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Ajit Shah

Publications and source records attributed to Ajit Shah.

31 records · Page 2Linked to original sources
PubMed2004

A longitudinal study of Alzheimer's disease: rates of cognitive and functional decline.

OBJECTIVE: To measure rates of decline in cognition and function in patients with Alzheimer's disease (AD) and to investigate their accelerating risk factors in Korea. METHODS: This study presents longitudinal data on a community-based sample of 107 patients with AD, followed at 6 months and 12 months. The cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini Mental State Examination (MMSE) and the Disability Assessment for Dementia Scale (DAD) were given. Mixed model analyses were conducted using the following independent variables: times of repeated assessment (0, 6 or 12 months), severity of dementia assessed by the Functional Assessment Staging (FAST) and individual indicators as covariates. RESULTS: Average annual rates of decline in the MMSE, the ADAS-cog and the DAD were 2.3, 11.4 and 15.1 points, respectively. Neither gender, duration of formal education, nor duration of AD since onset was significant predictors of cognitive and functional decline. Patterns of functional decline in total DAD, instrumental ADLs, planning and organization and performance subscale are linear as MMSE score declines, while those of the basic ADLs and the initiation are curvilinear. CONCLUSION: This naturalistic observational study measured rates of cognitive and functional decline in AD, and can provide reference data for further longitudinal studies or clinical trials. Further study will be necessary to determine whether linear or curvilinear pattern in functional decline is due to progression of AD itself or statistical artifact.

Activities of Daily Living↗
PubMed2004

A pilot study of behavioural and psychological signs and symptoms of dementia in patients of Indian sub-continent origin admitted to a dementia day hospital in the United Kingdom.

BACKGROUND: There is a paucity of cross-cultural studies of behavioural and psychological symptoms of dementia (BPSD). METHOD: BPSD were examined in a consecutive series of Indian sub-continent origin and white indigenous elders admitted to a dementia day hospital using the BEHAVE-AD. The correlates of individual BPSD in each of the two ethnic groups and the differences between the two ethnic groups were examined. RESULTS: There were no differences between the two groups on most of the demographic and clinical variables examined, except that Indian sub-continent elders had a greater number of children. There were no differences between the two groups on the MMSE scores, BEHAVE-AD total scores and BEHAVE-AD subscale scores (with one exception). Indian sub- continent origin patients had lower scores on the anxiety and phobias subscale. Within the Indian sub-continent origin group, Alzheimer's disease (AD) was associated with activity disturbance and vascular dementia with affective disturbance. Within the indigenous group, aggressivity was associated with males and prescription of neuroleptics, and affective disturbance with prescription of antidepressants. CONCLUSION: There is a need to develop and evaluate translated versions of instruments that measure BPSD. After development of these instruments there is a need for cross-cultural population-based epidemiological studies of BPSD.

Age Distribution↗
PubMed2004

A comparative study of behavioral and psychological signs and symptoms of dementia in patients with dementia referred to psychogeriatric services in Korea and the United Kingdom.

BACKGROUND: There is a paucity of cross-cultural studies of behavioral and psychological symptoms of dementia (BPSD). METHOD: BPSD were examined in a consecutive series of referrals to a psychogeriatric service in the United Kingdom (U.K.) and in Korea, using the BEHAVE-AD, the Cornell Scale for Depression in Dementia and the Mini-mental State Examination (MMSE). The U.K. service served a well-defined geographical catchment area with a multidisciplinary team and emphasis on home assessments. The Korean service was a nationwide service with limited community resources. The correlates of individual BPSD in each country and the differences between the two countries were examined. RESULTS: Koreans were younger, were more likely to be married, less likely to be single, had a greater number of people in their household and were more likely to live in their own homes than the U.K. sample. Koreans were more likely to be referred by general psychiatrists or family members, and the U.K. sample was more likely to be referred by general practitioners. Koreans were more likely to have Alzheimer's disease and the U.K. sample to have vascular dementia. The Korean sample had a lower MMSE score than the U.K. sample. In both countries, the total BEHAVE-AD score and most subscale scores were negatively correlated with the MMSE score. The total BEHAVE-AD score and all subscale scores were higher in the Korean sample than in the U.K. sample. The prevalence of all BPSD measured with the BEHAVE-AD were higher in the Korean sample (except aggressivity). CONCLUSION: These differences may be explained by differing interpretation and administration of the measurement instruments, models of service delivery, availability of primary and secondary care services, health seeking behavior of patients and families, cultural influences, and knowledge, expectations and recognition of BPSD by professionals in primary and secondary care. However, despite this, there was possible evidence of genuine differences worthy of further cross-cultural population-based epidemiological study of BPSD between these two countries.

