Mild Cognitive Impairment, Elderly, Substance-Related Disorders
Conditions
Keywords
addiction, cognition, impulsivity, neuropsychology, prescription drug misuse, dependence
Brief summary
The project focuses on investigating problematic medication use, especially overuse of potentially addictive drugs among the elderly. The investigators aim firstly to develop and validate instruments for detecting and describing behavioral aspects and consequences of dependence on, and misuse of, prescription medication among elderly. In addition to evaluating diagnostic utility of screening instruments, the investigators aim to identify and report characteristics, risk factors and consequences of medication misuse and dependence among the elderly.
Detailed description
Elderly represent a particularly vulnerable group with many contributing factors including age-related multifactorial morbidity, cognitive function, polypharmacy, dependence and multiple prescribers with suboptimal communication. Centrally active pain killers and sedative/hypnotic medications give increased risk of addiction, adverse drug events, reduced physical and/or cognitive function. The project comprises diagnostic accuracy, descriptive screening, cross-sectional and case-control studies, with aims to: i) assess diagnostic utility of instruments for elderly patients; ii) describe risk factors for medication misuse and dependence; iii) describe consequences of the use of centrally active medications among elderly compared to a control population. Moreover, the investigators aim to examine the association between medication misuse and changes in cognitive function, focusing on deficits in specific domains of cognition. An additional aim is to explore the possibility of dissociating such cognitive changes from other causes of mild cognitive impairment (MCI) associated with development of dementia.
Interventions
DIAGNOSTIC_TESTSubstance misuse screening
Diagnostic and Statistical manual of mental disorders, version 4 (DSM-IV)/MINI-international Neuropsychiatric interview (MINI interview) for Diagnostics of dependence, additional questions for DSM-V classification, severity of dependence scale (SDS)
DIAGNOSTIC_TESTEQ-5D
Health related Quality of life
DIAGNOSTIC_TESTImpulsivity screening
Barratts impulsivity test v. 11, Behavioural inhibition/behavioural activation test
DIAGNOSTIC_TESTCognitive screening
Minimental state examination (MMSE), Hospital anxiety and depression scale (HADS), Trail-making test, clock drawing test
DIAGNOSTIC_TESTFunctional tests
Timed up and go (TUG), Single leg balancing test (SLB)
DIAGNOSTIC_TESTCognistat
Assessment of cognitive domains
DIAGNOSTIC_TESTNeuropsychological profiling
Controlled Oral Word Association Test, Categorical fluency tests, Wechsler Adult Intelligence Scale, Color-Word Interference Test (CWIT) from the Delis-Kaplan Executive Function test
OTHERClinical interview
Interview for sociodemographics, utilisation of health care, economic varables, The De Jong Gierveld Loneliness Scale
OTHERMedication use
Detailed screen of used medications, interactions, side effects in electronic patient registry
OTHERComorbidity
Charlson comorbidity index and Cumulated illness rating scale (CIRS) based on electronic patient registry
Sponsors
King's College London
University of Oslo
University Hospital, Akershus
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
65 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Admitted to geriatric or Neurology dept of hospital during inclusion time
Exclusion criteria
* MMSE \< 21, * diagnosis of pre-existing severe depression or psychotic disease, * pre-existing dementia diagnosis, * new pain requiring start-up of central pain killers not previously used, * Palliative treatment. * Insufficient Norwegian language * Serious visual disturbance and hearing impairment * Strongly reduced general health precluding partcipation in interview and questionnaires
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Medication misuse y/n | Past year prior to in-hospital stay (data collected within 2 weeks of admission) | Use of any of: opiates/benzodiazepine/Z-hypnotics \>5 days per week for \>3 months |
| Dependence y/n | Within 2 weeks of admission | DSM-IV defined substance dependence assessed by MINI interview |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| MMSE | Within 2 weeks of admission | Numerical score of cognitive function |
| COGNISTAT | Within 2 weeks of admission | Cognitive profile |
| EQ-5D | Within 2 weeks of admission | Quality of life |
| BIS-11 | Within 2 weeks of admission | Impulsivity score |
| BIS/BAS score | Within 2 weeks of admission | Behavioura inhibition/activation score |
| TUG | Within 2 weeks of admission | Functional test score (time in secs) |
| SLB | Within 2 weeks of admission | Functional test score (time in secs) |
| Neuropsychological profiles | Within 2 weeks of admission | Tests as listed |
| MCI - Mild cognitive impairment | Within 2 weeks of admission | Defined by MMSE \< 26 |
| No.of inappropriate medications for elderly during in-hospital stay | Within 2 weeks of admission | No.of inappropriate medications as defined by NORGEP criteria |
| No.of inappropriate medications for elderly at discharge | Within 2 weeks of admission | No.of inappropriate medications as defined by NORGEP criteria |
| Substance use disorder | Within 2 weeks | DSM-IV criteria assessed through additional questions to MINI interview |
| Use of addictive medication y/n | Within 2 weeks of admission | Prescription use of any of the following: opiates, benzodiazepines, Z-hypnotics |
| No of days of use of defined addictive medications/month | Within 2 weeks of admission | No. days of use of any of the following: opiates, benzodiazepines, Z-hypnotics |
| No. of possible side effects | Within 2 weeks of admission | No. possible side effects of any of the following: opiates, benzodiazepines, Z-hypnotics |
| No. of possible serious interactions | Within 2 weeks of admission | No. possible serious interactions of any of the following: opiates, benzodiazepines, Z-hypnotics |
| No.of inappropriate medications for elderly at admission | Within 2 weeks of admission | No.of inappropriate medications as defined by NORGEP criteria (Norwegian general practice criteria) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Mortality | 2 years | Crude mortality from patient registry data |
| Total readmission days | 5 years | Total number of readmission days |
| Readmission rate | 5 years | Number of readmissions after index admission |
Countries
Norway
Outcome results
None listed