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Elderly Drivers with Cognitive Impairment


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161. Insomnia

for elderly people). Lormetazepam 500 micrograms at night. Benzodiazepines are contraindicated in people with [ ]: Respiratory depression, marked neuromuscular respiratory weakness such as unstable myasthenia gravis, acute pulmonary insufficiency, and sleep apnoea syndrome. Adverse effects of benzodiazepines include : Cognitive and psychomotor impairment, depression, emotional blunting, and, less commonly, paradoxical excitement with increased anxiety, irritability, or hyperactive or aggressive behaviour (...) that may exacerbate insomnia. The diary should be kept for at least 2 weeks. Good sleep hygiene should be established in all people with insomnia. This aims to make people more aware of behavioural, environmental, and temporal factors that may be detrimental or beneficial to sleep. For short-term insomnia, a short course (less than 2 weeks) of a hypnotic drug may be considered if daytime impairment is severe. For long-term insomnia, cognitive and behavioural interventions are recommended first line

2014 NICE Clinical Knowledge Summaries

162. MI - secondary prevention

of Direct Oral Anticoagulants in the Elderly for Stroke Prevention in Atrial Fibrillation andSecondary Prevention of Venous Thromboembolism: Systematic Review and Meta-Analysis. Circulation 132 (3), 194-204. [ ] Primary evidence No new randomized controlled trials published since 1 June 2014. New policies New policies No new national policies or guidelines since 1 June 2014. New safety alert New safety alert No new safety alerts since 1 June 2014. Changes in product availability Changes in product (...) on the person's physical and psychological status, the nature of the work, and the work environment. Driving The latest information from the Driver and Vehicle Licensing Agency (DVLA) regarding medical fitness to drive can be obtained at . In general: For a car or motorcycle licence holder, following an MI the person does not need to inform the DVLA. However, driving should stop for a time (the length depends on factors such as type of MI and treatments). The person should check with their insurer

2014 NICE Clinical Knowledge Summaries

163. Opioid dependence

is healthcare professionals working within the NHS in the UK, and providing first contact or primary health care. How up-to-date is this topic? How up-to-date is this topic? Changes Changes April 2017 — revised. Updated structure, no changes have been made to the recommendations. April 2015 — minor update. Update to the text to reflect a new law on drugs and impaired driving [ ]. October 2013 to March 2014 — reviewed. A literature search was conducted in October 2013 to identify evidence-based guidelines (...) costs to the criminal justice system in the UK estimated at £1 billion per annum in 1996 [ ]. Imprisonment. Effect on partner and children including child protection issues. Deprivation and social exclusion. Involvement in the sex trade. Homelessness. Loss of driving licence. Psychological problems include [ ] : Craving and fear of withdrawal. Guilt. Anxiety. Loss of memory or cognitive skills. Diagnosis Diagnosis of opioid dependence Presentation of opioid dependency When should I suspect a person

2014 NICE Clinical Knowledge Summaries

164. Canadian best practice recommendations for stroke care

and community-based rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E58 5.5 Follow-up and community reintegration . . . . . . . . E61 6 6: : S Se el le ec ct te ed d t to op pi ic cs s i in n s st tr ro ok ke e m ma an na ag ge em me en nt t E63 6.1 Dysphagia assessment . . . . . . . . . . . . . . . . . . . . . . . E63 6.2 Identification and management of post-stroke depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E65 6.3 Vascular cognitive impairment (...) discharge planning • New recommendation on vascular cognitive impairment and dementia for patients who have experienced a stroke, with guidance on screening and assessment for vascular cognitive impairment, appropriate timing for assessments, pharmacotherapy and nonpharmacologic management Focus on implementation • Strategic initiatives related to implementation are under way • Point-of-care tools have been developed and made avail- able to support implementation of the best practice rec- ommendations

2009 CPG Infobase

165. Highway driving in the elderly the morning after bedtime use of hypnotics: a comparison between temazepam 20 mg, zopiclone 7.5 mg, and placebo. (PubMed)

performed a standardized highway driving test between 10 and 11 hours after hypnotic intake. Before and after the driving test, cognitive performance was assessed. Driving performance did not differ between temazepam and placebo but was significantly impaired after zopiclone 7.5 mg (P < 0.002). The results of the laboratory tests were in line with the effects on driving of both hypnotics. Temazepam 20 mg is unlikely to impair driving 10 hours or more after bedtime administration in healthy elderly aged (...) of hypnotics are older people who may be more sensitive to drug effects. The aim of this study was to evaluate the residual effects the morning after evening doses of temazepam 20 mg and zopiclone 7.5 mg on driving performance in healthy elderly drivers. Eighteen healthy elderly drivers (10 females and 8 males; mean age, 64.3 years) participated in a double-blind, 3-way crossover study. Treatments were single oral doses of temazepam 20 mg, zopiclone 7.5 mg, and placebo administered at bedtime. Subjects

