More Medicare recipients received influenza vaccine when their physicians used standing orders for its administration than when their physicians did not. Influenza vaccine represents an important prevention modality that demands widespread implementation, and standing orders can increase its usage.

Background: Early onset dementias have variable clinical presentations and are often difficult to diagnose. We established a family pedigree that demonstrated consistent recurrence of very early onset dementia in successive generations.Objective and Method: In order to refine the diagnosis in this family, we sequenced the exomes of two affected family members and relied on discrete filtering to identify disease genes and the corresponding causal variants.Results: Among the 720 nonsynonymous single nucleotide polymorphisms (SNPs) shared by two affected members, we found a C to T transition that gives rise to a Thr147Ile missense substitution in the presenilin 1 (PS1) protein. The presence of this same mutation in a French early-onset Alzheimer’s disease family, other affected members of the family, and the predicted high pathogenicity of the substitution strongly suggest that it is the causal variant. In addition to exceptionally young age of onset, we also observed significant limb spasticity and early loss of speech, concurrent with progression of dementia in affected family members. These findings extend the clinical presentation associated with the Thr147Ile variant. Lastly, one member with the Thr147Ile variant was treated with the PKC epsilon activator, bryostatin, in a compassionate use trial after successful FDA review. Initial improvements with this treatment were unexpectedly clear, including return of some speech, increased attentional focus, ability to swallow, and some apparent decrease in limb spasticity.Conclusions: Our findings confirm the role of the PS1 Thr147Ile substitution in Alzheimer’s disease and expand the clinical phenotype to include expressive aphasia and very early onset of dementia.

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Objective To determine the prevalence of benzodiazepine use in adults aged 65 and older at two West Virginia academic medical centers as phase one of a benzodiazepine deprescribing strategy. Design Cross-sectional Setting Two academic hospitals in West Virginia with 107,504 hospitalized adults age 65 and older from the years 2010 to 2018 with information on admission medication use. Measurements Use of benzodiazepines based on presence on the admission medication list. Demographics, select comorbidities, and laboratory tests were also recorded. Results The prevalence of benzodiazepine use was 13.5% and use remained relatively constant with increasing age over 65, even in those over age 89. Conclusion Efforts aimed at assessing the true need for benzodiazepine use and deprescribing need to be employed, particularly with advancing age.

he clinical changes accompanying the evolution of Alzheimer's disease have been classified into two primary domains, cognitive, T which relates to declining intellectual and cortical functioning, and behavioral symptomatology, which includes paranoid and delusional ideation, hallucinations, and affective disturbances including depression, anxiety, and phobias. We report two patients with a delusion, not previously described in the literature, of pictures perceived as real. We discuss two known neuropsychiatric disorders, which are possibly pathogenetically related, as well as an immediate therapeutic implication for demented patients in long-term care settings. For patients suffering this delusion, there may be significant negative emotional effects if the common psychosocial modalities of reality orientation, reminiscence and life review, are used indiscriminately.CASE REPORTS Case 1. E.T., a 76 year old white female, was initially seen for evaluation of a 2-year history of progressive dementia with increased irritability, marked forgetfulness, and increasingly lax attitude toward keeping her home. These symptoms became more pronounced after the successive deaths of her husband in the Spring of 1987 and her only daughter in December, 1987. She was moved from Florida, where she had lived alone, to West Virginia upon the insistence of her son-in-law. She is presently still living alone with the help of concerned neighbors.Physical examination was normal. She was oriented to person and, with prompting, could approximate the time and place. Screening of motor and sensory functions revealed no gross deficits. Thyroid function tests, complete blood count, and chemistry profile were norFrom the Veterans Affairs Medical Center and the Hanshaw

Background Caring for the growing dementia population with complex health care needs in West Virginia has been challenging due to its large, sizably rural-dwelling geriatric population and limited resource availability. Objective This paper aims to illustrate the application of an informatics platform to drive dementia research and quality care through a preliminary study of benzodiazepine (BZD) prescription patterns and its effects on health care use by geriatric patients. Methods The Maier Institute Data Mart, which contains clinical and billing data on patients aged 65 years and older (N=98,970) seen within our clinics and hospital, was created. Relevant variables were analyzed to identify BZD prescription patterns and calculate related charges and emergency department (ED) use. Results Nearly one-third (4346/13,910, 31.24%) of patients with dementia received at least one BZD prescription, 20% more than those without dementia. More women than men received at least one BZD prescription. On average, patients with dementia and at least one BZD prescription sustained higher charges and visited the ED more often than those without one. Conclusions The Appalachian Informatics Platform has the potential to enhance dementia care and research through a deeper understanding of dementia, data enrichment, risk identification, and care gap analysis.

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