Roxanna Guilford-Blake

ATLANTA — Although most parents in a national survey say that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention. However, only 52% of parents of boys aged 9–17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission rather than disease protection, even though there's no evidence the vaccine protects against transmission, Dr. Dempsey noted in an interview.

In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine—more than those who cited preventing male cancers (93%) or genital warts (91%). Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility—but not perceived severity—was also a factor. Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, they noted. The research is a starting point; it may help identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Disclosures: Dr. Dempsey serves on an advisory board for Merck & Co.

ATLANTA — Although most parents in a national survey say that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention. However, only 52% of parents of boys aged 9–17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission rather than disease protection, even though there's no evidence the vaccine protects against transmission, Dr. Dempsey noted in an interview.

In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine—more than those who cited preventing male cancers (93%) or genital warts (91%). Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility—but not perceived severity—was also a factor. Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, they noted. The research is a starting point; it may help identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Disclosures: Dr. Dempsey serves on an advisory board for Merck & Co.

ATLANTA — Although most parents in a national survey say that they believe the male HPV vaccine is important, only about half said they would have their own sons vaccinated.

Of the 1,178 parents of boys aged 18 years and younger who responded, 90% said they believed the male HPV vaccination was important in general, Dr. Amanda Dempsey of the University of Michigan, Ann Arbor, reported in a poster at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention. However, only 52% of parents of boys aged 9–17 years indicated that they would have their own son vaccinated in the near future, and only 48% of the parents of boys aged 8 years and younger said they would do so when their son was older.

Parents appeared to be more motivated by the possibility of transmission rather than disease protection, even though there's no evidence the vaccine protects against transmission, Dr. Dempsey noted in an interview.

In data not reported on the poster, 100% of parents cited decreased transmission as a reason to get the vaccine—more than those who cited preventing male cancers (93%) or genital warts (91%). Perceived benefits to vaccination had the largest impact on parental vaccination intention; perceived susceptibility—but not perceived severity—was also a factor. Parents having less than a high school education were associated with decreased vaccination intention for older, but not younger, boys.

The study was conducted before the vaccine was licensed for males, and that may have had an impact on parental decisions, they noted. The research is a starting point; it may help identify key messages that resonate with parents. Intervention studies are underway to explore ways to tailor effective messages.

Disclosures: Dr. Dempsey serves on an advisory board for Merck & Co.

ATLANTA — During administration of the new quadrivalent meningococcal conjugate vaccine Menveo, what happens if you fail to reconstitute the Men A powder with the Men CWY liquid?

The short answer is that you end up with “orphan A” that cannot be used; you then need to determine whether the patient needs a subsequent full dose of the meningococcal vaccine, said Dr. William Atkinson of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases.

You cannot reconstitute the powder with another liquid (such as sterile water); you must use the right diluent, he said.

“Novartis writes this all over the box,” Dr. Atkinson noted.

What happens next depends on the particular patient.

“You have to factor in the epidemiology of meningococcal disease, which says that we don't have, for all practical purposes, any [serogroup] A in this country.”

So whether another dose needs to be administered depends on the individual, he explained:

▸ If the patient is a student getting ready for college, he or she probably doesn't need the Neisseria meningitidis serogroup A component.

▸ In contrast, if the patient is a missionary headed for central Africa, he or she needs the N. meningitidis serogroup A. In that situation, the provider must readminister the entire dose.

The question, posed during a Q&A session at the National Immunization Conference sponsored by the CDC, ok didn't surprise Dr. Atkinson.

“We knew people … would use it incorrectly and give the liquid without reconstituting it,” he said

Dr. Atkinson added that the CDC has been discussing this particular issue with Menveo manufacturer Novartis Vaccines and Diagnostics Inc.

Dr. Atkinson said he did not have an relevant financial disclosures.

ATLANTA — During administration of the new quadrivalent meningococcal conjugate vaccine Menveo, what happens if you fail to reconstitute the Men A powder with the Men CWY liquid?

The short answer is that you end up with “orphan A” that cannot be used; you then need to determine whether the patient needs a subsequent full dose of the meningococcal vaccine, said Dr. William Atkinson of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases.

You cannot reconstitute the powder with another liquid (such as sterile water); you must use the right diluent, he said.

“Novartis writes this all over the box,” Dr. Atkinson noted.

What happens next depends on the particular patient.

“You have to factor in the epidemiology of meningococcal disease, which says that we don't have, for all practical purposes, any [serogroup] A in this country.”

So whether another dose needs to be administered depends on the individual, he explained:

▸ If the patient is a student getting ready for college, he or she probably doesn't need the Neisseria meningitidis serogroup A component.

▸ In contrast, if the patient is a missionary headed for central Africa, he or she needs the N. meningitidis serogroup A. In that situation, the provider must readminister the entire dose.

The question, posed during a Q&A session at the National Immunization Conference sponsored by the CDC, ok didn't surprise Dr. Atkinson.

“We knew people … would use it incorrectly and give the liquid without reconstituting it,” he said

Dr. Atkinson added that the CDC has been discussing this particular issue with Menveo manufacturer Novartis Vaccines and Diagnostics Inc.

Dr. Atkinson said he did not have an relevant financial disclosures.

ATLANTA — During administration of the new quadrivalent meningococcal conjugate vaccine Menveo, what happens if you fail to reconstitute the Men A powder with the Men CWY liquid?

The short answer is that you end up with “orphan A” that cannot be used; you then need to determine whether the patient needs a subsequent full dose of the meningococcal vaccine, said Dr. William Atkinson of the Centers for Disease Control and Prevention's National Center for Immunization and Respiratory Diseases.

You cannot reconstitute the powder with another liquid (such as sterile water); you must use the right diluent, he said.

“Novartis writes this all over the box,” Dr. Atkinson noted.

What happens next depends on the particular patient.

“You have to factor in the epidemiology of meningococcal disease, which says that we don't have, for all practical purposes, any [serogroup] A in this country.”

So whether another dose needs to be administered depends on the individual, he explained:

▸ If the patient is a student getting ready for college, he or she probably doesn't need the Neisseria meningitidis serogroup A component.

▸ In contrast, if the patient is a missionary headed for central Africa, he or she needs the N. meningitidis serogroup A. In that situation, the provider must readminister the entire dose.

The question, posed during a Q&A session at the National Immunization Conference sponsored by the CDC, ok didn't surprise Dr. Atkinson.

“We knew people … would use it incorrectly and give the liquid without reconstituting it,” he said

Dr. Atkinson added that the CDC has been discussing this particular issue with Menveo manufacturer Novartis Vaccines and Diagnostics Inc.

Dr. Atkinson said he did not have an relevant financial disclosures.

ATLANTA — Physicians who provide immunizations to children need to be cognizant of potential injuries associated with postvaccination syncope—and with the recommendations for preventing them, based on a national survey of physicians and a review of Vaccine Adverse Event Reporting System data.

Although serious injuries are rare, prevention of postvaccination syncope is crucial, according to presenters at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Current guidelines—including those from the CDC's Advisory Committee on Immunization Practices (ACIP)—strongly recommend observing pediatric patients for 15 minutes after the vaccination, but most physicians were unaware of or did not adhere to that guidance, based on data presented in a session on postvaccination adverse events.

In fact, Dr. Angela Calugar of the CDC noted there's been a nearly sixfold increase in the number of syncope events reported to the Vaccine Adverse Event Reporting System (VAERS) in 2008, compared with 2006 (821 vs. 146).

Low Adherence, Low Awareness

Little research has been conducted into how well physicians adhere to postvaccination syncope recommendations, noted Dr. Christina Suh of the University of Colorado at Denver.

She reported on a national survey of physicians who immunize adolescents (conducted from October 2008 through January 2009). Respondents included 321 pediatricians and 299 family physicians.

Most (61%) reported that postvaccination syncope or near syncope had occurred in their practices, but fewer than half were familiar with the ACIP recommendations.

More pediatricians than family physicians were aware of the ACIP recommendations (37% vs. 24%), but fewer pediatricians thought their practices could easily adhere to them (69% vs. 84%).

Fifty-one percent of the pediatricians and 59% of the family physicians indicated that they routinely observe adolescent patients following vaccinations.

Of all the physicians who reported observing patients, only 31% (34% of the pediatricians and 27% of the family physicians) did so for the recommended 15 minutes or longer.

Overall, only 18% of pediatricians and 16% of family physicians adhered to the 15-minute recommendation, Dr. Suh reported.

Physicians cited several barriers, including lack of room space (76% of pediatricians and 65% of family physicians) and lack of staff (69% of pediatricians and 56% of family physicians).

In multivariate modeling, the following factors were associated with adherence: practicing in a hospital, university, or community health center (compared with private practice settings); awareness of ACIP recommendations; a belief that postvaccination syncope can result in serious injuries; adequate room space; and adequate staff to observe patients.

Dr. Suh called for more efforts to educate physicians about the potential for injuries from postvaccination syncope in adolescents, to disseminate guidance, and to identify ways to better implement these recommendations in settings with limited staff and room space.

Surveying VAERS Reporters

Early findings from the survey of VAERS reporters yielded similar findings and highlighted that postvaccination syncope can result in serious injury.