2009 Journal of Clinical Psychopharmacology

166. Evaluation and management of driving risk in dementia

with dementia seek to identify those patients with cognitive impairment who may be at higher risk for unsafe driving, without unnecessarily restricting those who are safe drivers. Clinicians' predictions of driving performance, when based primarily on the Mini-Mental State Examination (MMSE), result in no correlation or have a relatively low sensitivity for identifying an unsafe driver. When elements of the driving history and additional cognitive testing are considered along with MMSE scores (...) linked to the strength of the evidence (appendix e-5). The panel reviewed studies of patients with dementia of any cause or mild cognitive impairment. Population studies of aged drivers without an a priori diagnosis of dementia were accepted for analysis when studies limited to drivers with dementia were unavailable or inconclusive. The justification for this is based on the strong correlation between aging and dementia, and the fact that these studies frequently identified individuals with cognitive

2010 American Academy of Neurology

167. CPG on the comprehensive care of people with Alzheimer's Disease and other Dementias

, with the participation of the scienti? c associations involved, CPGs, such as this one have addressed the comprehensive care of people with Alzheimer’s disease and other demen- tias, which is presented today. Dementia as a clinical syndrome is characterised by an acquired impairment affecting more than one cognitive domain, which represents a decline from a previous level that is serious enough so as to affect personal and social functioning. Given the increase in life expectancy and progressive population ageing (...) evolve? 6. What is understood by degenerative dementia? 7. What is Alzheimer’s disease? 8. What is dementia with Lewy bodies? 9. What is Parkinson’s disease dementia? 10. What is frontotemporal lobar degeneration? 11. What other neurodegenerative diseases are accompanied by dementia? 12. What are vascular dementias? 13. What is and how is secondary dementia classi? ed? 14. What is understood by mild cognitive impairment (MCI)? 15. What types of MCI exist? 16. What is the incidence and prevalence

2010 GuiaSalud

168. Benzodiazepine and z-drug withdrawal

symptoms. Outcome measures Outcome measures No outcome measures were found during the review of this topic. Audit criteria Audit criteria No audit criteria were found during the review of this topic. QOF indicators QOF indicators No QOF indicators were found during the review of this topic. QIPP - Options for local implementation QIPP - Options for local implementation The risks associated with hypnotics, such as falls, cognitive impairment, dependence and withdrawal symptoms, are well recognised. Only (...) -drug withdrawal symptoms include insomnia/sleep disturbance, anxiety, depression, impaired concentration, abdominal cramps, palpitations, and perceptual disturbances (such as hypersensitivity to physical, visual and auditory stimuli). The risk of withdrawal symptoms increases with longer use, higher dosage, and higher potency. Other effects of long-term use of benzodiazepines include: Cognitive effects, anxiety, agarophobia, emotional blunting, reduced coping skills, and amnesia. Reduced social

2013 NICE Clinical Knowledge Summaries

169. Depression - antenatal and postnatal

Depression - antenatal and postnatal Depression - antenatal and postnatal - NICE CKS Clinical Knowledge Summaries Share Depression - antenatal and postnatal: Summary Depression refers to a spectrum of mental health problems characterized by the absence of positive affect (that is a loss of interest and enjoyment in ordinary things and experiences), low mood, and additional emotional, cognitive, physical, and behavioural symptoms. Women who are pregnant or postnatal can develop or have the same (...) , antidepressants are an option. In a postnatal woman with depression it is recommended that specialist advice is sought (ideally from a specialist perinatal mental health team, where available; or from secondary psychiatric care) before starting, stopping, or switching antidepressant treatment, particularly if the woman is breastfeeding. Antidepressant treatment should be discussed with a paediatrician if the if the baby was premature or has health problems or liver or kidney impairment. Sertraline

2013 NICE Clinical Knowledge Summaries

170. Generalized anxiety disorder

will initially present with somatic symptoms such as muscle tension or insomnia. The somatic, cognitive, and behavioural symptoms of GAD can severely impair day-to-day functioning and commonly present in association with other depressive and physical health comorbidities. The aetiology of anxiety disorders is multifactorial and includes environmental stressors, genetic factors, chronic illness, and substance abuse. Anxiety disorders as a diagnostic category are the most common psychiatric disorders (...) of the person's symptoms, functioning, and response to treatment (if applicable) at intervals as detailed below, and/or determined by clinical judgement. Step 2 — For people without marked functional impairment who have not improved following step 1 interventions, offer low-intensity psychological interventions based on cognitive behavioural therapy (CBT) principles, such as : Individual non-facilitated self-help — should include suitable written or electronic materials that the person works through

