Disease Management Update
Volume IV, No. 52
April 24, 2008
Dear Healthcare Intelligence Network Client,
This week's Disease Management update looks at cognitive impairment and decline in the elderly. A study from the Mayo Clinic suggests exercise can reduce the risk of cognitive impairments such as Alzheimer's disease, while the American Academy of Neurology cautions certain drugs may increase cognitive decline.
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Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update
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Table of Contents
- Using Anticholinergic Drugs May Increase Cognitive Decline in Older People
- Disease Management Q&A: Conducting Geriatric Depression Scale and Mini Mental Status Exams
- HealthSounds Podcast: Managing Transitions to Care for the Frail Elderly
- Exercise Can Reduce the Risk of Mild Cognitive Impairment
- Survey of the Month: Personal Health Records for Consumers
- Depression and Disease Management: Beyond the Stigma to Identification and Treatment
1. Using Anticholinergic Drugs May Increase Cognitive Decline in Older People
Anticholinergic drugs, such as medicines for stomach cramps, ulcers, motion sickness and urinary incontinence, may cause older people to experience greater decline in their thinking skills than people not taking the drugs.
The study, which looked at the effects of taking a medication with anticholinergic properties on the annual change in thinking abilities of 870 Catholic nuns and clergy members who were an average of 75 years old, found those people who took anticholinergic drugs saw their rate of cognitive function decline 1.5 times as fast as those people who did not take the drugs. All of the participants underwent annual cognitive tests and reported their medication use for an average follow-up period of eight years. During the study, 679 people took at least one medication with anticholinergic properties.
To learn more about this study, please visit:
2. Disease Management Q&A: Conducting Geriatric Depression Scale and Mini Mental Status Exams
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Gregg Lehman, Ph.D., president and chief CEO of HealthFitness Corporation. Lehman is also a member of the board of directors at INSPIRIS, Inc., where he was serving as president and CEO when he responded to this question.
Question: How do you conduct your geriatric depression scale and mini mental status exams on the frail elderly? Is it telephonic? When depression is diagnosed, what steps are taken to address it?
Response: In many cases we work with the attending physician. When we do our assessment and identify depression, for example, we evaluate the patient, the degree of impairment and the medications. Itís important to determine if the medications are appropriate. This is a coordinated effort between the physician and the nurse practitioner.
The evaluation is conducted on site at the bedside. This frail elderly population often does not have a telephone in their room because of their high levels of dementia or cognitive impairment. In many cases, we can only do the evaluation face to face.
For more information on coordinating care transitions for the elderly and dually eligible, please visit:
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3. HealthSounds Podcast: Managing Transitions to Care for the Frail Elderly
In this week's disease management podcast, Dr. John Charde, vice president of strategic development for Enhanced Care Initiatives, and Laurie Russell, senior director of health solutions for XLHealth, explore how to create effective care management approaches for the frail elderly.
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4. Exercise Can Reduce the Risk of Mild Cognitive Impairment
Regular physical exercise may help protect against mild cognitive impairment, a disorder of the brain that affects nerve cells involved in thinking abilities, according to a new study from the Mayo Clinic.
Researchers randomly identified 868 individuals 70 to 89 years old. Of those, 128 had mild cognitive impairment and 740 were cognitively normal. The team conducted surveys to gather data on the individuals' physical exercise between the ages of 50 and 65 and one year prior to the survey. They found that moderate physical exercise two to five times per week during the ages of 50 to 65 was associated with a reduced risk of mild cognitive impairment. However, the individual's exercise habits one year prior to the survey did not appear to be associated with a reduced risk.
To find out more about this story, please visit:
5. Survey of the Month: Personal Health Records for Consumers
Complete our online survey on personal health records for consumers by April 30, and you'll get a free executive summary of the compiled results.
To participate in this survey and receive its results, please visit:
6. Depression and Disease Management: Beyond the Stigma to Identification and Treatment
With the economic burden of depression and its co-morbidities estimated at $83 billion annually --- hitting employers hardest in the form of lost workdays, compromised productivity and workplace accidents --- the healthcare industry is formalizing programs for early identification, adequate treatment and medical adherence of individuals with depressive disorder. This is no small task, given the challenges of screening depression severity, overcoming the stigma of mental illness, and educating primary care physicians on the value of this initiative. In an online survey, the Healthcare Intelligence Network (HIN) asked its audience for details on initiatives for depression and disease management.
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