Dr. Calugar presented preliminary data based on 114 cases reported to VAERS between Jan. 1, and Aug. 31, 2009. Most (92) involved females. The mean age for females was 17.3 years and for males, was 16.2.

Thirty-one (27%) of those cases involved falls resulting in injury, three of which were serious.

Of the 88 cases in which the time between vaccination and syncope was reported, 76 (86%) involved fainting within the first 15 minutes. Investigators asked reporters if the provider had a policy for patients to wait after all vaccines. Fifty-six (49%) said no, 44 (39%) said yes, and 14 (12%) did not know. As a result of the incident, nine providers subsequently instituted such a policy.

Not only are the injuries themselves worrisome, but patient fear of such injuries may affect vaccine acceptance, Dr. Calugar warned.

Gardasil (quadrivalent human papillomavirus vaccine), Menactra (meningococcal polysaccharide diphtheria toxoid conjugate vaccine), and tetanus-diphtheria-pertussis vaccine administered alone or in combination were the most frequently reported among the sample of cases; these vaccines are administered to adolescents, Dr. Calugar said. She noted that at the time of the survey, Gardasil was recommended to females in a three-dose series; this also may have contributed to the higher weight of this vaccine among the VAERS reports.

Disclosures: None was reported.

My Take

Time, Lack of Space Are Barriers

I was unaware of the ACIP recommendation to observe children for 15 minutes after a vaccination, and we do not have a formal office policy to do so. The nurses routinely screen kids after shots, and if they seem pale or complain of being dizzy or nauseated, they lie down on the exam table for a few minutes (with a cool towel on the forehead and a cup of cold water to drink) until they feel better.

Keeping all children in the exam room for 15 minutes after the visit would be problematic. An office visit is scheduled for 15 minutes so that would prevent another visit after each exam that includes an immunization, which would have a significant impact on our productivity.

We fortunately have not seen any serious injuries after fainting in the office. Ironically, after discussing this with the nurses this morning, a child fainted later the same morning and then had a brief seizure after receiving DTaP (diphtheria-tetanus-acellular pertussis vaccine) and IPV (inactivated polio vaccine)! She was 4 years old. She was fine after a few minutes but the mom (and the nurses) were a little upset. Again, the main problem we see in teenagers who faint is extreme embarrassment.

H. GARRY GARDNER, M.D., is a pediatrician in private practice in Darien, Ill. He said he had no conflicts of interest relevant to this article.

ATLANTA — Physicians who provide immunizations to children need to be cognizant of potential injuries associated with postvaccination syncope—and with the recommendations for preventing them, based on a national survey of physicians and a review of Vaccine Adverse Event Reporting System data.

Although serious injuries are rare, prevention of postvaccination syncope is crucial, according to presenters at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Current guidelines—including those from the CDC's Advisory Committee on Immunization Practices (ACIP)—strongly recommend observing pediatric patients for 15 minutes after the vaccination, but most physicians were unaware of or did not adhere to that guidance, based on data presented in a session on postvaccination adverse events.

In fact, Dr. Angela Calugar of the CDC noted there's been a nearly sixfold increase in the number of syncope events reported to the Vaccine Adverse Event Reporting System (VAERS) in 2008, compared with 2006 (821 vs. 146).

Low Adherence, Low Awareness

Little research has been conducted into how well physicians adhere to postvaccination syncope recommendations, noted Dr. Christina Suh of the University of Colorado at Denver.

She reported on a national survey of physicians who immunize adolescents (conducted from October 2008 through January 2009). Respondents included 321 pediatricians and 299 family physicians.

Most (61%) reported that postvaccination syncope or near syncope had occurred in their practices, but fewer than half were familiar with the ACIP recommendations.

More pediatricians than family physicians were aware of the ACIP recommendations (37% vs. 24%), but fewer pediatricians thought their practices could easily adhere to them (69% vs. 84%).

Fifty-one percent of the pediatricians and 59% of the family physicians indicated that they routinely observe adolescent patients following vaccinations.

Of all the physicians who reported observing patients, only 31% (34% of the pediatricians and 27% of the family physicians) did so for the recommended 15 minutes or longer.

Overall, only 18% of pediatricians and 16% of family physicians adhered to the 15-minute recommendation, Dr. Suh reported.

Physicians cited several barriers, including lack of room space (76% of pediatricians and 65% of family physicians) and lack of staff (69% of pediatricians and 56% of family physicians).

In multivariate modeling, the following factors were associated with adherence: practicing in a hospital, university, or community health center (compared with private practice settings); awareness of ACIP recommendations; a belief that postvaccination syncope can result in serious injuries; adequate room space; and adequate staff to observe patients.

Dr. Suh called for more efforts to educate physicians about the potential for injuries from postvaccination syncope in adolescents, to disseminate guidance, and to identify ways to better implement these recommendations in settings with limited staff and room space.

Surveying VAERS Reporters

Early findings from the survey of VAERS reporters yielded similar findings and highlighted that postvaccination syncope can result in serious injury.

Dr. Calugar presented preliminary data based on 114 cases reported to VAERS between Jan. 1, and Aug. 31, 2009. Most (92) involved females. The mean age for females was 17.3 years and for males, was 16.2.

Thirty-one (27%) of those cases involved falls resulting in injury, three of which were serious.

Of the 88 cases in which the time between vaccination and syncope was reported, 76 (86%) involved fainting within the first 15 minutes. Investigators asked reporters if the provider had a policy for patients to wait after all vaccines. Fifty-six (49%) said no, 44 (39%) said yes, and 14 (12%) did not know. As a result of the incident, nine providers subsequently instituted such a policy.

Not only are the injuries themselves worrisome, but patient fear of such injuries may affect vaccine acceptance, Dr. Calugar warned.

Gardasil (quadrivalent human papillomavirus vaccine), Menactra (meningococcal polysaccharide diphtheria toxoid conjugate vaccine), and tetanus-diphtheria-pertussis vaccine administered alone or in combination were the most frequently reported among the sample of cases; these vaccines are administered to adolescents, Dr. Calugar said. She noted that at the time of the survey, Gardasil was recommended to females in a three-dose series; this also may have contributed to the higher weight of this vaccine among the VAERS reports.

Disclosures: None was reported.

My Take

Time, Lack of Space Are Barriers

I was unaware of the ACIP recommendation to observe children for 15 minutes after a vaccination, and we do not have a formal office policy to do so. The nurses routinely screen kids after shots, and if they seem pale or complain of being dizzy or nauseated, they lie down on the exam table for a few minutes (with a cool towel on the forehead and a cup of cold water to drink) until they feel better.

Keeping all children in the exam room for 15 minutes after the visit would be problematic. An office visit is scheduled for 15 minutes so that would prevent another visit after each exam that includes an immunization, which would have a significant impact on our productivity.

We fortunately have not seen any serious injuries after fainting in the office. Ironically, after discussing this with the nurses this morning, a child fainted later the same morning and then had a brief seizure after receiving DTaP (diphtheria-tetanus-acellular pertussis vaccine) and IPV (inactivated polio vaccine)! She was 4 years old. She was fine after a few minutes but the mom (and the nurses) were a little upset. Again, the main problem we see in teenagers who faint is extreme embarrassment.

H. GARRY GARDNER, M.D., is a pediatrician in private practice in Darien, Ill. He said he had no conflicts of interest relevant to this article.

ATLANTA — Physicians who provide immunizations to children need to be cognizant of potential injuries associated with postvaccination syncope—and with the recommendations for preventing them, based on a national survey of physicians and a review of Vaccine Adverse Event Reporting System data.

Although serious injuries are rare, prevention of postvaccination syncope is crucial, according to presenters at the National Immunization Conference sponsored by the Centers for Disease Control and Prevention.

Current guidelines—including those from the CDC's Advisory Committee on Immunization Practices (ACIP)—strongly recommend observing pediatric patients for 15 minutes after the vaccination, but most physicians were unaware of or did not adhere to that guidance, based on data presented in a session on postvaccination adverse events.

In fact, Dr. Angela Calugar of the CDC noted there's been a nearly sixfold increase in the number of syncope events reported to the Vaccine Adverse Event Reporting System (VAERS) in 2008, compared with 2006 (821 vs. 146).

Low Adherence, Low Awareness

Little research has been conducted into how well physicians adhere to postvaccination syncope recommendations, noted Dr. Christina Suh of the University of Colorado at Denver.

She reported on a national survey of physicians who immunize adolescents (conducted from October 2008 through January 2009). Respondents included 321 pediatricians and 299 family physicians.

Most (61%) reported that postvaccination syncope or near syncope had occurred in their practices, but fewer than half were familiar with the ACIP recommendations.

More pediatricians than family physicians were aware of the ACIP recommendations (37% vs. 24%), but fewer pediatricians thought their practices could easily adhere to them (69% vs. 84%).

Fifty-one percent of the pediatricians and 59% of the family physicians indicated that they routinely observe adolescent patients following vaccinations.

Of all the physicians who reported observing patients, only 31% (34% of the pediatricians and 27% of the family physicians) did so for the recommended 15 minutes or longer.

Overall, only 18% of pediatricians and 16% of family physicians adhered to the 15-minute recommendation, Dr. Suh reported.