2013 NICE Clinical Knowledge Summaries

171. Stroke and TIA

levels of oral bacteria can increase the risk of aspiration pneumonia and sepsis. Dehydration and malnutrition can occur due to swallowing problems, inability to self-feed, cognitive impairment, anxiety, depression, unfamiliar foods and fatigue. Sexual dysfunction Vascular disease, altered sensation, limited mobility, adverse effects of medication, mood disorders and fear of precipitating further strokes can lead to sexual dysfunction after stroke. Skin problems Reduced mobility increases the risk (...) of pressure sores. Visual problems Stroke can lead to visual problems such as altered acuity, hemianopia, diplopia, nystagmus, and blurred vision. Cognitive problems General cognitive impairment is common in the early period following a stroke. A systematic review and meta-analysis of 73 papers (n = 7511) found that 10% of patients had dementia before first stroke, 10% developed new dementia soon after first stroke, and over a third had dementia following recurrent stroke [ ]. Dyspraxia (difficulty

2013 NICE Clinical Knowledge Summaries

172. Obsessive-compulsive disorder

impairment. Management options include: Cognitive-behavioural therapy (CBT), ideally including exposure and response prevention (ERP). A selective serotonin reuptake inhibitor (SSRI) or clomipramine. SSRIs should only be prescribed to people under 18 years of age following assessment and diagnosis by a child and adolescent psychiatrist. Specialist referral (depending on factors including the person's age, severity of symptoms, and previous treatment failures). Referral for urgent psychiatric assessment (...) leaflets on , , and . For adults with mild functional impairment: Recommend a psychological intervention. This is accessed by referral or self-referral to (Improving Access to Psychological Therapies). Following assessment, a low intensity cognitive-behavioural therapy (CBT), including exposure and response prevention (ERP) may be offered. The format for low-intensity CBT should be up to 10 therapist-hours per person, of one of the following: Brief individual CBT (including ERP) with structured self

2013 NICE Clinical Knowledge Summaries

173. Brain Sleep Clearance of Amyloid-Beta Peptides

the protective effect of SWS on Aβ42 dynamics in a group of cognitively normal elderly subjects as well as the effect of acute sleep disruption by CPAP withdrawal on CSF Aβ42 levels in a well characterized clinical sample of severe obstructive SDB patients on treatment with CPAP. The results from this study will improve our understanding of the nature of the Aβ diurnal pattern and the brain consequences of full night sleep disruptions as well as sleep disruptions during specific stages of sleep. Condition (...) Comparator: Group A 25 cognitively normal elderly subjects (age 55-75), newly enrolled or currently participating in R01HL118624-01 (IRB S12-03068), a 2-year longitudinal on-going study that is aimed at examining the longitudinal associations between SDB and cognitive decline in the elderly. Device: Continuous positive airway pressure device GROUP B ONLY will be evaluated on two randomized counterbalanced nights, on one they will undergo a full night of therapeutic CPAP; on the other the investigators

2015 Clinical Trials

174. Guidelines on Diagnosis and Management of Syncope

. . . . . . . . . . . . . . . . . . . . . . . 2661 3.4.1 Ischaemic and non-ischaemic cardiomyopathies . . . 2661 3.4.2 Hypertrophic cardiomyopathy . . . . . . . . . . . . . . 2661 3.4.3 Arrhythmogenic right ventricular cardiomyopathy/ dysplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2661 3.4.4 Patients with primary electrical diseases . . . . . . . . 2661 Part 4. Special issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2662 4.1 Syncope in the elderly . . . . . . . . . . . . . . . . . . . . . . 2662 4.2 Syncope (...) cerebral hypoperfusion at the centre, adjacent to low or inadequate peripheral resistance and low CO. A low or inadequate peripheral resistance can be due to inap- propriate re?ex activity depicted in the next ring, causing vasodila- tation and bradycardia manifesting as vasodepressor, mixed, or cardioinhibitory re?ex syncope, seen in the outer ring. Other causes of a low or inadequate peripheral resistance are functional and structural impairments of the autonomic nervous system (ANS) with drug

2009 European Society of Cardiology

175. Position Statement: the management of patients with physical and psychological problems in primary care - a practical guide

emphasised the need for individuals with physical illness to have access to both psychiatric and psychological services and to encourage staff working in mainstream services to develop their skills in identifying and managing psychological aspects of physical illness, common across all age groups, including the elderly, children and adolescents. It still remains difficult, however, for most individuals with a combination of physical and psychological needs to access appropriate services (...) experience and express illness – one of them is ‘attachment theory’. Children learn from their own behaviours and the responses of others. The early ‘mother’ – infant relationship acts as ‘a homeostatic regulatory system that facilitates the emergence of a primitive mind from the bodily functions of the infant’ (Mahler, 1982), from whom we move over time from external to internal regulation, with development of independence. A child’s emotional and cognitive development requires him or her to internalise

