George Alexopoulos, MD
Vice-Chair, Department of Psychiatry
Graduate School of Medical Sciences
Weill Medical College of Cornell University
Director, Clinical Research Center for Geriatric Mood Disorders
Director, Cornell Institute of Geriatric Psychiatry
White Plains, New York
Raymond C. Love, PharmD, BCPP, FASHP
Professor of Pharmacy
Vice-Chair, Department of Pharmacy Practice and Science
Director, Mental Health Programs
University of Maryland, School of Pharmacy
Physicians and Pharmacists: 1
Nurses and NPs: 1.2 (based on 50 minute hour) Medium
THIS ACTIVITY WAS ORIGINALLY PRESENTED AS A LIVE AUDIOCONFERENCE BEGINNING ON JUNE 26, 2006. IF YOU EARNED CME OR CE CREDIT FOR THE AUDIOCONFERENCE YOU ARE NOT ELIGIBLE TO RECEIVE CREDIT FOR THIS ONLINE RELEASE.
It is estimated that over 7,000,000 people in the United States have dementia. Although cognitive decline is the hallmark of dementia, it is the behavioral manifestations of neuropsychiatric symptoms that commonly lead to nursing home placement. Approximately half of all nursing home residents have some form of dementia, with a majority of those exhibiting psychotic and/or behavioral symptoms. The burden is substantial. Physical aggression, agitation, hallucinations, and wandering not only negatively impact the functioning and quality of life of the afflicted residents, but also are distressing to other residents, family, and caregivers.
Treatment can be challenging. These non-cognitive manifestations of dementia are often caused by multiple factors, such as medical problems, environmental issues, or reduced cognition. Non-pharmacological approaches may provide some benefit in patients in the early stages. However, as the disease progresses and behavioral symptoms intensify, non-pharmacological strategies might not be sufficient and pharmacological agents may be indicated.
Studies have shown that the atypical antipsychotics are effective in managing these behavioral manifestations. However, recent clinical trials suggest an association between atypical antipsychotic use and stroke in the elderly prompting clinicians to discontinue or avoid using these agents altogether. In order to appropriately manage behavioral and psychotic symptoms in this vulnerable population, it is essential that clinicians understand the risks and benefits associated with these agents.
This program provides an overview of the special needs of long-term care residents with psychotic symptoms. Strategies for treating and preventing some of the most common and debilitating behavioral problems are addressed. Current practice guidelines and clinical studies are also assessed, including the Clinical Antipsychotic Trials of Intervention Effectiveness protocol for Alzheimer’s disease (CATIE-AD), a national study funded by the National Institute of Mental Health (NIMH) that assesses the effectiveness of atypical antipsychotics for psychoses and agitation in Alzheimer’s disease. Program Developer/Facilitator
. Target Audience
This program has been developed specifically for healthcare professionals caring for patients with dementia in long-term care.
Upon completion of this educational activity, the participant should be able to:
Identify the most frequent disease states contributing to behavioral disturbances in dementia.
Review the unique pharmacologic requirements of the elderly.
Discuss the pharmacology of antipsychotic therapy, its impact on metabolic changes and cognitive function, and the differences and side effect profiles of the available antipsychotic agents.
Discuss current studies (including CATIE-AD) and practice guidelines evaluating the use of atypical antipsychotics in the elderly.
It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The faculty must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflict of interest is resolved by AKH prior to accreditation of the activity.
George Alexopoulos, MD, discloses that he is has received research grants from Cephalon, Inc.and Forest Laboratories, Inc.; is a member of a scientific advisory board for Forest Laboratories, Inc., and is a member of speakers’ bureaus for Cephalon, Inc., Forest Laboratories, Inc., Eli Lilly and Company, Bristol-Myers Squibb Company, GlaxoSmithKline, Pfizer Inc, and Janssen Pharmaceutica Inc.
Raymond C. Love, PharmD, discloses that he has received research support from AstraZeneca and Janssen Pharmaceutica Inc.
This educational activity may contain discussion of published and/or investigational uses of pharmaceutical agents. Some uses of these agents may not have been approved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Credit Statements
The American Society of Consultant Pharmacists (ASCP) is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program (ACPE Universal Program #203-999-06-063-H01) is accredited for 1.0 Contact Hour (0.1 CEU). Statement of credit will be mailed to participants 6 weeks after program date.
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of AKH Inc. and Medical Communications Media. AKH Inc. is accredited by the ACCME to provide continuing medical education for physicians.
AKH Inc. designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
NADONA/LTC is an approved provider of continuing nursing education by Georgia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation #1087. This program has been approved for 1.2 contact hours by NADONA/LTC. (Based on 50 minute hour)
AKH Inc. is approved as a provider of nurse practitioner continuing education by the American Academy of Nurse Practitioners. Provider #030803. AKH Inc. designates this educational activity for 1.2 contact hours. (Based on 50 minute hour)
Credit will be awarded upon submission of a completed program evaluation and a post-test with a passing grade of 70% or better.
Commercial Support Statements
Supported by an educational grant from Bristol-Myers Squibb Company
Please turn off all pop-up blockers to assure access to the educational activity.
Click on the "Start program" icon. If you are not already logged in to the site, this will bring you to the login/registration page where you will be able to register as a new cmecorner.com member or check existing registration information. When ready, click on the "Continue to Program" icon at the bottom of the screen.
The next main menu screen will permit you to check for or download the Flash player required to run this program. Clicking on "slides" on this screen will begin the program presentation. You may return to this main menu to view the question and answer segment, the reference list, and the CME/CE post-test and evaluation. The program will take approximately 60 minutes to complete.
Upon completion of the program, click on the post-test button to register and/or access the post-test and program evaluation. Please note that a link to the ASCP website is provided for all pharmacists requesting CPE credit.
Instructions for completing and submitting the post-test are provided on the post-test screen. A minimum score of 70% on the post-test is required for a CME/CPE/CE certificate/statement.
©2006, Medical Communications Media, Inc. All rights reserved. None of the contents may be reproduced in any form without prior written permission from the publisher. The opinions expressed in this activity are those of the speakers and do not necessarily reflect the opinions or recommendations of their affiliated institutions, the publisher, AKH Inc., the American Society of Consultant Pharmacists, the National Association of Directors of Nursing Administration in Long-Term Care, or Bristol-Myers Squibb Company. Any medications or other diagnostic or treatment procedures discussed by the program speakers should not be utilized by clinicians without evaluation of their patients’ conditions and possible contraindications or risks, and without a review of any applicable manufacturer’s product information and comparison with the recommendations of other authorities.