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Elderly Drivers with Cognitive Impairment

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222. In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving (PubMed)

-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation (...) In the Zzz Zone: The Effects of Z-Drugs on Human Performance and Driving Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have

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2013 Journal of Medical Toxicology

223. Real-life driving outcomes in Parkinson disease. (PubMed)

strategies, low driving exposure, impairments in visual perception (especially visual processing speed and attention) and cognitive abilities, parkinsonism (especially activities of daily living score and total daily dose of antiparkinsonian medications), and higher error counts on a road test. Within PD, crashes were associated with poorer postural stability and history of driving citations, and citations were associated with younger age and road errors at baseline.Drivers with PD are at a higher risk (...) of driving cessation than elderly control drivers. A battery evaluating motor and nonmotor aspects of PD, driving record, and performance can be useful in assessing future driving outcomes in PD.

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2011 Neurology

224. A Study to Evaluate Next Day Effects of MK-4305 on Driving Performance (MK-4305-035 AM1)

the last 3 years Is capable of driving a manual transmission vehicle and is willing to drive on a highway Is judged to be in good health Has a regular sleep pattern Is not visually impaired Exclusion Criteria: Has a history of a persistent sleep abnormality Has neurological disease/cognitive impairment Has a history of cataplexy Is a regular user of sedative-hypnotic agents Is allergic to zopiclone Has traveled across 3 or more time zones (transmeridian travel) in the last 2 weeks prior to study start (...) . Information provided by (Responsible Party): Merck Sharp & Dohme Corp. Study Details Study Description Go to Brief Summary: This is a study to evaluate next-day residual effects of MK-4305 on highway driving performance in healthy, non-elderly participants. Condition or disease Intervention/treatment Phase Insomnia Drug: MK-4305 40 mg Drug: MK-4305 20 mg Drug: Zopiclone Drug: Grossly Matching Placebo for Zopiclone Drug: Matching Placebo for MK-4305 Phase 1 Study Design Go to Layout table for study

2011 Clinical Trials

225. Comprehensive Informatics Framework for Comparative Effectiveness Research (CER) Dissemination

information via combination of high technology media along with traditional media that are easily usable is helpful (Longo, 2005). A recent review of barriers and drivers of health IT use by elderly, very ill, and underserved, revealed that such technology can play a role in offering effective interventions. The consumer perceptions on benefits from use of system, convenience of use, and familiar technology were all important factors for intervention success (Jimison et al., 2008). Study Design Go (...) ; presence of significant cognitive impairment based on a Mini-Mental State Examination (MMSE) score ≤23 do not speak English. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01493258 Locations Layout table for location information United States

2011 Clinical Trials

226. Driving Simulator Performance in Patients with Possible and Probable Alzheimer’s Disease (PubMed)

AD) and nine at a CDR of 1 (probable AD), were compared to 63 cognitively normal, elderly controls. All subjects were trained to drive a computerized interactive driving simulator and then tested on a 19.3 km (12 mile) test course.The AD subjects demonstrated impaired driving performance when compared to the controls. The simulated driving performance of the CDR 1 AD subjects was so degraded that it would be regarded as unsafe by standard assessment criteria. The CDR 0.5 subjects made similar (...) Driving Simulator Performance in Patients with Possible and Probable Alzheimer’s Disease Drivers with more advanced stages of Alzheimer's disease (AD) have been previously associated with an increased rate of motor vehicle accidents. Drivers suffering from early AD are also involved in, and may even cause motor vehicle accidents with greater frequency than "normal" drivers. Consequently there is considerable public concern regarding traffic safety issues for those with AD and subsequently

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2011 Annals of Advances in Automotive Medicine / Annual Scientific Conference