2009 Royal College of General Practitioners

176. Enabling medication management through health information technology

and reduce potential and real errors in medication management while at the same time providing cost-effective care. The Agency for Healthcare Research and Quality (AHRQ) is committed to summarizing and providing the evidence base for health IT. It has produced evidence summaries on health IT related to costs and benefits; 2 barriers and drivers of health IT for the elderly, chronically ill, and underserved; 3 the impact of consumer informatics applications; 4 and telemedicine. 5 AHRQ also has contracted (...) -Way Prescriber and Pharmacy Electronic Data Interchange (e-Prescribing) (a) What Evidences Exists Demonstrating the Barriers and Drivers of Implementation of Complete EDI That Can Support the Prescription, Transmittal and Receipt, and Perfection viii Process of e-Prescriptions? (b) How Do Barriers, Facilitators, and Economic Incentives Vary Across Pharmacists, Physicians, and Other Relevant Stakeholders With Respect to Adoption and Use of Complete EDI (e-Prescribing/Ordering With e-Transmission

2011 EvidenceUpdates

177. Occupational therapy for people with Parkinson's disease

the fi ndings of an inquiry regarding ‘access to health and social care services for people with Parkinson’s disease and their carers’. Key recommendations of the report are to improve leadership; ensure drivers are in place to support implementation of national guidance; strengthen service monitoring; and support better commissioning and planning of services, through the provision of evidence and guidance, and in particular strengthening workforce planning so that suffi cient skilled professionals (...) pathways in the brain: projecting from the substantia nigra to the caudate nucleus- putamen (neostriatum – concerned with sensory stimuli and movement); the ventral tegmentum to the mesolimbic forebrain (believed to be associated with cognitive function, reward and emotional behaviour); and to the tubero- infundibular system (concerned with neuronal control of the hypothalmic- pituatory endocrine system). The role of dopamine in the performance of skilled movement Dopamine is a major neurochemical

2010 British Association of Occupational Therapists

178. Smoking cessation

and increases the risk of developing pneumonia and tuberculosis. Stomach and duodenal ulcers. Erectile dysfunction. Male and female infertility. Progressive harm to the musculoskeletal system — smoking is a risk factor for osteoporosis, and there is an association between smoking and an increased risk of bone fracture. It is a cause of rheumatoid arthritis, especially among men. Progressive harm to the cognitive system. People who smoke are over 50% more likely to develop cognitive impairment than those who

2012 NICE Clinical Knowledge Summaries

179. Neuro-ophthalmic Examination (Overview)

. It is not uncommon for patients to mistake homonymous visual loss for ipsilateral monocular visual loss. Furthermore, cognitively impaired patients may be incapable of performing formal perimetry. Fields should be examined monocularly with the patient fixating on the examiner's nose. By convention, confrontation field defects are recorded from the perspective of the patient rather than the examiner. Some examiners test confrontation fields by moving a finger, pen, or red-headed pin inward from the periphery (...) be placed on either side of the vertical midline to see if desaturation (fading) is present on 1 side. Clinical suspicions can be confirmed with formal perimetry testing. Confrontation visual fields are tested monocularly with the patient fixating on the examiner's eye or nose. The patient can be asked to add up the number of fingers, which are simultaneously presented on either side of the midline. In some patients who are cognitively impaired, confrontation fields may provide a more accurate


180. Obstructive Sleep Apnea-Hypopnea Syndrome (Overview)

quiet activities (eg, reading, watching television); as the severity worsens, patients begin to feel sleepy during activities that generally require alertness (eg, school, work, driving) Daytime fatigue/tiredness Cognitive deficits; memory and intellectual impairment (short-term memory, concentration) Decreased vigilance Morning confusion Personality and mood changes, including depression and anxiety Sexual dysfunction, including impotence and decreased libido Gastroesophageal reflux Hypertension (...) to diagnose OSA. Routine laboratory tests, however, are usually not helpful in OSA unless a specific indication is present. Pulmonary function tests are not indicated to make a diagnosis of, or treatment plan for, OSA alone. The standard indications for such testing apply to all patients, with or without OSA. Obtain a thyrotropin test on any patient with possible OSA who has other signs or symptoms of hypothyroidism, particularly in elderly individuals. AASM standards and guidelines for diagnostic


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