Vitamin D and neurocognitive disorder due to Alzheimer's disease: A review of the literature.

BACKGROUND: According to the Alzheimer's Disease 2014 Facts and Figures report, an estimated 5 million older Americans are living with Alzheimer's disease (AD). AD is the sixth leading cause of death in the United States and the only 1 among the top 10 that cannot be prevented, cured, or even slowed. Predictably, AD puts an enormous cost burden on the U.S. health care system, with costs expected to soar to $1.2 trillion in 2050. Many individuals with minor cognitive impairment do not seek treatment and/or delay treatment until perceptible deficits indicative of moderate stage of disease are present. Several new drugs for AD are under development based on etiological disease theories, but their long-term impact on cognition and/or function is unclear. One potential treatment is to address low serum 25-hydroxy vitamin D (25[OH]D). METHODS: We performed a literature review on the topic of low vitamin D levels and cognition in geriatric patients. RESULTS: Recent studies have associated low vitamin D levels with cognitive complaints, impairment, and AD in geriatric patients; however, there is a dearth of prospective studies on the topic. CONCLUSIONS: Available data suggest that more research is needed to promote a better understanding of vitamin D levels and incident AD.

Vitamin D and neurocognitive disorder due to Alzheimer's disease: A review of the literature.

BACKGROUND: According to the Alzheimer's Disease 2014 Facts and Figures report, an estimated 5 million older Americans are living with Alzheimer's disease (AD). AD is the sixth leading cause of death in the United States and the only 1 among the top 10 that cannot be prevented, cured, or even slowed. Predictably, AD puts an enormous cost burden on the U.S. health care system, with costs expected to soar to $1.2 trillion in 2050. Many individuals with minor cognitive impairment do not seek treatment and/or delay treatment until perceptible deficits indicative of moderate stage of disease are present. Several new drugs for AD are under development based on etiological disease theories, but their long-term impact on cognition and/or function is unclear. One potential treatment is to address low serum 25-hydroxy vitamin D (25[OH]D). METHODS: We performed a literature review on the topic of low vitamin D levels and cognition in geriatric patients. RESULTS: Recent studies have associated low vitamin D levels with cognitive complaints, impairment, and AD in geriatric patients; however, there is a dearth of prospective studies on the topic. CONCLUSIONS: Available data suggest that more research is needed to promote a better understanding of vitamin D levels and incident AD.

Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011.

OBJECTIVE: To describe patterns of care for men diagnosed with prostate cancer in Victoria, Australia, between 2008 and 2011. DESIGN, SETTING AND PATIENTS: Men who were diagnosed with prostate cancer at 11 public and six private hospitals in Victoria from August 2008 to February 2011, and for whom prostate cancer notifications were received by the Prostate Cancer Registry. MAIN OUTCOME MEASURES: Characteristics of men diagnosed with prostate cancer; details of treatment provided within 12 months of diagnosis, according to National Comprehensive Cancer Network risk categories; and characteristics of men who did not receive active treatment within 12 months of diagnosis. RESULTS: Treatment details were collected for 98.1% of men who were assessed as eligible to participate in the study (2724/2776) and were confirmed by telephone 12 months after diagnosis for 74.4% of them (2027/2724). Most patients (2531/2724 [92.9%]) were diagnosed with clinically localised disease, of whom 1201 (47.5%) were at intermediate risk of disease progression. Within 12 months of diagnosis, 299 of the 736 patients (40.6%) who had been diagnosed as having disease that was at low risk of progression had received no active treatment, and 72 of 594 patients (12.1%) who had been diagnosed as having disease that was at high risk of progression had received no active treatment. Of those diagnosed as having intermediate risk of disease progression, 54.5% (655/1201) had undergone radical prostatectomy. Those who received no active treatment were more likely than those who received active treatment to be older (odds ratio [95% CI], 2.96 [2.01-4.38], 10.94 [6.96-17.21] and 32.76 [15.84-67.89], respectively, for age 65-74 2013s, 75-84 2013s and ≥ 85 2013s, compared with < 55 2013s), to have less advanced disease (odds ratio [95% CI], 0.20 [0.16-0.26], 0.09 [0.06-0.12] and 0.05 [0.02-0.90], respectively, for intermediate, high and very high-risk [locally advanced] or metastatic disease, compared with low-risk disease) and to have had their prostate cancer notified by a private hospital (odds ratio [95% CI], 1.35 [1.10-1.66], compared with public hospital). CONCLUSION: Our data reveal a considerable "stage migration" towards earlier diagnosis of prostate cancer in Victoria and a large increase in the use of radical prostatectomy among men with clinically localised disease.

The Prostate Cancer Registry: monitoring patterns and quality of care for men diagnosed with prostate cancer.

OBJECTIVE: To establish a pilot population-based clinical registry with the aim of monitoring the quality of care provided to men diagnosed with prostate cancer. PATIENTS AND METHODS: All men aged >18 years from the contributing hospitals in Victoria, Australia, who have a diagnosis of prostate cancer confirmed by histopathology report notified to the Victorian Cancer Registry are eligible for inclusion in the Prostate Cancer Registry (PCR). A literature review was undertaken aiming to identify existing quality indicators and source evidence-based guidelines from both Australia and internationally. RESULTS: A Steering Committee was established to determine the minimum dataset, select quality indicators to be reported back to clinicians, identify the most effective recruitment strategy, and provide a governance structure for data requests; collection, analysis and reporting of data; and managing outliers. A minimum dataset comprising 72 data items is collected by the PCR, enabling ten quality indicators to be collected and reported. Outcome measures are risk adjusted according to the established National Comprehensive Cancer Network and Cancer of the Prostate Risk Assessment Score (surgery only) risk stratification model. Recruitment to the PCR occurs concurrently with mandatory notification to the state-based Cancer Registry. The PCR adopts an opt-out consent process to maximize recruitment. The data collection approach is standardized, using a hybrid of data linkage and manual collection, and data collection forms are electronically scanned into the PCR. A data access policy and escalation policy for mortality outliers has been developed. CONCLUSIONS: The PCR provides potential for high-quality population-based data to be collected and managed within a clinician-led governance framework. This approach satisfies the requirement for health services to establish quality assessment, at the same time as providing clinically credible data to clinicians to drive practice improvement.

Update on pharmacogenetics in epilepsy: a brief review.

Recent developments in the pharmacogenetics of antiepileptic drugs provide new prospects for predicting the efficacy of treatment and potential side-effects. Epilepsy is a common, serious, and treatable neurological disorder, yet current treatment is limited by high rates of adverse drug reactions and lack of complete seizure control in a significant proportion of patients. The disorder is especially suitable for pharmacogenetic investigation because treatment response can be quantified and side-effects can be assessed with validated measures. Additionally, there is substantial knowledge of the pharmacodynamics and kinetics of antiepileptic drugs, and some candidate genes implicated in the disorder have been identified. However, recent studies of the association of particular genes and their genetic variants with seizure control and adverse drug reactions have not provided unifying conclusions. This article reviews the published work and summarises the state of research in this area. Future directions for research and the application of this technology to the clinical practice of individualising treatment for epilepsy are discussed.