Physicians cited several barriers, including lack of room space (76% of pediatricians and 65% of family physicians) and lack of staff (69% of pediatricians and 56% of family physicians).

In multivariate modeling, the following factors were associated with adherence: practicing in a hospital, university, or community health center (compared with private practice settings); awareness of ACIP recommendations; a belief that postvaccination syncope can result in serious injuries; adequate room space; and adequate staff to observe patients.

Dr. Suh called for more efforts to educate physicians about the potential for injuries from postvaccination syncope in adolescents, to disseminate guidance, and to identify ways to better implement these recommendations in settings with limited staff and room space.

Surveying VAERS Reporters

Early findings from the survey of VAERS reporters yielded similar findings and highlighted that postvaccination syncope can result in serious injury.

Dr. Calugar presented preliminary data based on 114 cases reported to VAERS between Jan. 1, and Aug. 31, 2009. Most (92) involved females. The mean age for females was 17.3 years and for males, was 16.2.

Thirty-one (27%) of those cases involved falls resulting in injury, three of which were serious.

Of the 88 cases in which the time between vaccination and syncope was reported, 76 (86%) involved fainting within the first 15 minutes. Investigators asked reporters if the provider had a policy for patients to wait after all vaccines. Fifty-six (49%) said no, 44 (39%) said yes, and 14 (12%) did not know. As a result of the incident, nine providers subsequently instituted such a policy.

Not only are the injuries themselves worrisome, but patient fear of such injuries may affect vaccine acceptance, Dr. Calugar warned.

Gardasil (quadrivalent human papillomavirus vaccine), Menactra (meningococcal polysaccharide diphtheria toxoid conjugate vaccine), and tetanus-diphtheria-pertussis vaccine administered alone or in combination were the most frequently reported among the sample of cases; these vaccines are administered to adolescents, Dr. Calugar said. She noted that at the time of the survey, Gardasil was recommended to females in a three-dose series; this also may have contributed to the higher weight of this vaccine among the VAERS reports.

Disclosures: None was reported.

My Take

Time, Lack of Space Are Barriers

I was unaware of the ACIP recommendation to observe children for 15 minutes after a vaccination, and we do not have a formal office policy to do so. The nurses routinely screen kids after shots, and if they seem pale or complain of being dizzy or nauseated, they lie down on the exam table for a few minutes (with a cool towel on the forehead and a cup of cold water to drink) until they feel better.

Keeping all children in the exam room for 15 minutes after the visit would be problematic. An office visit is scheduled for 15 minutes so that would prevent another visit after each exam that includes an immunization, which would have a significant impact on our productivity.

We fortunately have not seen any serious injuries after fainting in the office. Ironically, after discussing this with the nurses this morning, a child fainted later the same morning and then had a brief seizure after receiving DTaP (diphtheria-tetanus-acellular pertussis vaccine) and IPV (inactivated polio vaccine)! She was 4 years old. She was fine after a few minutes but the mom (and the nurses) were a little upset. Again, the main problem we see in teenagers who faint is extreme embarrassment.

H. GARRY GARDNER, M.D., is a pediatrician in private practice in Darien, Ill. He said he had no conflicts of interest relevant to this article.

SAVANNAH, GA. — An innovative intervention combining exercise and exposure therapy addresses the outsized fear of falling that limits many seniors' activities.

Fear of falling, a debilitating but undertreated condition, is generally correlated more with anxiety than with physical disability. However, the proposed intervention called ABLE—Activity, Balance, Learning, and Exposure—may help solve the problem.

A quarter of the elderly report moderate to severe fear of falling; about 10% of those avoid activities as a result of that fear, Julie Wetherell, Ph.D., reported during a symposium on anxiety at the annual meeting of the American Association for Geriatric Psychiatry. She noted that fear of falling has been described in many epidemiologic studies.

Fear of falling actually increases the risk of falls, she reported. In fact, those with no falls but high fear have a nearly fivefold increased risk of nursing home admission, even after controlling for age and disability. It also increases the risk of depression.

The condition often goes undetected and therefore untreated. Seniors are reluctant to discuss concerns about falling because of the associated stigmas, and they may be unwilling to seek help for the anxiety because of the stigmas related to mental health issues.

That the fear is rooted in an objective risk also makes identification and treatment more challenging. Nevertheless, Dr. Wetherell, who is with the department of psychiatry at the University of California, San Diego, noted that fear of falling is more closely correlated with symptoms of anxiety than with physical symptoms.

Community-based exercise and fall-education programs are available, but seniors who are unwilling to leave their homes as a result of their fear don't have access to them. Moreover, families often reinforce the avoidant behavior.

Dr. Wetherell offered a case study to illustrate some of these issues. An 85-year-old woman who had fallen twice in the past 3 years, once in the last year, was diagnosed with osteoporosis. The intervention consisted of her doctor telling her “don't fall.” She went online to find balance exercises, but she won't leave the house alone. Her daughter pays someone to accompany her when she goes out, thus reinforcing the avoidant behavior.

When Dr. Wetherell tried to discuss treatment, the woman turned her down because she was a psychologist. “My problem isn't in my head, it's real,” the woman said. The woman did not receive an intervention.

Dr. Wetherell's proposed ABLE plan addresses several of those barriers. It includes exercise, a medication review, and a home safety evaluation. The intervention is delivered in the home by a physical therapist, not a mental health professional. Families and caregivers are encouraged to participate.

As part of the intervention, the patient creates a hierarchy of activities, such as walking to the driveway alone, walking with a full cart of groceries through a parking lot, getting in and out of a car alone, and so on. Then the patient rates, on a scale of 0–10, which of the activities are the most anxiety provoking.

The therapy starts with situations rated 5–6. The patient is asked to perform one of the activities in the presence of the therapist and then with a friend or family member between sessions.

This is continued until the anxiety is only mild; then the process begins with the next items on the list.

Dr. Wetherell presented another case, this time one in which the ABLE intervention seemed to have been effective. A 79-year-old man had multiple medical problems, and in addition to his fear of falling, he had symptoms of generalized anxiety disorder and depression. He wouldn't leave his home, nor would he use an assistive device.

After 4 months, he showed marked improvement. The man had fallen 10 times in the past year, but fell only twice during treatment. His exercise capacity doubled and his gait and balance improved. Moreover, he eventually started going out of his home.

In an interview, Dr. Wetherell said that, pending funding, she hopes to start recruiting for a larger pilot this summer.

Disclosures: Dr. Wetherell has received research support from Forest Laboratories.

SAVANNAH, GA. — An innovative intervention combining exercise and exposure therapy addresses the outsized fear of falling that limits many seniors' activities.

Fear of falling, a debilitating but undertreated condition, is generally correlated more with anxiety than with physical disability. However, the proposed intervention called ABLE—Activity, Balance, Learning, and Exposure—may help solve the problem.

A quarter of the elderly report moderate to severe fear of falling; about 10% of those avoid activities as a result of that fear, Julie Wetherell, Ph.D., reported during a symposium on anxiety at the annual meeting of the American Association for Geriatric Psychiatry. She noted that fear of falling has been described in many epidemiologic studies.

Fear of falling actually increases the risk of falls, she reported. In fact, those with no falls but high fear have a nearly fivefold increased risk of nursing home admission, even after controlling for age and disability. It also increases the risk of depression.

The condition often goes undetected and therefore untreated. Seniors are reluctant to discuss concerns about falling because of the associated stigmas, and they may be unwilling to seek help for the anxiety because of the stigmas related to mental health issues.

That the fear is rooted in an objective risk also makes identification and treatment more challenging. Nevertheless, Dr. Wetherell, who is with the department of psychiatry at the University of California, San Diego, noted that fear of falling is more closely correlated with symptoms of anxiety than with physical symptoms.

Community-based exercise and fall-education programs are available, but seniors who are unwilling to leave their homes as a result of their fear don't have access to them. Moreover, families often reinforce the avoidant behavior.

Dr. Wetherell offered a case study to illustrate some of these issues. An 85-year-old woman who had fallen twice in the past 3 years, once in the last year, was diagnosed with osteoporosis. The intervention consisted of her doctor telling her “don't fall.” She went online to find balance exercises, but she won't leave the house alone. Her daughter pays someone to accompany her when she goes out, thus reinforcing the avoidant behavior.

When Dr. Wetherell tried to discuss treatment, the woman turned her down because she was a psychologist. “My problem isn't in my head, it's real,” the woman said. The woman did not receive an intervention.

Dr. Wetherell's proposed ABLE plan addresses several of those barriers. It includes exercise, a medication review, and a home safety evaluation. The intervention is delivered in the home by a physical therapist, not a mental health professional. Families and caregivers are encouraged to participate.

As part of the intervention, the patient creates a hierarchy of activities, such as walking to the driveway alone, walking with a full cart of groceries through a parking lot, getting in and out of a car alone, and so on. Then the patient rates, on a scale of 0–10, which of the activities are the most anxiety provoking.

The therapy starts with situations rated 5–6. The patient is asked to perform one of the activities in the presence of the therapist and then with a friend or family member between sessions.

This is continued until the anxiety is only mild; then the process begins with the next items on the list.

