ABSTRACT
Dopamine agonists provide an effective means of treating early, middle, and late stages of Parkinson's disease. This article outlines the advantages and disadvantages of dopamine agonists as compared with levodopa therapy. The features and costs of the four Food and Drug Administration-approved agonists (bromocriptine, pergolide, pramipexole, and ropinirole) and apomorphine, another agonist presently under investigation, are discussed.
Subject(s)
Dopamine Agonists/economics , Dopamine Agonists/therapeutic use , Drug Costs , Parkinson Disease/drug therapy , Antiparkinson Agents/therapeutic use , Dopamine Agents/therapeutic use , Humans , Levodopa/therapeutic useSubject(s)
Activities of Daily Living , Depression/diagnosis , Geriatric Assessment/statistics & numerical data , Health Status , Telephone , Aged , Aged, 80 and over , Bias , Cognition , Female , Humans , Interview, Psychological , Male , Mental Status Schedule , Middle Aged , Regression Analysis , Reproducibility of ResultsABSTRACT
OBJECTIVE: To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM). DESIGN: Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self-administered questionnaire. The high-risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care. SETTING: Outpatient GEM clinic at an urban university hospital. SUBJECTS: Elderly Medicaid recipients whose probability of repeated hospital admission (Pra) within 4 years was calculated as 40% or greater (Pra > or = 0.40). MAIN OUTCOME MEASURES: Mortality, use of institutional services, satisfaction. RESULTS: Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health-related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long-term prescription medications. During the program's first 17 months of follow-up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful. CONCLUSION: Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.
Subject(s)
Ambulatory Care , Geriatric Assessment , Health Status , Aged , Aged, 80 and over , Clinical Trials as Topic , Female , Health Services for the Aged/statistics & numerical data , Hospitalization , Humans , Male , Mortality , Patient Satisfaction , Risk Factors , Surveys and QuestionnairesABSTRACT
We followed 65 patients with probable Alzheimer's disease, who were initially mildly to moderately impaired, with semiannual assessments of cognitive and functional performance for up to 4 years. Scores on the Mini Mental State Examination and a combination of instrumental and self-maintenance scale of activities of daily living were regressed on time of examination (measured in 6-month increments) to estimate cognitive and functional progression rates in individual patients. Lower scores on the verbal neuropsychological tests at the time of study entry, more aggressive behavior, and sleep disturbance during the first year of observation predicted faster cognitive progression. Faster functional progression was predicted by paranoid behavior, hallucinations and activity disturbances during the first year and the presence of extrapyramidal signs and lower scores on nonverbal neuropsychological tests at the time of entry into the study. Hallucinations occurred independently of cognitive severity and may identify a distinct subgroup of patients with rapid functional progression. Because of the greater significance of functional progression for caregivers' ability to manage patients, the presence of specific behavior problems early in the disease course may help to identify individuals who will experience greater functional decline and be at risk for earlier institutionalization.
Subject(s)
Activities of Daily Living , Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Cognition , Aged , Aged, 80 and over , Female , Humans , Linear Models , Male , Middle Aged , Neuropsychological Tests , Predictive Value of Tests , Prospective StudiesABSTRACT
A prospective study was conducted by means of a questionnaire to determine the prevalence of delayed reactions to contrast media administered intravenously (iopamidol) and orally (diatrizoate sodium) in 170 patients who had received interleukin-2 (IL-2) and in 631 patients who did not. Another control group of 100 non-IL-2 patients received only oral contrast medium. Delayed reactions (eg, fever rash, flulike symptoms, joint pain, flushing, pruritus, and dizziness) were reported in 3.9% (25 of 631) of non-IL-2 patients and in 11.8% (20 of 170) of IL-2 patients. Reactions were mild in the non-IL-2 patients but were more severe in the IL-2 patients. Two IL-2 patients required hospitalization. Only rash, flulike symptoms, and pruritus were statistically more common in IL-2 patients than in non-IL-2 patients. The prevalence of delayed reactions to nonionic contrast medium is higher in patients who have received IL-2 than in the general population. Most delayed reactions do not require therapy, but, when necessary, therapy is usually limited to relief of symptoms.
