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Tablet devices show promise in managing agitation among patients with dementia

“The biggest advantage is versatility,” said Vahia. “We know that art therapy can work, music therapy can work. The tablet, however, gives you the option of switching from one app to another easily.”

A new pilot study led by McLean Hospital’s Ipsit Vahia, MD, medical director of Geriatric Psychiatry Outpatient Services at McLean Hospital, suggests that the use of tablet computers is both a safe and a potentially effective approach to managing agitation among patients with dementia.

“Tablet use as a nonpharmacologic intervention for agitation in older adults, including those with severe dementia, appears to be feasible, safe, and of potential utility,” said Vahia. “Our preliminary results are a first step in developing much-needed empirical data for clinicians and caregivers on how to use technology such as tablets as tools to enhance care and also for app developers working to serve the technologic needs of this population.”

“Use of Tablet Devices in the Management of Agitation Among Inpatients with Dementia: An Open Label Study” was recently published in the online version of The American Journal of Geriatric Psychiatry. This research builds upon previous studies demonstrating that art, music, and other similar therapies can effectively reduce symptoms of dementia without medication. By using tablet devices to employ these therapies, however, patients and providers also benefit from a computer’s inherent flexibility.

“The biggest advantage is versatility,” said Vahia. “We know that art therapy can work, music therapy can work. The tablet, however, gives you the option of switching from one app to another easily, modifying the therapy seamlessly to suit the individual. You don’t need to invest in new equipment or infrastructure.”

Researchers loaded a menu of 70 apps onto the tablets for the study. The apps were freely available on iTunes and varied greatly in their cognitive complexity — from an app that displayed puppy photos to one that featured Sudoku puzzles.

The researchers found that tablet use was safe for every patient, regardless of the severity of their dementia, and that with proper supervision and training, the engagement rate with the devices was nearly 100 percent. The study also found that the tablets demonstrated significant effectiveness in reducing symptoms of agitation, particularly — but not exclusively — among patients with milder forms of dementia.

Vahia cited several examples of the tablet’s potential to improve a patient’s condition. One particular patient, who only spoke Romanian, was very withdrawn and irritable, and medications were ineffective in controlling his symptoms.

“We started showing him Romanian video clips on YouTube, and his behavior changed dramatically and instantaneously,” said Vahia. “His mood improved. He became more interactive. He and his medical support team also started using a translation app so that staff could ask him simple questions in Romanian, facilitating increased interaction. These significant improvements are a clear testament of the tablet’s potential as a clinical tool.”

Based on such promising outcomes, the Geriatric Psychiatry Outpatient Services clinical team is expanding the use of tablet devices as a means to control agitation in dementia patients at McLean. This will allow researchers to develop more robust data and expand the scope of the study, including a focus on specific clinical factors that may impact how patients with dementia engage with and respond to apps.


Story Source: McLean Hospital.


Journal Reference:

  1. Ipsit V. Vahia, Rujvi Kamat, Cheng Vang, Carolina Posada, Lisa Ross, Sarah Oreck, Alok Bhatt, Colin Depp, Dilip V. Jeste, Daniel D. Sewell. Use of Tablet Devices in the Management of Agitation Among Inpatients with Dementia: An Open-Label StudyThe American Journal of Geriatric Psychiatry, 2016; DOI: 10.1016/j.jagp.2016.07.011
Alcohol abuse increases risk of heart conditions as much as other factors

Alcohol abuse increases the risk of atrial fibrillation, heart attack and congestive heart failure as much as other well-established risk factors such as high blood pressure, diabetes, smoking and obesity.

“We hope this data will help people avoid any justification for excessive drinking because people think it will be good for their heart”

This new information was published today a new study in the  Journal of the American College of Cardiology.

Despite advances in prevention and treatments, heart disease is the No. 1 killer of men and women in the US. Reducing alcohol abuse might result in meaningful reductions of heart disease, according to the researchers. “We found that even if you have no underlying risk factors, abuse of alcohol still increases the risk of these heart conditions,” said lead researcher Gregory M. Marcus, MD, director of clinical research in the Division of Cardiology at the University of California, San Francisco. The researchers analyzed data from a database of all California residents ages 21 and older who received ambulatory surgery, emergency or inpatient medical care in California between 2005 and 2009. Among the 14.7 million patients in the database, 1.8 percent, or approximately 268,000, had been diagnosed with alcohol abuse. The researchers found that after taking into account other risk factors, alcohol abuse was associated with a twofold increased risk of atrial fibrillation, a 1.4-fold increased risk of heart attack and a 2.3-fold increased risk of congestive heart failure. These increased risks were similar in magnitude to other well-recognized modifiable risk factors such as diabetes, high blood pressure and obesity.

Completely eradicating alcohol abuse would result in over 73,000 fewer atrial fibrillation cases, 34,000 fewer heart attacks, and 91,000 fewer patients with congestive heart failure in the United States alone, the researchers said.

“We were somewhat surprised to find those diagnosed with some form of alcohol abuse were at significantly higher risk of a heart attack,” Marcus said. “We hope this data will temper the enthusiasm for drinking in excess and will avoid any justification for excessive drinking because people think it will be good for their heart. These data pretty clearly prove the opposite.”

Previous research has suggested that moderate levels of alcohol consumption may help prevent heart attack and congestive heart failure, while even low to moderate levels of alcohol consumption have been shown to increase the incidence of atrial fibrillation.

“The great majority of previous research relied exclusively on self-reports of alcohol abuse,” Marcus said. “That can be an unreliable measure, especially in those who drink heavily. In our study, alcohol abuse was documented in patients’ medical records.” He said that the study did not quantify how much alcohol patients drank.

In an editorial accompanying the new study, Michael H. Criqui, MD, MPH, of the University of California San Diego, wrote that previous studies that found a benefit from alcohol consumption in protecting against heart attack and congestive heart failure were so-called cohort studies, which include defined populations. Such studies tend to recruit stable, cooperative and health-conscious participants who are more likely to be oriented toward a heathier lifestyle.

“Cohort studies have minimal participation by true alcohol abusers, so the current study likely presents a more valid picture of heavy drinking outcomes,” Criqui said.


Story Source: American College of Cardiology.


Journal Reference:

  1. Isaac R. Whitman, Vratika Agarwal, Gregory Nah, Jonathan W. Dukes, Eric Vittinghoff, Thomas A. Dewland, Gregory M. Marcus. Alcohol Abuse and Cardiac DiseaseJournal of the American College of Cardiology, 2017 DOI: 10.1016/j.jacc.2016.10.048
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On Call with Dr. Lyons

As summer quickly comes to an end, our thoughts reluctantly begin to focus on Back to School. We start getting our homes “in order”, clothes and school supply shopping, cleaning out the summer sun, sand and fun of our thoughts so we can refocus our minds on the upcoming school year and all it brings. With that thought process, we tend to think about getting our health in order as well. Are the kids going to make it through the year “germ free”? Am I healthy enough to keep me and those around me going on the hectic schedule we call life?

In this issue we continue to give helping information about you and your family’s health. One very important part of keeping healthy is maintaining a healthy relationship with your family doctor. Cleveland Clinic gives us an informative perspective on this VIP we should all have access to (see page 16). Your Primary Care Physician (PCP) isn’t just for children, they should be your first resource in any stage of life and healthcare. Maintaining a long-term relationship with your PCP is a huge benefit in keeping you healthy.

As your thoughts turn to a seasonal change…we hope the information in this issue will continue to help you keep your healthcare goals.

Till next issue…

 

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