Dr. Wetherell presented another case, this time one in which the ABLE intervention seemed to have been effective. A 79-year-old man had multiple medical problems, and in addition to his fear of falling, he had symptoms of generalized anxiety disorder and depression. He wouldn't leave his home, nor would he use an assistive device.

After 4 months, he showed marked improvement. The man had fallen 10 times in the past year, but fell only twice during treatment. His exercise capacity doubled and his gait and balance improved. Moreover, he eventually started going out of his home.

In an interview, Dr. Wetherell said that, pending funding, she hopes to start recruiting for a larger pilot this summer.

Disclosures: Dr. Wetherell has received research support from Forest Laboratories.

SAVANNAH, GA. — An innovative intervention combining exercise and exposure therapy addresses the outsized fear of falling that limits many seniors' activities.

Fear of falling, a debilitating but undertreated condition, is generally correlated more with anxiety than with physical disability. However, the proposed intervention called ABLE—Activity, Balance, Learning, and Exposure—may help solve the problem.

A quarter of the elderly report moderate to severe fear of falling; about 10% of those avoid activities as a result of that fear, Julie Wetherell, Ph.D., reported during a symposium on anxiety at the annual meeting of the American Association for Geriatric Psychiatry. She noted that fear of falling has been described in many epidemiologic studies.

Fear of falling actually increases the risk of falls, she reported. In fact, those with no falls but high fear have a nearly fivefold increased risk of nursing home admission, even after controlling for age and disability. It also increases the risk of depression.

The condition often goes undetected and therefore untreated. Seniors are reluctant to discuss concerns about falling because of the associated stigmas, and they may be unwilling to seek help for the anxiety because of the stigmas related to mental health issues.

That the fear is rooted in an objective risk also makes identification and treatment more challenging. Nevertheless, Dr. Wetherell, who is with the department of psychiatry at the University of California, San Diego, noted that fear of falling is more closely correlated with symptoms of anxiety than with physical symptoms.

Community-based exercise and fall-education programs are available, but seniors who are unwilling to leave their homes as a result of their fear don't have access to them. Moreover, families often reinforce the avoidant behavior.

Dr. Wetherell offered a case study to illustrate some of these issues. An 85-year-old woman who had fallen twice in the past 3 years, once in the last year, was diagnosed with osteoporosis. The intervention consisted of her doctor telling her “don't fall.” She went online to find balance exercises, but she won't leave the house alone. Her daughter pays someone to accompany her when she goes out, thus reinforcing the avoidant behavior.

When Dr. Wetherell tried to discuss treatment, the woman turned her down because she was a psychologist. “My problem isn't in my head, it's real,” the woman said. The woman did not receive an intervention.

Dr. Wetherell's proposed ABLE plan addresses several of those barriers. It includes exercise, a medication review, and a home safety evaluation. The intervention is delivered in the home by a physical therapist, not a mental health professional. Families and caregivers are encouraged to participate.

As part of the intervention, the patient creates a hierarchy of activities, such as walking to the driveway alone, walking with a full cart of groceries through a parking lot, getting in and out of a car alone, and so on. Then the patient rates, on a scale of 0–10, which of the activities are the most anxiety provoking.

The therapy starts with situations rated 5–6. The patient is asked to perform one of the activities in the presence of the therapist and then with a friend or family member between sessions.

This is continued until the anxiety is only mild; then the process begins with the next items on the list.

Dr. Wetherell presented another case, this time one in which the ABLE intervention seemed to have been effective. A 79-year-old man had multiple medical problems, and in addition to his fear of falling, he had symptoms of generalized anxiety disorder and depression. He wouldn't leave his home, nor would he use an assistive device.

After 4 months, he showed marked improvement. The man had fallen 10 times in the past year, but fell only twice during treatment. His exercise capacity doubled and his gait and balance improved. Moreover, he eventually started going out of his home.

In an interview, Dr. Wetherell said that, pending funding, she hopes to start recruiting for a larger pilot this summer.

Disclosures: Dr. Wetherell has received research support from Forest Laboratories.

SAVANNAH, GA. — Regular use of a brain fitness program appears to produce slight memory improvements in elderly participants at 2 months and significant gains at 6 months, compared with an active control group.

Extended exposure is correlated with enhanced visual and verbal memory in the elderly, Karen Miller, Ph.D., of the University of California, Los Angeles, said at the annual meeting of the American Association for Geriatric Psychiatry.

The program, Dakim BrainFitness, uses games to exercise long- and short-term memory, critical thinking, visuospatial skills, calculation, and language.

The trial included 38 elderly subjects, 22 in the intervention group (average age, 82.4 years) and 16 in the control group (average age, 83.1 years). The program offers 300–400 activities and five levels of difficulty, allowing participants to engage in different activities each session. Although the program is computer-based, it is designed to be used by those with no computer experience.

Patients with Alzheimer's disease were excluded; those with mild cognitive impairment and age-consistent memory impairment were not.

Significant differences were observed at 6 months after randomization between the intervention group, which was enrolled in the program for the duration of the study (an average of 93.3 sessions) and the control group, which, after a 2-month testing phase, also was enrolled (for an average of 45.2 sessions).

Neuropsychological testing was done at baseline, at 2 months, and at 6 months.

After 2 months, preliminary analysis of intervention group subjects revealed better delayed recall for list learning. The intervention group improved by recalling 8.3 words, compared with its initial recall of 7.6 words during baseline testing. The controls' recall declined to an average of 5.3 words during the posttesting period from the initial recall of 6.8 words.

At 6 months, participants in the intervention vs. control groups were significantly different in their delayed memory domain score. In the intervention group, which had played for the full 6 months, scores rose from 10.4 at baseline to 12.1. In the control group, which played from month 2 to month 6, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

The key finding at this point, Dr. Miller said, is that the longer a person uses the program, the more likely he or she is to improve. The results at 2 months were “mild,” while those at 6 months were “most overwhelmingly positive,” she said in an interview.

With numerous brain fitness products on the market, an audience member asked how to separate the legitimate programs from the “Elmer Gantries.” A session panelist, Dr. Gary Small also of the University of California, Los Angeles, suggested using the same skepticism that should taken toward nutritional supplements. “We need more evidence before we get all excited about it,” he said.

Disclosures: Dakim sponsored the research. Dr. Miller is a consultant for Dakim, and Dr. Small is a shareholder.

In the intervention group, scores rose from 10.4 at baseline to 12.1. In the control group, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

Source Courtesy Dakim

SAVANNAH, GA. — Regular use of a brain fitness program appears to produce slight memory improvements in elderly participants at 2 months and significant gains at 6 months, compared with an active control group.

Extended exposure is correlated with enhanced visual and verbal memory in the elderly, Karen Miller, Ph.D., of the University of California, Los Angeles, said at the annual meeting of the American Association for Geriatric Psychiatry.

The program, Dakim BrainFitness, uses games to exercise long- and short-term memory, critical thinking, visuospatial skills, calculation, and language.

The trial included 38 elderly subjects, 22 in the intervention group (average age, 82.4 years) and 16 in the control group (average age, 83.1 years). The program offers 300–400 activities and five levels of difficulty, allowing participants to engage in different activities each session. Although the program is computer-based, it is designed to be used by those with no computer experience.

Patients with Alzheimer's disease were excluded; those with mild cognitive impairment and age-consistent memory impairment were not.

Significant differences were observed at 6 months after randomization between the intervention group, which was enrolled in the program for the duration of the study (an average of 93.3 sessions) and the control group, which, after a 2-month testing phase, also was enrolled (for an average of 45.2 sessions).

Neuropsychological testing was done at baseline, at 2 months, and at 6 months.

After 2 months, preliminary analysis of intervention group subjects revealed better delayed recall for list learning. The intervention group improved by recalling 8.3 words, compared with its initial recall of 7.6 words during baseline testing. The controls' recall declined to an average of 5.3 words during the posttesting period from the initial recall of 6.8 words.

At 6 months, participants in the intervention vs. control groups were significantly different in their delayed memory domain score. In the intervention group, which had played for the full 6 months, scores rose from 10.4 at baseline to 12.1. In the control group, which played from month 2 to month 6, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

The key finding at this point, Dr. Miller said, is that the longer a person uses the program, the more likely he or she is to improve. The results at 2 months were “mild,” while those at 6 months were “most overwhelmingly positive,” she said in an interview.

With numerous brain fitness products on the market, an audience member asked how to separate the legitimate programs from the “Elmer Gantries.” A session panelist, Dr. Gary Small also of the University of California, Los Angeles, suggested using the same skepticism that should taken toward nutritional supplements. “We need more evidence before we get all excited about it,” he said.

Disclosures: Dakim sponsored the research. Dr. Miller is a consultant for Dakim, and Dr. Small is a shareholder.

In the intervention group, scores rose from 10.4 at baseline to 12.1. In the control group, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

Source Courtesy Dakim

SAVANNAH, GA. — Regular use of a brain fitness program appears to produce slight memory improvements in elderly participants at 2 months and significant gains at 6 months, compared with an active control group.

Extended exposure is correlated with enhanced visual and verbal memory in the elderly, Karen Miller, Ph.D., of the University of California, Los Angeles, said at the annual meeting of the American Association for Geriatric Psychiatry.