Aged↗
PubMed2004

The clinical and demographic characteristics of elderly patients of Polish origin newly referred to a geriatric psychiatry service.

OBJECTIVE: To compare the clinical, demographic, social and service utilization characteristics of elderly Poles with indigenous elders. SETTING: A geriatric psychiatry service in an urban area. METHODS: All newly referred patients to a West London geriatric psychiatry service were studied. The uptake of service and clinical, demographic, social and service utilization characteristics of elderly Poles and indigenous elders were compared after extracting information from case-notes. RESULTS: Twelve percent of all referrals were of Polish origin. This figure is considerably higher than 4% of all community-dwelling elderly being of Polish origin in Ealing. There were no differences in clinical, demographic, social and service utilization characteristics between Polish and indigenous patients with a few exceptions. Elderly Poles were more likely to be married (p < 0.005) and indigenous elders were more likely to be single (p < 0.05). Elderly Poles were more likely to be advised to take out power of attorney (p < 0.014). Elderly Poles were less fluent in English (p < 0.0005). CONCLUSIONS: Newly referred elderly Poles accessed and utilized the geriatric psychiatry service resources and social services at least as equitably as indigenous elders.

Aged↗
PubMed2004

Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in U.S. and Japanese healthy subjects.

Palonosetron (Aloxi, Onicit) is a selective 5-HT(3) receptor antagonist recently approved by the Food and Drug Administration for the prevention of acute and delayed chemotherapy-induced nausea and vomiting. This study was performed to determine the pharmacokinetics and assess the safety and tolerability of intravenous (IV) palonosetron in healthy U.S. and Japanese subjects. Subjects were administered a single IV dose of palonosetron, ranging from 0.3 to 90 microg/kg in either of two randomized, double-blind, placebo-controlled, ascending-dose studies (n = 80 and n = 32, respectively). Serial blood samples were obtained in both studies to evaluate the pharmacokinetics of palonosetron and its N-oxide metabolite, M9. Intravenous palonosetron was well tolerated across a wide range of doses in both studies. The incidence and severity of adverse events (AEs) were similar between subjects receiving palonosetron and those receiving placebo, with no dose-dependent incidences. The most frequently reported AEs were headache, transient elevation of liver enzymes, and constipation. Systemic exposure (AUC and C(max)) for palonosetron generally increased with increasing dose. Mean total body clearance, elimination half-life, and apparent volume of distribution ranged from 1.11 to 3.90 mL/min/kg, 33.7 to 54.1 hours, and 3.85 to 12.6 L/kg, respectively, in U.S. subjects and from 2.58 to 3.50 mL/min/kg, 30.8 to 36.8 hours, and 6.96 to 9.85 L/kg, respectively, in Japanese subjects. The pharmacokinetics of palonosetron appeared to be independent of dose, with no dose adjustment required in Japanese subjects. The plasma concentration profile of palonosetron, as represented by a half-life of approximately 40 hours, may provide a clinical advantage over other 5-HT(3) antagonists.

Adult↗
PubMed2004

Psychotropic prescriptions and elderly suicide rates.

Suicide rates in the elderly have declined in recent years in several countries including England and Wales. There have also been major changes in prescribing patterns of psychotropics in many countries during recent years. This study examined the association between a trend of decline in suicide rates in the elderly in England and Wales and changes in the prescribing of psychotropics for the period 1985 to 1996. Data on suicide rates was ascertained from the annual mortality statistics for the years 1985 to 1996. Data on the prescriptions of psychotropics was ascertained from the Statistic Division (SD1E) at the Department of Health. Spearman's rank correlation coefficient (rho) was used to examine the relationship between the prescription of psychotropics and suicide rates. The main findings of this study were: (i) a highly significant negative correlation between the prescription of tricyclic antidepressants or selective serotonin reuptake inhibitors (SSRIs) and elderly suicide rates; (ii) a significant positive correlation between the prescription of monoamine oxidase inhibitors (MAOIs) and elderly suicide rates; (iii) a highly significant negative correlation between the prescription of antimanics and antipsychotics and elderly suicide rates; (iv) a highly significant positive correlation between the prescription of hypnotics, anxiolytics and barbiturates and elderly suicide rates; and, (v) a significant negative correlation between the prescription of analgesics and elderly suicide rates. A trend of decline in suicide rates in the elderly in England and Wales for 1985 to 1996 and changes in the prescribing of psychotropics were significantly associated. The results of this study suggest that prescription patterns of psychotropics may be an important factor contributing to the recent decline in suicide rates in the elderly in England and Wales but this effect should be viewed in the context of other health and social factors.

