic resonance imaging and/or computer tomography, and electroencephalogram (EEG). The diagnosis of epilepsy, age of onset, etiology, and antiepileptic medication were recorded.ResultsWe identified 70 patients who developed epilepsy after the age of 65 years. The mean age of seizure onset was 73.1 years and 52.9% patients were males. Complex partial seizures (CPS) without secondarily generalization (n = 33, 47.1%) were most frequent. The most frequent diagnosis was temporal lobe epilepsy (n = 50, 71.4%). Etiological diagnosis was possible in nearly 50% patients, including those with cerebrovascular disease. A clear cause of epilepsy was not found (i.e., non-lesional epilepsy) in 52.8% patients. Interictal EEG revealed focal epileptiform discharges in 72.9% (n = 51) patients. Of the 54 patients who were followed more than 1 year, 42 patients (77.8%) were on antiepileptic monotherapy and 52 patients (96.3%) had been seizure-free for more than 1 year.ConclusionThe most frequent diagnosis in our cohort of elderly persons with new-onset epilepsy was temporal lobe epilepsy. Non-lesional temporal lobe epilepsy was not uncommon. Epileptogenecity was relatively low in elderly patients and they responded well to antiepileptic medication.     

New-onset status epilepticus and cluster seizures in the elderly

We evaluated the frequency, therapeutic response and predictors of status epilepticus (SE) and cluster seizures among elderly people. Patients over 60 years old with epilepsy (n = 201; age, 68.0 ± 7.5 years) were prospectively recruited. Among them, 64 patients (32%) who presented with new-onset cluster attacks and/or SE formed the study group. All underwent evaluation with electroencephalography (EEG) and CT scans. The mean duration of SE and cluster seizures at admission was 14.9 ± 53.7 hours. Cluster seizures were observed in 53 (26.4%) and SE in 34 (17%) elderly patients with seizures (n = 201). The types of SE were: generalized convulsive (23 patients), epilepsia partialis continua (eight patients), non-convulsive (two patients) and myoclonic (one patient). The types of epilepsy syndrome included were: acute symptomatic (37 patients; 57.8%), cryptogenic (15 patients; 23.4%) and remote symptomatic (12 patients; 18.8%). Interictal EEG was abnormal in 79.7% of patients with critical presentation compared to 53.3% of patients without critical presentation. Epileptiform activity was observed in 46.9% of patients with SE and/or cluster seizures compared to 27.0% without SE and/or cluster seizures (p = 0.001). The neuroimaging differences between the two groups were the absence of white-matter changes on CT scan in those with, compared to those without, SE and/or cluster seizures (28.1% compared to 41.6%, p = 0.06). The risk factors for SE and/or cluster seizures were: acute symptomatic seizures, simple partial seizures, a higher number of seizures, lower Glasgow coma scale (GCS) score and an absence of white-matter changes on CT scan. After multivariate analysis, lower GCS score (p = 0.01; odds ratio [OR] = 0.82) and a higher number of seizures (p = 0.03; OR = 1.03) significantly predicted the occurrence of SE and/or cluster seizures. Seizures were controlled with two antiepileptic drugs in 70.6%. To conclude, SE and/or cluster seizures are common (32%) among elderly patients with epilepsy. Early and aggressive treatment is effective in the majority.     

Reproducibility of peroneal motor nerve conduction measurement in older adults

ObjectiveWhile neuropathy is common in the elderly, nerve conduction (NC) reproducibility in older adults is not well-established. We sought to evaluate intraobserver reproducibility of peroneal motor NC measures in a diverse sample of older adults.MethodsWe measured peroneal motor NC amplitude and velocity in a subset of participants (mean age = 82.9 ± 2.7, n = 62, 50% female, 51.6% black, 35.5% DM) in the Health, Aging, and Body Composition Study. Using coefficients of variation (CVs), intraclass correlation coefficients (ICCs), and Bland Altman Plots, we compared two sets of measurements taken by the same examiner hours apart on the same day.ResultsLow CVs (2.15–4.24%) and moderate to high ICCs (0.75–0.99) were observed. No systematic variation was found across measures. Despite small numbers in some subgroups, we found no differences in reproducibility by diabetes, race or study site.ConclusionNC measures have moderate to high intraobsever reproducibility in older adults and are not affected by diabetes, race, or gender.SignificanceThese data provide evidence to support use of these measures in aging research.