227. Occupational Therapy (OT)

The Gerontological Society of America. Occupational therapists may also assess the home for hazards and make recommendations to ensure home safety (eg, removing throw rugs, increasing hallway and kitchen lighting, moving a night table within reach of the bed, placing a family picture on a door to help patients recognize their room). Determining when driving is a risk and whether driver retraining is indicated is best done by occupational therapists with specialized training. Information that can help elderly (...) (ADLs) because they are the cornerstone of independent living. Basic ADLs (BADLs) include eating, dressing, bathing, grooming, toileting, and transferring (ie, moving between surfaces such as the bed, chair, and bathtub or shower). Instrumental ADLs (IADLs) require more complex cognitive functioning than BADLs. IADLs include preparing meals; communicating by telephone, writing, or computer; managing finances and daily drug regimens; cleaning; doing laundry, food shopping, and other errands

2013 Merck Manual (19th Edition)

228. Vertigo part 2 - management in general practice

. 24 Rebuilding the confidence in mobilisation and implementation of fall preventive measures can allow resumption of independent living for elderly patients with impaired vestibular function. conclusion Management of vertigo can be a daunting task due to a large number of potential underlying conditions. Treatment for vertigo is still mainly symptomatic. While some underlying conditions can be satisfactorily managed, further research is needed to establish treatment efficacy for other conditions (...) , such as pilots or divers. The fistula will usually heal after 2 weeks from the onset of symptoms with appropriate bed rest and avoidance of straining and coughing. Initial and follow up audiological assessments are mandatory and surgical repair is required if there is progressive hearing loss. medication induced vertigo This is usually of slow onset with bilateral hearing and vestibular functional impairment. The offending medications should be ceased. However, the damage may be irreversible. Driving Driving

2008 The Royal Australian College of General Practitioners

229. Alcohol abuse

over time. Alcohol also causes impairment in a person's critical thinking. A person's ability to reason in stressful situations is compromised, and they seem very inattentive to what is going on around them. are significantly impaired in people suffering from due to the effects of alcohol on the brain, especially the area of the brain. The is responsible for cognitive functions such as , and decision making. This region of the brain is vulnerable to chronic alcohol-induced . The social skills (...) known to disagree with this view. Alcohol use disorders often cause a wide range of cognitive impairments that result in significant impairment of the affected individual. If alcohol-induced has occurred a period of abstinence for on average a year is required for the cognitive deficits of alcohol abuse to reverse. College/university students who are heavy binge drinkers (three or more times in the past two weeks) are 19 times more likely to be diagnosed with alcohol dependence, and 13 times more

2012 Wikipedia

230. Hippocampus

this finding. There is, however, a reliable relationship between the size of the hippocampus and memory performance; so that where there is age-related shrinkage, memory performance will be impaired. There are also reports that memory tasks tend to produce less hippocampal activation in the elderly than in the young. Furthermore, a published in 2011 found that could increase the size of the hippocampus in adults aged 55 to 80 and also improve spatial memory. Effects of cortisol [ ] The hippocampus contains (...) , and vice versa. One of the consequences of this is that the medial pallium ("hippocampal" zone) of a typical vertebrate is thought to correspond to the lateral pallium of a typical fish. Several types of fish (particularly goldfish) have been shown experimentally to have strong spatial memory abilities, even forming "cognitive maps" of the areas they inhabit. There is evidence that damage to the lateral pallium impairs spatial memory. It is not yet known whether the medial pallium plays a similar role

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2012 Wikipedia

231. Inflammation

[ ] It has long been recognized that infection with HIV is characterized not only by development of profound immunodeficiency but also by sustained inflammation and immune activation. A substantial body of evidence implicates chronic inflammation as a critical driver of immune dysfunction, premature appearance of aging-related diseases, and immune deficiency. Many now regard HIV infection not only as an evolving virus-induced immunodeficiency but also as chronic inflammatory disease. Even after (...) clearance and release of anti-inflammatory and reparative such as transforming growth factor-β1. The anti-inflammatory program ends with the departure of macrophages through the . ” — Charles Serhan Connection to depression [ ] There is evidence for a link between inflammation and depression. Inflammatory processes can be triggered by negative cognitions or their consequences, such as stress, violence, or deprivation. Thus, negative cognitions can cause inflammation that can, in turn, lead to depression