Aged↗
PubMed2003

Metabolism, pharmacokinetics, and excretion of a highly selective N-methyl-D-aspartate receptor antagonist, traxoprodil, in human cytochrome P450 2D6 extensive and poor metabolizers.

The excretion, biotransformation, and pharmacokinetics of a selective N-methyl-D-aspartate receptor antagonist, traxoprodil, were investigated in six healthy male volunteers, phenotyped either as CYP2D6 extensive or poor metabolizers of dextromethorphan. Each subject received an i.v. infusion of a single 50-mg (100 microCi) dose of [(14)C]traxoprodil. Approximately 89% of the administered dose was recovered in poor metabolizers (PMs) and 61% in extensive metabolizers (EMs), with the majority of the dose being excreted in the urine (86% in PMs and 52% in EMs). The elimination of traxoprodil was more rapid in EMs than in PMs with terminal elimination half-lives of 2.8 and 26.9 h, respectively, for EMs and PMs. Area under the plasma concentration-time curve from time 0 to T (AUC((0-Tlast))) values for unchanged traxoprodil were 1.2 and 32.7% of the corresponding AUC values for total radioactivity in EMs and PMs, respectively. Traxoprodil was metabolized in both EMs and PMs, with approximately 7 and 50% of the administered radioactivity excreted as unchanged drug in the excreta of EMs and PMs, respectively. Hydroxylation at the 3-position of the hydroxyphenyl ring and methylation of the resulting catechol followed by conjugation were identified as the main metabolic pathways in EMs. In contrast, direct conjugation of traxoprodil with glucuronic or sulfuric acid was the major pathway in PMs. In vitro studies using CYP2D6-selective inhibitor and recombinant enzyme also support that the metabolism of traxoprodil is mainly mediated by CYP2D6. Taken together, these studies suggest that traxoprodil is eliminated mainly by Phase I oxidative metabolism mediated by CYP2D6 isozyme in EMs and by Phase II conjugation and renal clearance of parent in PMs.

Adolescent↗
PubMed2003

Low baseline Bispectral Index of the electroencephalogram in patients with dementia.

UNLABELLED: The baseline value of the Bispectral Index (BIS) is 96-99 in the awake state. Patients with Alzheimer's disease or vascular dementia may show an increase in slow wave and a decrease in fast wave activity of the electroencephalogram (EEG). BIS is presumed to decrease with EEG slowing. We hypothesized that the baseline "awake" BIS is lower in dementia than in normal elderly patients. We studied 36 patients with Alzheimer's disease or multiinfarct dementia and 36 control patients aged >75 yr. Both groups were assessed with a Mini-Mental State Test. BIS (version 3.4) was recorded from a frontal derivation using an Aspect A-2000 EEG monitor. Off-line data analysis was also performed with the newer version 4.0 of the BIS algorithm. Fourteen of 36 (38%) dementia patients and 4 of 36 (11%) controls had mean baseline BIS 3.4 <93 (P = 0.006). Eighteen of 36 (50%) dementia patients and 8 of 36 (22%) controls had mean BIS 4.0 <93 (P = 0.026). Mean (95% confidence interval) BIS 3.4 was 92.9 (91-95) in the dementia and 96.1 (95-97) in the control group (P = 0.02). Values with BIS 4.0 were, respectively, 89.1 (86-92) and 94.7 (93-96) (P = 0.002). No significant difference was found in age, sex, activity from the electromyogram, and signal quality index. As expected, the difference in Mini-Mental State Test scores was significant (P < 0.0001). A significant proportion of patients with dementia shows a low baseline BIS. The utility of the BIS monitor in detecting dementia warrants further investigation. IMPLICATIONS: This prospective, controlled, observational study demonstrates that electroencephalogram slowing associated with dementia affects the Bispectral Index of the electroencephalogram. A significant proportion of patients with dementia have a lower than normal "awake" Bispectral Index.

Aged↗
PubMed2003

Ascertaining capacity to consent: a survey of approaches used by psychiatrists.

