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5 Anticholinergic Medications, Cognition, and Parkinson’s Disease. Do Medications matter?
- Lauren G Santos, Lauren E Kenney, Alyssa Ray, Alfredo A Paredes, Adrianna M Ratajska, Dawn Bowers
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 111-112
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- Article
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Objective:
While Parkinson’s disease (PD) is traditionally known as a movement disorder, cognitive decline is one of the most debilitating and common non-motor symptoms. Cognitive profiles of individuals with PD are notably heterogeneous (Goldman et al., 2018). While this variability may arise from the disease itself, other factors might play a role. Greater anticholinergic medication use has been linked to worse cognition in those with PD (Fox et al., 2011, Shah et al., 2013). However, past studies on this topic had small sample sizes, limited ranges of disease duration, and only used cognitive screeners. Thus, this study aimed to examine this question within a large, clinical sample, using a more comprehensive neuropsychological battery. We hypothesized that higher anticholinergic medication usage would relate to worse cognitive performance, particularly memory.
Participants and Methods:Participants included 491 nondemented individuals with PD (m=64.7, SD=9.04 years old; education m=15.01, SD=2.79; 71.9% male; 94.3% non-Hispanics white) who underwent a comprehensive neuropsychological assessment at the UF Fixel Institute’s movement disorders program. Medications at the time of the neuropsychological evaluation were identified from chart review and scored based on anticholinergic properties using the Magellan Anticholinergic Risk Scale (Rudolph J.L., et al, 2008); each medication was scored from 0 (no load) to 3 (high load). The neuropsychological battery included measures across 5 cognitive domains: (1) executive function (Trails B, Stroop Interference, Letter Fluency), (2) verbal delayed memory (WMS-III Logical Memory and Hopkin’s Verbal Learning Test-Revised delayed recalls), (3) language (Boston Naming Test-II, Animal Fluency), (4) visuospatial skills (Judgment of Line Orientation, Face Recognition Test), and (5) attention/working memory (WAIS-III Digit Span Forward and Backward). The published normative scores for each task were converted into z-scores and averaged into a domain composite. Due to non-normality of Magellan scores, Spearman correlations examined the relationship between each cognitive domain composite score and Magellan scores.
Results:As predicted, higher Magellan scores were significantly associated with worse memory (r=-0.11, p=0.016), with a small effect size. There were no significant relationships between Magellan scores and the remaining cognitive domains (EF, language, visuospatial, attention).
Conclusions:We found that greater anticholinergic burden was associated with worse performance on memory, but not other neuropsychological domains, in a large cohort of nondemented individuals with PD who underwent comprehensive assessment. This finding corresponds to previous literature in smaller PD cohorts. Though the effect size was low, this finding highlights the importance of monitoring anticholinergic burden in PD patients in order to minimize detrimental effects of medications on memory function. Future work should examine whether greater anticholinergic burden predicts future progression of memory decline.
Acknowledgement: Supported in part by the NIH, T32-NS082168
82 - Breast reconstruction after mastectomy
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- By Alfredo A. Paredes, Jr., Emory University, School of Medicine, Atlanta, GA, T. Roderick Hester, Jr., Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 633-637
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Summary
Breast cancer continues to present an alarming health concern for women. As a treatment for breast cancer, mastectomy remains a common modality despite numerous advances in cancer therapy. Fortunately, breast reconstruction has become state-of-the-art plastic surgery, capable of restoring a woman's breast and sense of wholeness, while minimizing the negative psychological impact of mastectomy. Furthermore, “immediate” breast reconstruction – where reconstruction is performed directly following the mastectomy – has become a standard component of breast cancer treatment. Nowadays, after a mastectomy, women can expect a soft, natural-appearing, symmetric breast that will last a lifetime. Delayed reconstruction, performed months to years later, remains an excellent option for women who were not offered immediate reconstruction or simply were not ready for the adjunctive procedure.
Breast reconstruction can be divided into two types: autologous tissue reconstruction or implant-expander reconstruction.
Autologous tissue reconstruction
Various tissue donor sites on the female body can be used for reconstruction, including the backs, hips, gluteal area, and lateral thigh. However, skin and fat from the lower abdomen is the most common region used in what is known as TRAM (transverse rectus abdominis myocutaneous) flap reconstruction. Similar to a “tummy tuck” procedure, TRAM flap involves dissection of an elliptical pattern of skin and fat below the umbilicus that is transferred up to the breast defect on either a “pedicle” (still attached to the rectus muscle and superior epigastric artery) or as a “free” flap (where it is completely detached and then inset into the breast defect with a microvascular anastomosis of artery and vein using a microscope).