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2012 Wikipedia

232. Sleep

, cognitive tasks, and mental health in elderly people. Many people experience a temporary drop in alertness in the early afternoon, commonly known as the "post-lunch dip". While a large meal can make a person feel sleepy, the post-lunch dip is mostly an effect of the circadian clock. People naturally feel most sleepy at two times of the day about 12 hours apart—for example, at 2:00 a.m. and 2:00 p.m. At those two times, the body clock "kicks in." At about 2 p.m. (14:00), it overrides the homeostatic (...) is the , an experience typically recounted in form, which resembles waking life while in progress, but which usually can later be distinguished as fantasy. During sleep, most of the are in an state, helping to restore the immune, nervous, skeletal, and muscular systems; these are vital processes that maintain mood, memory, and cognitive function, and play a large role in the function of the and . The internal promotes sleep daily at night. The diverse purposes and mechanisms of sleep are the subject of substantial

2012 Wikipedia

233. Visual extinction

, Simon-Dack S, Baylis LL, Baylis GC (2009). "Visual extinction: The effect of temporal and spatial bias". Neuropsychologia 47 ,321-329. ^ Bailey, M, Riddoch, MJ, Crome, P (2002). "Treatment of visual neglect in elderly patients with stroke: A single-subject series using either a scanning and cueing strategy or a left-limb activation strategy". Physical Therapy 82.8 , 782-797. Ladavas, E, Menghini, G, Umilta, C. "On the Rehalibation of Hemispatial Neglect." In Riddoch & Humphreys (Ed.) Cognitive (...) Neuropsychology and Cognitive Rehabilitation 151-172. East Sussex, UK: Lawrence Erlbaum Associateds Publishing. GA Eskes, B Butler, A McDonald, ER Harrison, SJ Phillips (2003). "Limb activation effects in hemispatial neglect" Archives of Physical Medicine and Rehabilitation 84(3) , 323-328. Vuilleumier, P (2000). "Faces call for attention: evidence from patients with visual extinction". Neuropsychologia 38(5) , 693-700. Mattingley, JB, Davis, G, Driver, J (1997). "Preattentive filling-in of visual surfaces

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2012 Wikipedia

234. Vasopressin

(nephrogenic, i.e. by mutation of V2 receptor or AQP) leads to , a condition featuring (increased blood concentration), (excess urine production), and (thirst). Excess [ ] Main article: in turn can be caused by a number of problems. Some forms of can cause SIADH, particularly but also a number of other tumors. A variety of diseases affecting the brain or the lung (infections, bleeding) can be the driver behind SIADH. A number of drugs has been associated with SIADH, such as certain antidepressants (...) of vasopressin and vasopressin receptors in the brain is associated with species-typical patterns of social behavior. In particular, there are consistent differences between monogamous species and promiscuous species in the distribution of AVP receptors, and sometimes in the distribution of vasopressin-containing axons, even when closely related species are compared. Human studies [ ] Vasopressin has shown effects on pain perception and cognitive function. Vasopressin also plays a role in , , , and . See

2012 Wikipedia

235. Diazepam

, diazepam can impair short-term memory and learning of new information. While benzodiazepine drugs such as diazepam can cause anterograde amnesia, they do not cause ; information learned before using benzodiazepines is not impaired. Tolerance to the cognitive-impairing effects of benzodiazepines does not tend to develop with long-term use, and the elderly are more sensitive to them. Additionally, after cessation of benzodiazepines, cognitive deficits may persist for at least six months; it is unclear (...) reactions are more likely to occur in children, the elderly, and individuals with a history of drug or alcohol abuse and or aggression. Diazepam may increase, in some people, the propensity toward self-harming behaviours and, in extreme cases, may provoke suicidal tendencies or acts. Very rarely can occur. Diazepam may impair the ability to drive vehicles or operate machinery. The impairment is worsened by consumption of alcohol, because both act as central nervous system depressants. During the course

