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The case of a 91-year-old woman is used to discuss the administration of tacrine therapy for enhancing cognitive functions in patients with Alzheimer's disease. Tacrine, an inhibitor of acetylcholinesterase, is generally given to patients with no history of liver disease. Patients who receive the drug, which causes increased liver transaminases and gastrointestinal effects, usually require a follow-up cognitive test and weekly blood tests to assess liver function., Mrs. L, age 91, has resided in a nursing home since she was diagnosed with Alzheimer's disease 7 years ago. Based on her medical history and the results of mental [...]

Objective: The authors investigated the relationships between concentrations of two acute-phase proteins, [[Alpha].sub.1]-antichymotrypsin (ACT) and [[Alpha].sub.2]-macroglobulin (MAC), and cognitive impairment in the very old. Method: Concentrations of ACT and MAC were determined in a prospective study using sera from medically stable elderly nursing home residents. Cognitive impairment was assessed with the Mini-Mental State. Results: Concentrations of ACT were associated with greater cognitive impairment, as reflected by lower Mini-Mental State scores. This relationship did not exist for MAC. Conclusions: These data extend previous reports that patients with Alzheimer's disease have greater concentrations of ACT in their blood by demonstrating in a diagnostically diverse nursing home population a relationship between serum ACT and mental status. Elevated serum ACT in patients with compromised mental status may reflect a cerebral acute-phase response.

The results of previous studies have indicated that psychotropic drugs, medications used for the treatment of mental illness, are frequently prescribed for the elderly in nursing homes. Estimates of psychotropic drug prescriptions among this group range from 11 to 74 percent. These results require further investigation because of this wide range of variability, and also to further examine the patterns of drug prescribing over time. This longitudinal study consisted of 91 residents of a 200-bed nursing home that was also a geriatric and psychiatric teaching facility affiliated with a medical college. The patients ranged in ages between 54 and 103, and the average age was 85 years old. Data on prescription frequency, the number of prescriptions, and individual doses were collected over a five-year period. All psychiatric diagnoses which accompanied the psychotropic medications were also reviewed. The results of the five-year analysis revealed that 70 percent of the patients were given a psychotropic drug, but fewer than 25 percent received continuous medication during this period. Episodic administration of psychotropic drugs was more common than continuous use among those who received these drugs. It is believed that this report represents the first longitudinal study of psychotropic drug prescribing and usage patterns among elderly nursing home residents. Other factors that may be indicative of the quality of treatment among nursing home residents which require more research include the incidence of drug reactions, drug efficacy, and the association of these drugs with adverse events, such as falls, fractures, and fainting. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case presentation A 78-year-old widow presents to her primary care physician with complaints of severe anxiety, insomnia, overwhelming fearfulness, and an unrelenting feeling that 'something terrible is going to happen.' [...]

Case presentation An 80-year-old woman is brought in by her husband and daughters for a psychiatric evaluation. They want a second opinion about the treatments the patient is receiving for [...]