The program, Dakim BrainFitness, uses games to exercise long- and short-term memory, critical thinking, visuospatial skills, calculation, and language.

The trial included 38 elderly subjects, 22 in the intervention group (average age, 82.4 years) and 16 in the control group (average age, 83.1 years). The program offers 300–400 activities and five levels of difficulty, allowing participants to engage in different activities each session. Although the program is computer-based, it is designed to be used by those with no computer experience.

Patients with Alzheimer's disease were excluded; those with mild cognitive impairment and age-consistent memory impairment were not.

Significant differences were observed at 6 months after randomization between the intervention group, which was enrolled in the program for the duration of the study (an average of 93.3 sessions) and the control group, which, after a 2-month testing phase, also was enrolled (for an average of 45.2 sessions).

Neuropsychological testing was done at baseline, at 2 months, and at 6 months.

After 2 months, preliminary analysis of intervention group subjects revealed better delayed recall for list learning. The intervention group improved by recalling 8.3 words, compared with its initial recall of 7.6 words during baseline testing. The controls' recall declined to an average of 5.3 words during the posttesting period from the initial recall of 6.8 words.

At 6 months, participants in the intervention vs. control groups were significantly different in their delayed memory domain score. In the intervention group, which had played for the full 6 months, scores rose from 10.4 at baseline to 12.1. In the control group, which played from month 2 to month 6, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

The key finding at this point, Dr. Miller said, is that the longer a person uses the program, the more likely he or she is to improve. The results at 2 months were “mild,” while those at 6 months were “most overwhelmingly positive,” she said in an interview.

With numerous brain fitness products on the market, an audience member asked how to separate the legitimate programs from the “Elmer Gantries.” A session panelist, Dr. Gary Small also of the University of California, Los Angeles, suggested using the same skepticism that should taken toward nutritional supplements. “We need more evidence before we get all excited about it,” he said.

Disclosures: Dakim sponsored the research. Dr. Miller is a consultant for Dakim, and Dr. Small is a shareholder.

In the intervention group, scores rose from 10.4 at baseline to 12.1. In the control group, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

Source Courtesy Dakim

SAVANNAH, GA. — An extended release formulation of memantine 28 mg taken once daily was safe and well-tolerated in patients with moderate to severe Alzheimer's disease in a 52-week, open-label, fixed-dose study.

Dr. Barnett Meyers of Weill Medical College, White Plains, N.Y., and his colleagues presented their findings in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Memantine (Namenda) is administered in twice-daily, immediate-release doses of 10 mg each. A previous 24-week trial indicated that a once-daily 28-mg dose of memantine ER was safe and effective for patients with moderate to severe AD on cholinesterase inhibitors (Alzheimers Dement. 2008;4[suppl. 1]:T793).

A total of 164 outpatients aged 50 or older with probable AD were either titrated to the target dose of memantine ER 28 mg daily over 4 weeks or were switched from twice-daily, immediate-release memantine 10 mg.

Overall, 150 patients reported adverse events, and 8 (5%) had events related to the study medication; 44 patients (27%) had a serious adverse event, but none of the 12 deaths were considered related to treatment. Dr. Meyers and his colleagues concluded that patients taking the 10-mg twice-daily dose can safely switch to memantine ER without a titration period.

Disclosures: The study was funded by Forest Laboratories. Dr. Meyers reported having no conflicts; two of his coauthors are employees of Forest Research Institute.

SAVANNAH, GA. — An extended release formulation of memantine 28 mg taken once daily was safe and well-tolerated in patients with moderate to severe Alzheimer's disease in a 52-week, open-label, fixed-dose study.

Dr. Barnett Meyers of Weill Medical College, White Plains, N.Y., and his colleagues presented their findings in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Memantine (Namenda) is administered in twice-daily, immediate-release doses of 10 mg each. A previous 24-week trial indicated that a once-daily 28-mg dose of memantine ER was safe and effective for patients with moderate to severe AD on cholinesterase inhibitors (Alzheimers Dement. 2008;4[suppl. 1]:T793).

A total of 164 outpatients aged 50 or older with probable AD were either titrated to the target dose of memantine ER 28 mg daily over 4 weeks or were switched from twice-daily, immediate-release memantine 10 mg.

Overall, 150 patients reported adverse events, and 8 (5%) had events related to the study medication; 44 patients (27%) had a serious adverse event, but none of the 12 deaths were considered related to treatment. Dr. Meyers and his colleagues concluded that patients taking the 10-mg twice-daily dose can safely switch to memantine ER without a titration period.

Disclosures: The study was funded by Forest Laboratories. Dr. Meyers reported having no conflicts; two of his coauthors are employees of Forest Research Institute.

SAVANNAH, GA. — An extended release formulation of memantine 28 mg taken once daily was safe and well-tolerated in patients with moderate to severe Alzheimer's disease in a 52-week, open-label, fixed-dose study.

Dr. Barnett Meyers of Weill Medical College, White Plains, N.Y., and his colleagues presented their findings in a poster at the annual meeting of the American Association for Geriatric Psychiatry.

Memantine (Namenda) is administered in twice-daily, immediate-release doses of 10 mg each. A previous 24-week trial indicated that a once-daily 28-mg dose of memantine ER was safe and effective for patients with moderate to severe AD on cholinesterase inhibitors (Alzheimers Dement. 2008;4[suppl. 1]:T793).

A total of 164 outpatients aged 50 or older with probable AD were either titrated to the target dose of memantine ER 28 mg daily over 4 weeks or were switched from twice-daily, immediate-release memantine 10 mg.

Overall, 150 patients reported adverse events, and 8 (5%) had events related to the study medication; 44 patients (27%) had a serious adverse event, but none of the 12 deaths were considered related to treatment. Dr. Meyers and his colleagues concluded that patients taking the 10-mg twice-daily dose can safely switch to memantine ER without a titration period.

Disclosures: The study was funded by Forest Laboratories. Dr. Meyers reported having no conflicts; two of his coauthors are employees of Forest Research Institute.

Major Finding: After 2003, rates of conventional antipsychotic use among outpatients with dementia were less than 2%.

Data Source: National data from the Department of Veterans Affairs on 254,564 outpatients with dementia.

Disclosures: Neither Dr. Kales nor Dr. Zivin disclosed any conflicts.

SAVANNAH, GA. — Black box warnings on antipsychotics led to a decrease in their use to treat patients with dementia, without a commensurate increase in use of antianxiety or other psychotropic agents but with a rise in the use of anticonvulsant therapies, some of which appear to be riskier than the antipsychotics in older patients.

In fact, valproate appears to have a higher mortality than the antipsychotics studied, Dr. Helen C. Kales and Kara Zivin, Ph.D., of the University of Michigan and the VA Healthcare System in Ann Arbor, said in reporting the preliminary findings from an ongoing National Institutes of Health–funded study at the annual meeting of the American Association for Geriatric Psychiatry.

Antipsychotics once were widely prescribed as an off-label treatment for dementia, but in 2005, the Food and Drug Administration issued a black box warning that the use of atypical antipsychotics in the treatment of behavioral disorders in elderly patients with dementia was associated with increased mortality. A similar warning for conventional antipsychotics was issued in 2008.

To see how the warnings affected practice patterns, Dr. Kales and Dr. Zivin looked at national data from 254,564 Department of Veterans Affairs outpatients with dementia.

They found that a decline in use of atypical antipsychotics began in 2003, coinciding with the release of data from randomized, controlled trials about cerebrovascular events. The decline accelerated after the black box warning.

For conventional antipsychotics, the major decline in use came during the 1990s with the introduction of atypical antipsychotics. After 2003, the rates of conventional antipsychotic use among outpatients with dementia were less than 2%.

No significant compensatory increase was found in the use of antianxiety or antidepressant agents, Dr. Zivin said. In an interview, Dr. Kales speculated that possibly those drugs are not viewed as substitute therapies for the types of behaviors for which antipsychotics are prescribed.

The research did turn up a small but statistically significant increase in anticonvulsant use among outpatients with dementia.

The researchers also examined mortality for 13,857 elderly patients with any diagnosis and 3,954 patients with dementia who had been prescribed individual antipsychotics (haloperidol, olanzapine, quetiapine, and risperidone) and individual anticonvulsants (valproate and carbamazepine).

The researchers examined records for elderly patients in general as well as for those with dementia. As in prior studies, they found that haloperidol was associated with higher mortality than were the atypicals.

What was unexpected was the finding that valproate was associated with higher mortality than all of the antipsychotics, including haloperidol.

The populations of older patients receiving haloperidol and valproate differed somewhat from those receiving atypicals. The haloperidol cohort included more African Americans, and more subjects with schizophrenia and medical comorbidities. The valproate cohort was younger and a lower proportion had dementia. Neither accounting for selection bias nor excluding for bipolar disorders changed the results, Dr. Kales reported.

More research on the association between mortality and antipsychotics is needed, Dr. Kales said in an interview. “Is it a direct medication effect or related to the pathophysiology underlying the need for use?” She plans to use an electronic medical record search engine to look for other variables in such studies, including the severity of cognitive impairment and the type of behavioral disturbance.