2012 Wikipedia

236. Lyme disease

, , , and changes in personality. Other problems, however, such as and , are no more common in people with Lyme disease than in the general population. Chronic , which may be progressive, can involve cognitive impairment, brain fog, , balance issues, weakness in the legs, awkward gait, facial palsy, bladder problems, , and back pain. In rare cases, untreated Lyme disease may cause , which has been misdiagnosed as or . Panic attacks and anxiety can occur; also, delusional behavior may be seen, including (...) can occur, including permanent of the lower extremities in extreme cases. The associated nerve pain radiating out from the spine is termed , named after . The late disseminated stage is where the infection has fully spread throughout the body. Chronic neurologic symptoms occur in up to 5% of untreated people. A that involves shooting pains, numbness, and tingling in the hands or feet may develop. A neurologic syndrome called Lyme encephalopathy is associated with subtle cognitive difficulties

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2012 Wikipedia

237. Dementia

may have secondary effects on brain cells, which may or may not be reversible if the condition is treated. Causes of dementia depend on the age when symptoms begin. In the elderly population (usually defined in this context as over 65 years of age), a large majority of dementia cases are caused by , , or both. is another commonly exhibited form, which again may occur alongside either or both of the other causes. sometimes causes slowly progressive cognitive impairment as the main symptom (...) Dementia Dementia - Wikipedia Dementia From Wikipedia, the free encyclopedia This is the , on 6 April 2019 . This article is about the cognitive disorder. For other uses, see . "Senile" redirects here. For other uses, see . long-term brain disorders causing impaired memory, reasoning, and normal function together with personality changes Dementia Other names Senility, senile dementia Comparison of a normal aged brain (left) and the brain of a person with (right). Differential characteristics

2012 Wikipedia

238. Neuroplasticity

unilateral dorsal-column lesions at cervical levels in macaque monkeys." Adult brains have the ability to change as a result of injury but the extent of the reorganization depends on the extent of the injury. His recent research focuses on the somatosensory system, which involves a sense of the body and its movements using many senses. Usually, damage of the somatosensory cortex results in impairment of the body perception. Kaas' research project is focused on how these systems (somatosensory, cognitive (...) central roles in were the most significantly affected by age, generally showing reduced expression over time. There was also a marked increase in cortical , likely , in with aging. appear to have a significant role in the regulation of synaptic plasticity and cognitive function. However age-related increases in reactive oxygen species may also lead to impairments in these functions. History [ ] Origin [ ] The term "plasticity" was first applied to behavior in 1890 by in . The first person to use

2012 Wikipedia

239. Effects of Insomnia on Simulated Driving (MK-0000-183-00)

Study Description Go to Brief Summary: This is a double-blind, parallel design study in elderly primary insomnia patients and demographically matched controls. The objectives if this study are primarily: 1. To determine if functional deficits in simulated driving performance can be demonstrated in primary insomnia patients, and detected in healthy volunteers, impaired by alcohol; and secondarily: 2. To compare simulated driving performance deficits in elderly primary insomnia patients to those (...) in healthy elderly volunteers impaired by alcohol, for at least one of the following driving endpoints: standard deviation of lane position (SDLP), standard deviation of speed (speed deviation), lane excursions, and a driving composite score. Condition or disease Intervention/treatment Phase Insomnia Other: Placebo/ethanol (blinded) Phase 1 Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 76 participants Allocation: Randomized

2010 Clinical Trials

240. Parkinson's Disease Management

common in older and cognitively impaired patients; greater with agonists). Options include the following: Monoamine-oxidase-B inhibitors (MAO-BIs) - selegiline, rasagiline. Oral or transdermal dopamine agonist. Pramipexole, ropinirole and rotigotine are effective. Initial treatment with an agonist is recommended in younger patients. Levodopa is the most effective symptomatic drug. The use of controlled-release formulations or adding entacapone is not effective in the delay of motor complications (...) or contra-indicated (eg, if cognitive impairment, hallucinations or delusions, or a history of adverse effects following anticholinergic treatment), consider referral to a specialist service for botulinum toxin. Only consider anticholinergic medicines other than glycopyrronium bromide to manage drooling of saliva in people with Parkinson's disease if their risk of cognitive adverse effects is thought to be minimal. Use topical preparations if possible (eg, atropine) to reduce the risk of adverse events

2008 Mentor

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