ScienceCache

Vol. 167
April 6, 2004

CAREGIVERS, REMEMBER THIS: MEDICATIONS EASE YOUR DISTRESS TOO
The so-called “memory drugs” used to treat Alzheimer’s disease and other causes of dementia also ease or prevent a barrage of troublesome behaviors that affect the majority of patients, ultimately lightening the burden on caregivers, researchers have found. They report their results in the March issue of the American Journal of Psychiatry. In a new analysis of a previous study involving 978 patients and their families, scientists have shown that such drugs ease behavioral symptoms like agitation, depression, and psychosis in patients who already have those symptoms, and that the medication delays the onset of those behaviors in patients not yet displaying them. Doctors also found that the medications ultimately ease distress among caregivers whose role is made easier when the patient’s symptoms improve. “To our knowledge, this is the first time that it’s been shown that the caregiver’s stress level is less because the patient’s behavior has improved,” says Pierre Tariot, one of the authors and a professor of psychiatry, medicine, and neurology. “Over time, it’s become clearer and clearer that it’s not just the patient who is distressed by his or her behavior, but the family as well. We decided maybe we should look at the indirect impact of the medications on the family as well as the direct impact on the patient.”
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DOCTORS DEBATE HOW TO TREAT EARLY, NONINVASIVE BREAST CANCER
Increasing use of screening mammography is uncovering more cases of ductal carcinoma in situ, or DCIS, an early form of breast cancer. But tremendous variations in care, variations that have been increasing, suggest a substantial lack of agreement over the best way to treat this disease, say researchers. Doctors tend to practice as their colleagues do, patients often make choices based on local behavior, and there are few randomized controlled clinical trials to compare strategies or guide treatment for DCIS, concludes the study, reported in the March issue of the journal Medical Care. “When a woman hears she has cancer, it is absolutely overwhelming, even if it’s caught early and she has this noninvasive form,” says Andrew Dick, assistant professor of community and preventive medicine, whose sister was diagnosed with DCIS as he was studying the treatment trends. “It’s crucial that physicians and others in the medical community provide accurate information to aid women in making decisions about their treatments.” DCIS is considered a precursor to invasive breast cancer. But left untreated, or improperly treated, it can develop into invasive disease, with the same risks of metastasis and death. The wide variations in treatment – especially a trend toward breast-sparing surgery alone – contradicts the most recent scientific literature showing that an aggressive approach may be best way to prevent a recurrence for some women, the study says.
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RESEARCHER FINDS KEYS TO DETECTING DEPRESSION IN OLDER PEOPLE
The ravages of depression have proven especially devastating among the elderly because the disease has been so misunderstood in that population. Now, researcher Paul Duberstein has identified risk factors associated with depression and suicide in the elderly, and observed some surprising differences in the way depression manifests itself in older adults compared to children and younger adults. The findings are important because friends, family members, and even care providers might not realize that the signs of depression in the elderly can be different. That lack of understanding is just one of several reasons older adults may not seek and receive the treatment they need, with sometimes tragic results in the case of the growing problem of geriatric suicide. “Kids with depression will express feelings of sadness more readily, but older adults may not show or express sadness as much,” explains Duberstein, who is co-director of the Center for the Study and Prevention of Suicide. More common signs of depression among the elderly include a lack of appetite, fatigue, and problems concentrating – the kinds of things often attributed to the aging process rather than depression. Older people with depression tend to stop doing things, says Duberstein. They might clean less or go to church less frequently. Again, friends and family might not realize the true cause of such changes in behavior. Duberstein recently found that poor health, family conflict, or money worries were the problems most likely to increase suicide risk in adults 50 years of age or older.
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