Disclosures: The study was funded by the National Institutes of Health. Neither Dr. Kales nor Dr. Zivin disclosed any relevant conflicts of interest.

Major Finding: After 2003, rates of conventional antipsychotic use among outpatients with dementia were less than 2%.

Data Source: National data from the Department of Veterans Affairs on 254,564 outpatients with dementia.

Disclosures: Neither Dr. Kales nor Dr. Zivin disclosed any conflicts.

SAVANNAH, GA. — Black box warnings on antipsychotics led to a decrease in their use to treat patients with dementia, without a commensurate increase in use of antianxiety or other psychotropic agents but with a rise in the use of anticonvulsant therapies, some of which appear to be riskier than the antipsychotics in older patients.

In fact, valproate appears to have a higher mortality than the antipsychotics studied, Dr. Helen C. Kales and Kara Zivin, Ph.D., of the University of Michigan and the VA Healthcare System in Ann Arbor, said in reporting the preliminary findings from an ongoing National Institutes of Health–funded study at the annual meeting of the American Association for Geriatric Psychiatry.

Antipsychotics once were widely prescribed as an off-label treatment for dementia, but in 2005, the Food and Drug Administration issued a black box warning that the use of atypical antipsychotics in the treatment of behavioral disorders in elderly patients with dementia was associated with increased mortality. A similar warning for conventional antipsychotics was issued in 2008.

To see how the warnings affected practice patterns, Dr. Kales and Dr. Zivin looked at national data from 254,564 Department of Veterans Affairs outpatients with dementia.

They found that a decline in use of atypical antipsychotics began in 2003, coinciding with the release of data from randomized, controlled trials about cerebrovascular events. The decline accelerated after the black box warning.

For conventional antipsychotics, the major decline in use came during the 1990s with the introduction of atypical antipsychotics. After 2003, the rates of conventional antipsychotic use among outpatients with dementia were less than 2%.

No significant compensatory increase was found in the use of antianxiety or antidepressant agents, Dr. Zivin said. In an interview, Dr. Kales speculated that possibly those drugs are not viewed as substitute therapies for the types of behaviors for which antipsychotics are prescribed.

The research did turn up a small but statistically significant increase in anticonvulsant use among outpatients with dementia.

The researchers also examined mortality for 13,857 elderly patients with any diagnosis and 3,954 patients with dementia who had been prescribed individual antipsychotics (haloperidol, olanzapine, quetiapine, and risperidone) and individual anticonvulsants (valproate and carbamazepine).

The researchers examined records for elderly patients in general as well as for those with dementia. As in prior studies, they found that haloperidol was associated with higher mortality than were the atypicals.

What was unexpected was the finding that valproate was associated with higher mortality than all of the antipsychotics, including haloperidol.

The populations of older patients receiving haloperidol and valproate differed somewhat from those receiving atypicals. The haloperidol cohort included more African Americans, and more subjects with schizophrenia and medical comorbidities. The valproate cohort was younger and a lower proportion had dementia. Neither accounting for selection bias nor excluding for bipolar disorders changed the results, Dr. Kales reported.

More research on the association between mortality and antipsychotics is needed, Dr. Kales said in an interview. “Is it a direct medication effect or related to the pathophysiology underlying the need for use?” She plans to use an electronic medical record search engine to look for other variables in such studies, including the severity of cognitive impairment and the type of behavioral disturbance.

Disclosures: The study was funded by the National Institutes of Health. Neither Dr. Kales nor Dr. Zivin disclosed any relevant conflicts of interest.

Major Finding: After 2003, rates of conventional antipsychotic use among outpatients with dementia were less than 2%.

Data Source: National data from the Department of Veterans Affairs on 254,564 outpatients with dementia.

Disclosures: Neither Dr. Kales nor Dr. Zivin disclosed any conflicts.

SAVANNAH, GA. — Black box warnings on antipsychotics led to a decrease in their use to treat patients with dementia, without a commensurate increase in use of antianxiety or other psychotropic agents but with a rise in the use of anticonvulsant therapies, some of which appear to be riskier than the antipsychotics in older patients.

In fact, valproate appears to have a higher mortality than the antipsychotics studied, Dr. Helen C. Kales and Kara Zivin, Ph.D., of the University of Michigan and the VA Healthcare System in Ann Arbor, said in reporting the preliminary findings from an ongoing National Institutes of Health–funded study at the annual meeting of the American Association for Geriatric Psychiatry.

Antipsychotics once were widely prescribed as an off-label treatment for dementia, but in 2005, the Food and Drug Administration issued a black box warning that the use of atypical antipsychotics in the treatment of behavioral disorders in elderly patients with dementia was associated with increased mortality. A similar warning for conventional antipsychotics was issued in 2008.

To see how the warnings affected practice patterns, Dr. Kales and Dr. Zivin looked at national data from 254,564 Department of Veterans Affairs outpatients with dementia.

They found that a decline in use of atypical antipsychotics began in 2003, coinciding with the release of data from randomized, controlled trials about cerebrovascular events. The decline accelerated after the black box warning.

For conventional antipsychotics, the major decline in use came during the 1990s with the introduction of atypical antipsychotics. After 2003, the rates of conventional antipsychotic use among outpatients with dementia were less than 2%.

No significant compensatory increase was found in the use of antianxiety or antidepressant agents, Dr. Zivin said. In an interview, Dr. Kales speculated that possibly those drugs are not viewed as substitute therapies for the types of behaviors for which antipsychotics are prescribed.

The research did turn up a small but statistically significant increase in anticonvulsant use among outpatients with dementia.

The researchers also examined mortality for 13,857 elderly patients with any diagnosis and 3,954 patients with dementia who had been prescribed individual antipsychotics (haloperidol, olanzapine, quetiapine, and risperidone) and individual anticonvulsants (valproate and carbamazepine).

The researchers examined records for elderly patients in general as well as for those with dementia. As in prior studies, they found that haloperidol was associated with higher mortality than were the atypicals.

What was unexpected was the finding that valproate was associated with higher mortality than all of the antipsychotics, including haloperidol.

The populations of older patients receiving haloperidol and valproate differed somewhat from those receiving atypicals. The haloperidol cohort included more African Americans, and more subjects with schizophrenia and medical comorbidities. The valproate cohort was younger and a lower proportion had dementia. Neither accounting for selection bias nor excluding for bipolar disorders changed the results, Dr. Kales reported.

More research on the association between mortality and antipsychotics is needed, Dr. Kales said in an interview. “Is it a direct medication effect or related to the pathophysiology underlying the need for use?” She plans to use an electronic medical record search engine to look for other variables in such studies, including the severity of cognitive impairment and the type of behavioral disturbance.

Disclosures: The study was funded by the National Institutes of Health. Neither Dr. Kales nor Dr. Zivin disclosed any relevant conflicts of interest.

SAVANNAH, Ga. – Despite minor adverse skin reactions in 20%-50% of patients, the advantages of modern transdermal drug-delivery patches outweigh potential skin problems, according to a literature review.

The skin problems associated with transdermal patches are usually mild to moderate and rarely lead to treatment cessation, Dr. George T. Grossberg, St. Louis University, and colleagues reported in a poster presented at the annual meeting of the American Association for Geriatric Psychiatry.

A growing number of medications are now available in the transdermal patch form, including rotigotine for Parkinson’s disease, rivastigmine for Alzheimer’s disease, selegiline for major depressive disorder, and oxybutynin for overactive bladder (Adv. Ther. 2009;26:920-35).

Transdermal delivery offers several benefits over oral delivery, including smooth, continuous drug delivery, increased bioavailability, and reduced drug-drug interactions. Patches can be easily applied by the caregiver, and they provide a visual cue that the medication has been administered.

The researchers reviewed the literature on the subject from March 1999–March 2009 using PubMed, the U.S. National Institutes of Health online database of published medical research. The search identified 96 articles, 14 of which contained skin tolerability data from studies evaluating transdermal medications.

The most common symptoms were localized redness, itching, and edema. They lasted from a few days to a few weeks, and resulted in cessation of the treatment in only 1.7%-6.8% of patents in 6-month trials.

“These signs and symptoms were usually mild, localized and transient in nature, resolving spontaneously after patch removal,” Dr. Grossberg and his colleagues wrote. Skin reactions were typically either irritant contact dermatitis or, less commonly, allergic contact dermatitis. Most studies, however, did not classify the nature of the reaction or determine whether they were caused by the patch materials or the drug itself, investigators reported.

Irritant contact dermatitis, a common complications can be caused by damage to the skin during patch removal; blocking of sweat ducts; irritation to residual soap, lotion, etc.; or friction. It may be related to patch size, patch type, treatment duration, the environment, or the application site.

Allergic contact dermatitis occurs infrequently; it is typically caused by an immunologic reaction to the patch or the drug.

Treatment can include moving the patch; applying moisturizers or calamine lotion to reduce itching, or using corticosteroid creams to reduce allergic contact dermatitis. Sedative antihistamines can address itch-related sleep impairment, but they should be used with caution in the elderly and those at risk for falls, Dr. Grossberg and his colleagues warned.

“The advantages of transdermal medications over oral administration outweigh any potential skin issues, particularly if these are correctly managed and treated,” they concluded.

