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Pharmacological Management Of Behavioral Disturbance in Dementia: Pharmacological Treatment
25 Feb2010
Patients with dementia may experience many symptoms, usually in the context of an incurable disease. Because treatment cannot address all of these symptoms, it is important to have a specific goal or goals in mind when therapy is initiated.
- In: Main
- Tags: Pharmacological Management
Introduction
This article discusses the assessment and treatment of BDD. Although the primary focus is on pharmacological therapy, it should be recognized that medications should be considered only after environmental and behavioral management are optimized.
- In: Main
- Tags: Pharmacological Management
Kids and Statins: DISCUSSION
23 Feb2010
DISCUSSION
We are left with these facts about the use of statin drugs in adolescence:
- Statins are highly effective for the short-term lowering of cholesterol and LDL-C levels.
- They have a favorable side-effect profile and are well tolerated.
Kids and Statins: Medical Management
22 Feb2010
Certainly in adult medicine, persistent dyslipidemia may be countered with the addition of cholesterol-lowering drugs. Also, intrinsic to the decision to prescribe medications is a consideration of comorbidities such as diabetes, obesity, smoking, hypertension, along with knowledge of the patient’s pre-existing cardiovascular or peripheral vascular disease. Aside from the growing predisposition toward obesity, children rarely exhibit the same comorbidities that afflict the adult population.
Kids and Statins: Screening
21 Feb2010
The first hurdle to clear is to identify who should be screened for hypercholesterolemia. Most practitioners agree on the American Heart Association’s recommendation of screening all children after two years of age who meet at least one of the following historical criteria:
- any parent or grandparent with cardiovascular, cerebro-vascular, or peripheral vascular disease before age 55 years
- either parent with a total cholesterol level above 240 mg/dL
- an unknown medical history of the biological family
Today, health care providers must ask themselves these questions:
- Should we consider at-risk children for medical management with hypercholesterolemic drugs, particularly the class reputed to be the most effective, the HMG-CoA reductase inhibitors (statins)?
- Should we recommend only lifestyle modification along with a low-fat or a low-carbohydrate diet and daily vigorous aerobic exercise?
- Should we do neither—and possibly wait for the manifestation of cardiovascular risks that affect millions of adults yearly?
Certainly, lifestyle changes have little down side, and their benefits extend far beyond the cardiovascular system. Experts debate constantly about the optimal nutritional approach to lowering cholesterol levels and weight. Short-term results have suggested that the low-carbohydrate approach might help to increase weight loss and lower total and low-density lipoprotein-cholesterol (LDL-C) levels. However, meta-analyses of the various popular low-fat and low-carbohydrate nutritional plans reveal little advantage to either when these regimens are extended for one year or greater. This is, in large part, a result of the difficulties in the long-term compliance with these diets. Although the concepts behind them are well intentioned and worthy of consideration, the public in general often sees only the extreme form of them on display. Compliance with lifestyle modifications, including diet and exercise, is discussed later in this article.
Kids and Statins
19 Feb2010
INTRODUCTION
Our children are being relentlessly exposed to a cardiotoxic environment. High calorically dense, fat-enriched foods, and technologically aided sedentary lifestyles predispose future generations to cardiovascular insult. An idea once considered unimaginable a generation ago, more and more children are developing risk factors for coronary artery disease at an alarming rate.