Doctors are increasingly criticised for imposing treatment without adequate consent. Approaches used by psychiatrists (of all grades and in all sub-specialities) to assess capacity to consent in a large west London psychiatric trust were surveyed with a questionnaire. The questionnaire consisted of two case-vignettes and a series of seven questions (six with forced choice yes/no answers and one with an open-ended answer). The responding psychiatrists' assessment of capacity and that judged by the research psychiatrist were compared. There was no relationship between age, sex, duration of experience in psychiatry, grade and speciality, and (i) the respondents' assessment of capacity and (ii) the research psychiatrist's assessment of capacity. The kappa concordance between the responding psychiatrists' assessment of capacity and that judged by the research psychiatrist was 0.17 (P=0.067) and 0.12 (P>0.05) for vignettes 1 and 2 respectively. Individual psychiatrists appear to variably interpret and apply the criteria for assessment of capacity to consent.

Adult↗
PubMed2002

Is mental health economics important in geriatric psychiatry in developing countries?

BACKGROUND: limited healthcare budgets and a seamless demand for resources suggests that a formula for allocating resources is needed. Economic evaluation can assist in developing this formula. METHOD: mental health economic studies (cost minimisation, cost-effectiveness, cost-utility, cost-benefit and cost of illness analysis) in geriatric psychiatry from developed and developed countries were examined along with all mental health economic studies in developed countries. RESULTS: there were no health economic studies in geriatric psychiatry from developing countries against a background of many such studies in developed countries. There were a greater number of health economic studies in other areas of psychiatry in developing countries. Several reasons for the paucity of such studies, the feasibility of undertaking these studies and their significance are discussed. CONCLUSION: mental health economic studies in geriatric psychiatry in developing countries are feasible, realistic and may well have an important part to play in the allocation of resources. Also, data sets necessary for such studies are emerging from many developing countries.

Cost-Benefit Analysis↗
PubMed2002

United Kingdom national survey of the views of geriatric psychiatrists on the administration of electroconvulsive therapy to patients with fractures.

Traditionally, psychiatrists have been cautious in administering electroconvulsive therapy (ECT) to patients with recent fractures. Drawing on the collective experience of geriatric psychiatrists in the United Kingdom may allow a better understanding of the use of ECT in fractures. The opinions of UK consultant geriatric psychiatrists on the use of ECT in the presence of recent fracture were acquired by a detailed questionnaire survey. Questionnaires were sent to 551 geriatric psychiatrists, and 306 (56%) usable responses were received. Twelve percent of geriatric psychiatrists had used ECT in fractures, and 55% would be prepared to administer ECT in the presence of fractures. They would seek specialist advice from anesthetists and orthopedic surgeons before, during, and after the administration of ECT. Geriatric psychiatrists generally did not seek advice from specialist ECT consultants. The researchers concluded that geriatric psychiatrists are prepared to administer ECT in the presence of fractures after seeking specialist advice from anesthetists and orthopedic surgeons.

Aged↗
PubMed1996

Single- and Multiple-Dose Pharmacokinetics of Reduced Metabolite (MDL 74,156) following Oral Administration of Dolasetron Mesylate to Normal Male Subjects.

Dolasetron, a 5-hydroxytryptamine(3) receptor antagonist, is under investigation for prevention of nausea and vomiting due to chemotherapy. The keto-reduced metabolite of dolasetron has been identified in human plasma and is likely responsible for the antiemetic activity. This study evaluated single and multiple dose pharmacokinetics of the reduced metabolite following oral administration of dolasetron mesylate in healthy male subjects. Five groups (six active/two placebo each) of subjects received either oral doses of dolasetron mesylate ranging from 25 to 200 mg or placebo on day 1 and every 12 h on days 2 through 9. Because plasma dolasetron concentrations were low and sporadic, pharmacokinetics of the parent compound could not be determined. The reduced metabolite appeared rapidly in the plasma and reached a maximal plasma concentration in about 1 h. The maximal plasma concentrations and areas under plasma concentration--time curves were proportional to the dose. The mean apparent oral clearance ranged from 9.89 to 23.10 ml min(minus sign1) kg(minus sign1). The half-life ranged from 5.20 to 10.80 h. Mean renal clearance and fraction of dose excreted in urine were 0.97 to 3.97 ml min(minus sign1) kg(minus sign1) and 7.47 to 31.9%, respectively. The pharmacokinetics of reduced metabolite appears to be dose independent after single and multiple dosing.

Journal Article↗