Novartis provided funding for the research.

SAVANNAH, Ga. – Despite minor adverse skin reactions in 20%-50% of patients, the advantages of modern transdermal drug-delivery patches outweigh potential skin problems, according to a literature review.

The skin problems associated with transdermal patches are usually mild to moderate and rarely lead to treatment cessation, Dr. George T. Grossberg, St. Louis University, and colleagues reported in a poster presented at the annual meeting of the American Association for Geriatric Psychiatry.

A growing number of medications are now available in the transdermal patch form, including rotigotine for Parkinson’s disease, rivastigmine for Alzheimer’s disease, selegiline for major depressive disorder, and oxybutynin for overactive bladder (Adv. Ther. 2009;26:920-35).

Transdermal delivery offers several benefits over oral delivery, including smooth, continuous drug delivery, increased bioavailability, and reduced drug-drug interactions. Patches can be easily applied by the caregiver, and they provide a visual cue that the medication has been administered.

The researchers reviewed the literature on the subject from March 1999–March 2009 using PubMed, the U.S. National Institutes of Health online database of published medical research. The search identified 96 articles, 14 of which contained skin tolerability data from studies evaluating transdermal medications.

The most common symptoms were localized redness, itching, and edema. They lasted from a few days to a few weeks, and resulted in cessation of the treatment in only 1.7%-6.8% of patents in 6-month trials.

“These signs and symptoms were usually mild, localized and transient in nature, resolving spontaneously after patch removal,” Dr. Grossberg and his colleagues wrote. Skin reactions were typically either irritant contact dermatitis or, less commonly, allergic contact dermatitis. Most studies, however, did not classify the nature of the reaction or determine whether they were caused by the patch materials or the drug itself, investigators reported.

Irritant contact dermatitis, a common complications can be caused by damage to the skin during patch removal; blocking of sweat ducts; irritation to residual soap, lotion, etc.; or friction. It may be related to patch size, patch type, treatment duration, the environment, or the application site.

Allergic contact dermatitis occurs infrequently; it is typically caused by an immunologic reaction to the patch or the drug.

Treatment can include moving the patch; applying moisturizers or calamine lotion to reduce itching, or using corticosteroid creams to reduce allergic contact dermatitis. Sedative antihistamines can address itch-related sleep impairment, but they should be used with caution in the elderly and those at risk for falls, Dr. Grossberg and his colleagues warned.

“The advantages of transdermal medications over oral administration outweigh any potential skin issues, particularly if these are correctly managed and treated,” they concluded.

Novartis provided funding for the research.

SAVANNAH, Ga. – Despite minor adverse skin reactions in 20%-50% of patients, the advantages of modern transdermal drug-delivery patches outweigh potential skin problems, according to a literature review.

The skin problems associated with transdermal patches are usually mild to moderate and rarely lead to treatment cessation, Dr. George T. Grossberg, St. Louis University, and colleagues reported in a poster presented at the annual meeting of the American Association for Geriatric Psychiatry.

A growing number of medications are now available in the transdermal patch form, including rotigotine for Parkinson’s disease, rivastigmine for Alzheimer’s disease, selegiline for major depressive disorder, and oxybutynin for overactive bladder (Adv. Ther. 2009;26:920-35).

Transdermal delivery offers several benefits over oral delivery, including smooth, continuous drug delivery, increased bioavailability, and reduced drug-drug interactions. Patches can be easily applied by the caregiver, and they provide a visual cue that the medication has been administered.

The researchers reviewed the literature on the subject from March 1999–March 2009 using PubMed, the U.S. National Institutes of Health online database of published medical research. The search identified 96 articles, 14 of which contained skin tolerability data from studies evaluating transdermal medications.

The most common symptoms were localized redness, itching, and edema. They lasted from a few days to a few weeks, and resulted in cessation of the treatment in only 1.7%-6.8% of patents in 6-month trials.

“These signs and symptoms were usually mild, localized and transient in nature, resolving spontaneously after patch removal,” Dr. Grossberg and his colleagues wrote. Skin reactions were typically either irritant contact dermatitis or, less commonly, allergic contact dermatitis. Most studies, however, did not classify the nature of the reaction or determine whether they were caused by the patch materials or the drug itself, investigators reported.

Irritant contact dermatitis, a common complications can be caused by damage to the skin during patch removal; blocking of sweat ducts; irritation to residual soap, lotion, etc.; or friction. It may be related to patch size, patch type, treatment duration, the environment, or the application site.

Allergic contact dermatitis occurs infrequently; it is typically caused by an immunologic reaction to the patch or the drug.

Treatment can include moving the patch; applying moisturizers or calamine lotion to reduce itching, or using corticosteroid creams to reduce allergic contact dermatitis. Sedative antihistamines can address itch-related sleep impairment, but they should be used with caution in the elderly and those at risk for falls, Dr. Grossberg and his colleagues warned.

“The advantages of transdermal medications over oral administration outweigh any potential skin issues, particularly if these are correctly managed and treated,” they concluded.

Novartis provided funding for the research.

SAVANNAH, GA. — An extended-release formulation of memantine 28 mg applied once daily was safe and well-tolerated in patients with moderate to severe Alzheimer's disease who participated in a 52-week, open-label, fixed-dose study.

Dr. Barnett Meyers of Weill Medical College at Cornell University, White Plains, N.Y., and his colleagues presented the study, which was funded by Forest Laboratories, at the annual meeting of the American Association for Geriatric Psychiatry.

Memantine (Namenda) has been approved for the treatment of moderate to severe Alzheimer's disease (AD). It's currently administered in twice-daily, immediate-release doses of 10 mg each.

A previous 24-week trial indicated that a once-daily 28-mg formulation of memantine (memantine ER) was safe and effective for patients with moderate to severe AD who were taking cholinesterase inhibitors (Alzheimers Dement. 2008;4[Suppl. 1]:T793).

Of 253 outpatients who were screened, 164 were either titrated to the target dose of memantine ER 28 mg daily over 4 weeks (75 of the 128 patients in this group completed the trial) or were switched from twice daily, immediate-release memantine 10 mg (23 of 36 patients completed the trial). All patients were 50 years or older, with similar baseline characteristics and a diagnosis of probable AD.

Of 150 patients who reported treatment-emergent adverse events, 8 (5%) experienced events that were determined to be related to the study medication.

Overall, 44 patients (27%) experienced a serious adverse event, and none of the 12 deaths that occurred during the trial was determined to be related to treatment.

During treatment, 18% of patients gained weight, 13% lost weight, and 10% had high blood urea nitrogen, Dr. Meyers and his colleagues reported in their poster.

The researchers concluded that patients taking the 10-mg twice-daily dose can safely switch to memantine ER without a titration period.

SAVANNAH, GA. — An extended-release formulation of memantine 28 mg applied once daily was safe and well-tolerated in patients with moderate to severe Alzheimer's disease who participated in a 52-week, open-label, fixed-dose study.

Dr. Barnett Meyers of Weill Medical College at Cornell University, White Plains, N.Y., and his colleagues presented the study, which was funded by Forest Laboratories, at the annual meeting of the American Association for Geriatric Psychiatry.

Memantine (Namenda) has been approved for the treatment of moderate to severe Alzheimer's disease (AD). It's currently administered in twice-daily, immediate-release doses of 10 mg each.

A previous 24-week trial indicated that a once-daily 28-mg formulation of memantine (memantine ER) was safe and effective for patients with moderate to severe AD who were taking cholinesterase inhibitors (Alzheimers Dement. 2008;4[Suppl. 1]:T793).

Of 253 outpatients who were screened, 164 were either titrated to the target dose of memantine ER 28 mg daily over 4 weeks (75 of the 128 patients in this group completed the trial) or were switched from twice daily, immediate-release memantine 10 mg (23 of 36 patients completed the trial). All patients were 50 years or older, with similar baseline characteristics and a diagnosis of probable AD.

Of 150 patients who reported treatment-emergent adverse events, 8 (5%) experienced events that were determined to be related to the study medication.

Overall, 44 patients (27%) experienced a serious adverse event, and none of the 12 deaths that occurred during the trial was determined to be related to treatment.

During treatment, 18% of patients gained weight, 13% lost weight, and 10% had high blood urea nitrogen, Dr. Meyers and his colleagues reported in their poster.

The researchers concluded that patients taking the 10-mg twice-daily dose can safely switch to memantine ER without a titration period.

SAVANNAH, GA. — An extended-release formulation of memantine 28 mg applied once daily was safe and well-tolerated in patients with moderate to severe Alzheimer's disease who participated in a 52-week, open-label, fixed-dose study.

Dr. Barnett Meyers of Weill Medical College at Cornell University, White Plains, N.Y., and his colleagues presented the study, which was funded by Forest Laboratories, at the annual meeting of the American Association for Geriatric Psychiatry.

Memantine (Namenda) has been approved for the treatment of moderate to severe Alzheimer's disease (AD). It's currently administered in twice-daily, immediate-release doses of 10 mg each.

A previous 24-week trial indicated that a once-daily 28-mg formulation of memantine (memantine ER) was safe and effective for patients with moderate to severe AD who were taking cholinesterase inhibitors (Alzheimers Dement. 2008;4[Suppl. 1]:T793).

