Pain Reporting, Opiate Dosing, and the Adverse Effects of Opiates After Hip or Knee Replacement in Patients 60 Years Old or Older.

Pain reporting, opiate dosing, and the adverse effects of opiates after hip or knee replacement in patients 60 years old or older.

Geriatr Orthop Surg Rehabil. 2012 Mar; 3(1): 3-7
Petre BM, Roxbury CR, McCallum JR, Defontes KW, Belkoff SM, Mears SC

Our goal was to determine whether there were age-related differences in pain, opiate use, and opiate side effects after total hip or knee arthroplasty in patients 60 years old or older. We hypothesized that there would be no significant differences between age groups in (1) mean pain score, (2) opiate use after adjusting for pain, or (3) opiate side effects after adjusting for opiate use and pain score. We retrospectively reviewed the electronic and paper charts of all patients undergoing total joint replacements at our institution over 3 years who met the following criteria: (1) 60 years old or older, (2) primary single total knee or total hip replacement, and (3) no preoperative dementia. Preoperative, intraoperative, and postoperative course data were collected using a customized data entry process and database. We divided the patients into 2 age groups, those 60 to 79 years old and those 80 years old or older. Using a marginal model with the panel variable of postoperative day, we investigated the associations between age group and pain, age group and pain adjusting for opiate use, and age group and complications (respiratory depression, naloxone usage as a measure of respiratory arrest, delirium, constipation, and urinary retention) adjusting for opiate use (Xtgee, Stata10, Stata Corp. LP, College Station, Texas). Significance was set at P < .05. We found no significant difference in pain scores between groups, but the older group had significantly fewer opiates prescribed yet significantly more side effects, including delirium (odds ratio 4.2), than did the younger group, even after adjusting for opiate dose and pain score. HubMed – depression


Elevated plasma homocysteine level in vascular dementia reflects the vascular disease process.

Dement Geriatr Cogn Dis Extra. 2013 Jan; 3(1): 16-24
Nilsson K, Gustafson L, Hultberg B

Patients with vascular dementia (VaD) exhibit particularly elevated levels of plasma total homocysteine (tHcy) compared to patients with other psychogeriatric diseases.We investigated the main determinants (age, renal impairment, cobalamin/folate status and presence of extracerebral vascular disease) of plasma tHcy in 525 patients with VaD. Furthermore, 270 patients with depression were used as a reference group to reveal the potential specificity of elevated plasma tHcy in patients with VaD.Elevated plasma tHcy levels in patients with VaD could only partly be attributed to cobalamin/folate deficiency or renal impairment. Plasma tHcy might also be related to the vascular disease process since patients with depression and vascular disease exhibited similar plasma tHcy levels to patients with VaD.Our findings suggest that elevated plasma tHcy might be a sensitive marker for the vascular disease process in patients with VaD and that the level also is a reflection of changes in the other main determinants of plasma tHcy. HubMed – depression


Depressive symptoms in Parkinson’s disease and in non-neurological medical illnesses.

Neuropsychiatr Dis Treat. 2013; 9: 389-96
Assogna F, Fagioli S, Cravello L, Meco G, Pierantozzi M, Stefani A, Imperiale F, Caltagirone C, Pontieri FE, Spalletta G

Patients with neurological and non-neurological medical illnesses very often complain of depressive symptoms that are associated with cognitive and functional impairments. We compared the profile of depressive symptoms in Parkinson’s disease (PD) patients with that of control subjects (CS) suffering from non-neurological medical illnesses.One-hundred PD patients and 100 CS were submitted to a structured clinical interview for identification of major depressive disorder (MDD) and minor depressive disorder (MIND), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR), criteria. The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory (BDI) were also administered to measure depression severity.When considering the whole groups, there were no differences in depressive symptom frequency between PD and CS apart from worthlessness/guilt, and changes in appetite reduced rates in PD. Further, total scores and psychic and somatic subscores of HDRS and BDI did not differ between PD and CS. After we separated PD and CS in those with MDD, MIND, and no depression (NODEP), comparing total scores and psychic/somatic subscores of HDRS and BDI, we found increased total depression severity in NODEP PD and reduced severity of the psychic symptoms of depression in MDD PD, with no differences in MIND. However, the severity of individual symptom frequency of depression was not different between PD and CS in MDD, MIND, and NODEP groups.Although MDD and MIND phenomenology in PD may be very similar to that of CS with non-neurological medical illnesses, neurological symptoms of PD may worsen (or confound) depression severity in patients with no formal/structured DSM-IV-TR, diagnosis of depressive mood disorders. Thus, a thorough assessment of depression in PD should take into consideration the different impacts of neurological manifestations on MDD, MIND, and NODEP. HubMed – depression


Association between bispectral index and age and use of sedative drugs in high spinal anaesthesia.

J Int Med Res. 2013 Feb 7;
Yi Y, Heo D, Son HJ, Joo Y, Lee SJ, Hwang B

OBJECTIVES: A prospective, randomized, double-blind study using bispectral index values to objectively quantify the sedative effect of high spinal anaesthesia in patients stratified according to age, and to determine whether sedative drugs are associated with additional adverse respiratory and haemodynamic effects in older patients. METHODS: Patients who were electively scheduled for lower limb or abdominal surgery were recruited and allocated into one of three groups according to their age and whether midazolam and fentanyl were used: younger (20-40 years); and older (61-80 years) with or without midazolam and fentanyl intravenous infusion. RESULTS: The study recruited a total of 90 patients (n?=?30 per group). Intraoperative bispectral index values were significantly lower than preoperative values in all groups. Patients in the older age group had significantly lower intraoperative bispectral index values than younger patients. Older patients were significantly more likely to experience respiratory depression (arterial oxyhaemoglobin saturation <90%) than younger patients. CONCLUSIONS: The sedative effect of high spinal anaesthesia is greater in older patients than in younger patients, with an increase in respiratory instability. HubMed – depression


Depressive Symptoms Among Heavy Cigarette Smokers: The Influence of Daily Rate, Gender, and Race.

Nicotine Tob Res. 2013 Apr 8;
Payne TJ, Ma JZ, Crews KM, Li MD

INTRODUCTION: Cigarette smokers experience higher levels of depressive symptoms and are more likely to be diagnosed with depressive disorders than nonsmokers. To date, the nature of the smoking-depression relationship has not been adequately studied among heavy smokers, a group at elevated risk for poor health outcomes. In this study, we examined depressive symptom expression among heavy smokers while considering the moderating roles of smoking status, gender, and race. We also explored whether amount of tobacco usually consumed had an impact. METHODS: We extracted data from a large, highly nicotine-dependent, nontreatment cigarette smoking study sample (N = 6,158). Participants who consented were screened for major exclusions, and they completed questionnaires. RESULTS: Smokers reported a higher, clinically meaningful level of depressive symptoms relative to nonsmokers (27.3% of smokers vs. 12.5% of nonsmokers) scored above the clinical cutoff on the Center for Epidemiological Studies Depression (CES-D) scale (p < .001), which differed among race × gender subgroups. Further, amount of daily intake was inversely associated with self-report of depressive symptoms. For every 10-cigarette increment, the likelihood of scoring above the CES-D clinical cutoff decreased by 62% (p < .0001). CONCLUSIONS: These findings improve our understanding of tobacco's influence on depressive symptom expression among heavy smokers, with implications for tailoring evidence-based tobacco treatments. HubMed – depression