Analysis Of Inappropriate Drug Use In Patients With Advanced Dementia And Serum Metabolome Of Patients With Alzheimer's Disease

PART ONE: ANALYSIS OF INAPPROPRIATE DRUG USE IN PATIENTS WITH ADVANCED DEMENTIABackground Patients with advanced dementia are at the end phase of the disease,characterized as severe cognitive impairment and completely dependence in life.The treatment of patients with advanced dementia should be guided by the goal of improving comfort of patients.The use of drugs should according to the principle of palliative care,and drugs that are inappropriate and cannot benefit patients should be minimized.Objective The aim of this study is to investigate the inappropriate medication use in a part of patients with advanced dementia in Chongqing,and then compare incidence associated with use of inappropriate drugs in hospitals and in nursing home,furthermore,analyze the causes,and to provide evidence for clinic medication of advanced dementia.Methods During 2017-2019,170 patients with advanced dementia from three medical institutions and four nursing homes were selected,consisting of 57 nursing home residents and 113 inpatients.We recorded medications for the patients and analyzed cross-sectional data.According to the consensus panel criteria of the Palliative Excellence in Alzheimer Care Efforts(PEACE)Program proposed in 2008,inappropriate medication was defined as the use of drugs classified as rarely or never appropriate in patients with advanced dementia.Results Mean age of 170 participants was 84.2 years old,of which 98(57.6%)were women and 72(42.4%)were men.Among all types of dementia,Alzheimer's disease(AD)accounted for 33.5%,mixed dementia accounted for 15.9%,and vascular dementia accounted for 15.3%,56 patients were not clearly diagnosed on type of dementia before.Patients were taking an average of 7.8 medications.The most commonly used inappropriate drug were memantine(25%),lipid-lowering agents(24%)and donepezil(19%).The number of medications and the incidence of inappropriate drug use for inpatients were significantly higher than those in nursing homes,and the difference was statistically significant(P<0.05).Conclusion Based on the results of our study,patients with advanced dementia often use inappropriate drugs.Inpatients are more likely to use inappropriate drugs than elderly residents living in nursing homes,associated with insufficient knowledge of clinicians and excessive drug intervention due to family members' treatment requirements sometimes.For patients with advanced dementia,under the premise of improvingcomfort as treatment goal,medical staff should fulfill the concept of palliative treatment and focus on relieving symptoms and improving quality of life for patients,they should refer to the standard of drug treatment for patients with advanced dementia and reduce inappropriate medication use.PART TWO: SERUM METABOLOME OF PATIENTS WITH ALZHEIMER'S DISEASEBackground Alzheimer's disease(AD)is the most common type of dementia.As the population aging,it is getting more and more attention,but there is no cure method for this disease so far.Recently,there have been many research on AD diagnostic tools,hoping to acquire early,sensitive,and accurate diagnostic tools,among which blood biomarkers have the advantages of simple,convenient,inexpensive and non-invasive.Objective The aim of this study is to find the metabonomic differences between AD patients and patients with normal cognition,and to get a blood biomarkers panel of AD,which serve as an early diagnostic tool for AD,it can provide a basis for future interventions and preventive measures to promote cognitive health.Methods During September 2016 to October 2018,we included 173 patients.Those with AD were enrolled in the AD group(n=87)and those with normal cognitive function were included in the control group(n=86).The patients' general information were collected and their blood was collected.The raw data was obtained by Gas Chromatography-Mass Spectrometer(GC-MS)and statistical analysis was analyzed.The AD biomarkers were obtained by identifying the difference in serum metabolism of two group of patients.Results The results showed that there were some metabolites in the serum of the two groups,among which the most associated with AD were cholesterol,putrescine,2-monopalmitin and cytidine-monophosphate,and the biomaker panel consisting of these four metabolites proved to have good sensitivity and specificity.Conclusion The serum metabolites of patients with AD are different from people with cognitive normal,and the metabolite panel may become the reference for early diagnosis of AD,bringing better treatment and more targeted prevention to patients maybe.