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The Chartered Care Collection (08/03/2021)

The Chartered Care Collection provides a review of the latest, pertinent publications from the medical literature on aging. I have selected interesting articles that describe some of the most current research that may be relevant to the loved one in your care. Each article will be referenced if you desire to read more of the study, but I will give a brief synopsis of each study so you are aware of the latest research. Let’s get to The Collection!

The Chartered Care Collection

Another month has passed, and it is time for another review of some of the latest research presented in various medical journals.

The first article I want to discuss covers the topic of pain management, specifically for those with nerve pain, called peripheral neuropathy. This type of pain is very common in our population, particularly those with diabetes and those who have neuropathy caused by chemotherapy. The Journal of Pain published an article that studied the drug amitriptyline, an antidepressant, to determine its efficacy in managing pain when used in the topical form. In an effort to avoid narcotics, which are not indicated in the management of neuropathic pain, there is ongoing research to find other efficacious medications to manage this often debilitating pain. There are several adverse side effects of amitriptyline and other antidepressants when taken systemically (by mouth), so this study looked at how well it worked in managing pain when applied topically. This study looked particularly at participants who had chemotherapy-induced neuropathy. Participants were treated with topical Amitriptyline twice a day for one month with the average pain score improving from 6/10 at the start to 3/10 at the end of one month. In addition, mice were also used in the study. Those treated with the topical Amitriptyline also showed an improvement in pain based on withdrawal to pain when compared to those receiving the placebo cream. The mice were then sacrificed and the pain-sensing nerves studied. It showed that the Amitriptyline inhibited the firing response of pain in the nerve fibers sensitive to pain. The findings of this study supported the use of topical Amitriptyline for pain management.

(Related blog post: Options For Medication Management)

The next interesting article I read looked at the age of onset of diabetes and its association with dementia. Diabetes is, unfortunately, a very common illness in the United States. It is associated with an increased risk of dementia. The article, published in JAMA, looked at the association between age of diabetes onset and the subsequent risk of dementia by following over 10,000 participants. This ongoing study, the Whitehall II study, has followed these participants since 1985. Since the start, 16.9% have developed diabetes. Of those that developed diabetes, 8.9% were subsequently diagnosed with dementia. In studying the age of onset of diabetes and age of subsequent diagnosis of dementia, diabetes onset at an early age was strongly associated with dementia. At the age of 70, when comparing those without diabetes, those who had developed diabetes at least 10 years earlier had an increased risk of dementia. The risk of dementia decreased somewhat for those with diabetes 5-10 years earlier, and those with diabetes less than 5 years had only slightly higher risk of developing dementia. 

(Related blog posts: Memory Care for Dad, Caring For Dementia Caregivers, The Voice Of Dementia)

The COVID-19 pandemic  has led to several studies. This particular study, from the journal Nature, followed 23,435 adults treated in the Veterans Health Administration with a diagnosis of COVID-19 but did not require hospitalization. Compared to those who did not have COVID-19, those with COVID-19 not requiring hospitalization had an increased risk of death within six months. They also had an increased risk for respiratory conditions, respiratory failure, neurocognitive disorders and heachaches. In regards to their mental health, those who had COVID-19 without hospitalization also had increased risk of sleep-wake disorders, anxiety and stress. They also showed increased risks of disorders of lipid metabolism and diabetes mellitus and obesity. In addition, there was an increased risk of multiple cardiovascular conditions and gastrointestinal disorders. There is still much to be studied on the why of this finding, but it further supported the negative effects of COVID-19 beyond the acute illness. 

(Related blog posts: What To Expect When Visiting A Nursing Home During COVID-19, Isolating Elderly During The Pandemic, COVID-19 Vaccine, COVID Recovery)

The last study I wanted to talk about for this month was published in British Medical Journal. This article reviewed multiple databases and compared the efficacy of drug and non-drug interventions for symptoms of depression in people with dementia. It specifically looked at interventions that targeted symptoms of depression in patients with dementia and without a diagnosis of major depressive disorder. It showed the most efficacious interventions were those of cognitive stimulation combined with exercise and social interaction, cognitive stimulation combined with a cholinesterase inhibitor (a particular class of antidepressant), and massage and touch therapy. It showed that drug approaches all by themselves were not any more efficacious than usual care.  Thus, the literature review supported the thought that non-drug approaches are associated with a meaningful reduction in symptoms of depression.

(Related blog posts: What Is Geriatric Psychiatry?, Recovery After Stroke)

That sums it up for the Chartered Care Collection for this month. Feel free to read each of these articles in full, and feel free to leave your comments or questions below!

References:

Al-Aly, Z., et al. High Dimensional Characterization of Post-Acute Sequelae of COVID-19. Nature. 2021, April: doi: 10.1038/s41586-021-03553-9. 

Amidei, C., et al. Association between Age at Diaetes Onset and Subsequent Risk of Dementia. JAMA. 2021, April 27; 325(16): 1640-1649.

Genovois, Al., et al, Analgesic Effects of Topical Amitriptyline in Patients with Chemotherapy-Induced Peripheral Neuropathy: Mechanistic Insights from Studies in Mice. J Pain. 2021, April; 22 (4): 440-453.

Watt, J., et al. Comparative Efficacy of Interventions for Reducing Sumptoms of Depression in People with Dementia: Systematic Review and Network Meta-analysis. BMJ. 2021; 372: n532. Published 2021 March 24. Doi: 10.1136/bmj.n532.

Share your thoughts on these articles in the Comments section.

© 2021 Jessica Kluetz, DO