Of 253 outpatients who were screened, 164 were either titrated to the target dose of memantine ER 28 mg daily over 4 weeks (75 of the 128 patients in this group completed the trial) or were switched from twice daily, immediate-release memantine 10 mg (23 of 36 patients completed the trial). All patients were 50 years or older, with similar baseline characteristics and a diagnosis of probable AD.

Of 150 patients who reported treatment-emergent adverse events, 8 (5%) experienced events that were determined to be related to the study medication.

Overall, 44 patients (27%) experienced a serious adverse event, and none of the 12 deaths that occurred during the trial was determined to be related to treatment.

During treatment, 18% of patients gained weight, 13% lost weight, and 10% had high blood urea nitrogen, Dr. Meyers and his colleagues reported in their poster.

The researchers concluded that patients taking the 10-mg twice-daily dose can safely switch to memantine ER without a titration period.

SAVANNAH, GA — Regular use of a brain fitness program appears to produce slight memory improvements in elderly participants at 2 months and significant gains at 6 months, compared with an active control group.

Extended exposure is correlated with enhanced visual and verbal memory in the elderly, Karen Miller, Ph.D., of the University of California, Los Angeles, reported at the annual meeting of the American Association for Geriatric Psychiatry.

The program, Dakim BrainFitness, uses games to exercise long- and short-term memory, critical thinking, visuospatial skills, calculation, and language. Dakim sponsored the research, and Dr. Miller serves as a consultant.

The trial included 38 elderly subjects, 22 in the intervention group (average age, 82.4 years), and 16 in the control group (average age, 83.1 years). The program offers 300-400 activities and five levels of difficulty, allowing participants to engage in different activities each session. Although the program is computer-based, it is designed to be used by those with no computer experience.

Patients with Alzheimer's disease were excluded; those with mild cognitive impairment and age-consistent memory impairment were not.

Significant differences were observed at 6 months after randomization between the intervention group, which was enrolled in the program for the duration of the study (an average of 93.3 sessions per participant) and the control group, which, after a 2-month testing phase, also was enrolled (for an average of 45.2 sessions).

Neuropsychological testing was conducted at baseline, at 2 months, and at 6 months. After 2 months, preliminary analysis of intervention group subjects revealed better delayed recall for list learning. The intervention group improved by recalling 8.3 words, compared with their initial recall of 7.6 words during baseline testing.

The control group's recall declined to on average 5.3 words during the posttesting period from the initial recall of 6.8 words.

At 6 months, participants in the intervention vs. control groups were significantly different in their delayed memory domain score. In the intervention group, which had played for the full 6 months, scores rose from 10.4 at baseline to 12.1.

In the control group, which played from month 2 to month 6, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

The key finding, Dr. Miller said, is the importance of exposure. The longer a person uses the program, the more likely he or she is to improve in verbal and visual memory. The results at 2 months were “mild,” while those at 6 months were “most overwhelmingly positive.”

She added that 2- and 6-month analyses of a larger study of 100 subjects, which will include data on perception of memory functioning and mood, should be available by the summer. If she secures additional funding, she plans to do a follow-up at years 1 and 5.

Numerous brain fitness products are on the market, and that prompted a question from the audience about how to separate the legitimate programs from the “Elmer Gantries.” Another session panelist, Dr. Gary Small also of the University of California, Los Angeles, fielded the question and suggested that the program should be viewed with the same kind of skepticism that should be taken toward nutritional supplements. “We need more evidence before we get all excited about it,” he said.

Dr. Small is a Dakim shareholder.

Participants who regularly used a touch-screen program had significant improvements on verbal and visual memory scores compared with a control group.

Source Courtesy Dakim

SAVANNAH, GA — Regular use of a brain fitness program appears to produce slight memory improvements in elderly participants at 2 months and significant gains at 6 months, compared with an active control group.

Extended exposure is correlated with enhanced visual and verbal memory in the elderly, Karen Miller, Ph.D., of the University of California, Los Angeles, reported at the annual meeting of the American Association for Geriatric Psychiatry.

The program, Dakim BrainFitness, uses games to exercise long- and short-term memory, critical thinking, visuospatial skills, calculation, and language. Dakim sponsored the research, and Dr. Miller serves as a consultant.

The trial included 38 elderly subjects, 22 in the intervention group (average age, 82.4 years), and 16 in the control group (average age, 83.1 years). The program offers 300-400 activities and five levels of difficulty, allowing participants to engage in different activities each session. Although the program is computer-based, it is designed to be used by those with no computer experience.

Patients with Alzheimer's disease were excluded; those with mild cognitive impairment and age-consistent memory impairment were not.

Significant differences were observed at 6 months after randomization between the intervention group, which was enrolled in the program for the duration of the study (an average of 93.3 sessions per participant) and the control group, which, after a 2-month testing phase, also was enrolled (for an average of 45.2 sessions).

Neuropsychological testing was conducted at baseline, at 2 months, and at 6 months. After 2 months, preliminary analysis of intervention group subjects revealed better delayed recall for list learning. The intervention group improved by recalling 8.3 words, compared with their initial recall of 7.6 words during baseline testing.

The control group's recall declined to on average 5.3 words during the posttesting period from the initial recall of 6.8 words.

At 6 months, participants in the intervention vs. control groups were significantly different in their delayed memory domain score. In the intervention group, which had played for the full 6 months, scores rose from 10.4 at baseline to 12.1.

In the control group, which played from month 2 to month 6, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

The key finding, Dr. Miller said, is the importance of exposure. The longer a person uses the program, the more likely he or she is to improve in verbal and visual memory. The results at 2 months were “mild,” while those at 6 months were “most overwhelmingly positive.”

She added that 2- and 6-month analyses of a larger study of 100 subjects, which will include data on perception of memory functioning and mood, should be available by the summer. If she secures additional funding, she plans to do a follow-up at years 1 and 5.

Numerous brain fitness products are on the market, and that prompted a question from the audience about how to separate the legitimate programs from the “Elmer Gantries.” Another session panelist, Dr. Gary Small also of the University of California, Los Angeles, fielded the question and suggested that the program should be viewed with the same kind of skepticism that should be taken toward nutritional supplements. “We need more evidence before we get all excited about it,” he said.

Dr. Small is a Dakim shareholder.

Participants who regularly used a touch-screen program had significant improvements on verbal and visual memory scores compared with a control group.

Source Courtesy Dakim

SAVANNAH, GA — Regular use of a brain fitness program appears to produce slight memory improvements in elderly participants at 2 months and significant gains at 6 months, compared with an active control group.

Extended exposure is correlated with enhanced visual and verbal memory in the elderly, Karen Miller, Ph.D., of the University of California, Los Angeles, reported at the annual meeting of the American Association for Geriatric Psychiatry.

The program, Dakim BrainFitness, uses games to exercise long- and short-term memory, critical thinking, visuospatial skills, calculation, and language. Dakim sponsored the research, and Dr. Miller serves as a consultant.

The trial included 38 elderly subjects, 22 in the intervention group (average age, 82.4 years), and 16 in the control group (average age, 83.1 years). The program offers 300-400 activities and five levels of difficulty, allowing participants to engage in different activities each session. Although the program is computer-based, it is designed to be used by those with no computer experience.

Patients with Alzheimer's disease were excluded; those with mild cognitive impairment and age-consistent memory impairment were not.

Significant differences were observed at 6 months after randomization between the intervention group, which was enrolled in the program for the duration of the study (an average of 93.3 sessions per participant) and the control group, which, after a 2-month testing phase, also was enrolled (for an average of 45.2 sessions).

Neuropsychological testing was conducted at baseline, at 2 months, and at 6 months. After 2 months, preliminary analysis of intervention group subjects revealed better delayed recall for list learning. The intervention group improved by recalling 8.3 words, compared with their initial recall of 7.6 words during baseline testing.

The control group's recall declined to on average 5.3 words during the posttesting period from the initial recall of 6.8 words.

At 6 months, participants in the intervention vs. control groups were significantly different in their delayed memory domain score. In the intervention group, which had played for the full 6 months, scores rose from 10.4 at baseline to 12.1.

In the control group, which played from month 2 to month 6, the same memory scores fell slightly, from 10.2 at baseline to 10.1 at follow-up.

The key finding, Dr. Miller said, is the importance of exposure. The longer a person uses the program, the more likely he or she is to improve in verbal and visual memory. The results at 2 months were “mild,” while those at 6 months were “most overwhelmingly positive.”

She added that 2- and 6-month analyses of a larger study of 100 subjects, which will include data on perception of memory functioning and mood, should be available by the summer. If she secures additional funding, she plans to do a follow-up at years 1 and 5.

Numerous brain fitness products are on the market, and that prompted a question from the audience about how to separate the legitimate programs from the “Elmer Gantries.” Another session panelist, Dr. Gary Small also of the University of California, Los Angeles, fielded the question and suggested that the program should be viewed with the same kind of skepticism that should be taken toward nutritional supplements. “We need more evidence before we get all excited about it,” he said.

Dr. Small is a Dakim shareholder.

Participants who regularly used a touch-screen program had significant improvements on verbal and visual memory scores compared with a control group.

Source Courtesy Dakim