Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this systematic review is to determine whether or not stimulant type medications help to improve cognitive function and apathy in geriatric patients.

STUDY DESIGN: Systematic review of three English language primary studies published in 2001 and 2008.

DATA SOURCES: Two randomized control trials and one individual randomized control trial comparing methylphenidate administration to placebo for improvement in cognitive function and apathetic mood in elderly patients were obtained using PubMed.

OUTCOMES MEASURED: Clinical outcomes of apathy were measured according to the Apathy Evaluation Scale (AES), Neuropsychiatric Inventory (NPI), the Montgomery Asberg Depression Rating Scale (MADRS) and the Barthel Index both before and after the administration of methylphenidate or placebo. One study measured improvements in cognitive function after the administration of methylphenidate. Cognitive function was measured through a computerized neuropsychological test known as Go-NoGo.

RESULTS: In the study by Ben-Itzhak et al, cognitive function scores were significantly improved from baseline after the administration of methylphenidate (P = 0.03), whereas there was no improvement from baseline after administration of a placebo (P = 0.96). Herrmann and colleagues showed a statistically significant (P = 0.047) improvement in AES scores (a decline in apathetic symptoms) after the administration of methylphenidate compared to the placebo. Unfortunately, multiple participants experienced adverse effects of the medication, which resolved upon discontinuation (NNH =7). In the study by Jansen et al, clinically significant treatment effect was shown in two depressed individuals with improvement in their MADRS score and one patient with improvement in their AES score. One patient could not complete the study.

CONCLUSIONS: Improvement in cognitive function and apathy were demonstrated by the administration of methylphenidate in all three studies. The results of the randomized control trial by Ben-Itzhak et al demonstrate overall improvement in executive function, specifically, higher cognitive processes, after the administration of methylphenidate. Herrmann and colleagues were able to prove that stimulants improve features of apathy, but adverse effects must be considered. Jansen et al concluded that single-patient trials are effective in determining the overall significance of methylphenidate use for apathy in depressed geriatric patients.

Download

Share

COinS