Browsing by Author "Manoharan, Sneha"

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    Deprescribing anticholinergics to preserve brain health: reducing the risk of dementia through deprescribing (R2D2): study protocol for a randomized clinical trial
    (Springer Nature, 2024-11-22) Campbell, Noll L.; Holden, Richard J.; Gao, Sujuan; Unverzagt, Frederick W.; Lane, Kathleen A.; Carter, Allie; Harrington, Addison B.; Manoharan, Sneha; Manoharan, Neha; Rosenthal, Danielle L.; Pitts, Christopher; Pelkey, Kathryn; Papineau, Emily; Lauck, David M.; Keshk, Noha; Alamer, Khalid; Khalil, Hussein; Boustani, Malaz A.; Psychiatry, School of Medicine
    Background: Older adults commonly experience chronic medical conditions and are at risk of cognitive impairment as a result of age, chronic comorbidity, and medications prescribed to manage multiple chronic conditions. Anticholinergic medications are common treatments for chronic conditions and have been repeatedly associated with poor cognitive outcomes, including delirium and dementia, in epidemiologic studies. However, no study has definitively evaluated the causal relationship between anticholinergics and cognition in a randomized controlled trial design. Utilizing our prior experience in deprescribing anticholinergic medications in various clinical environments, we designed an outpatient deprescribing intervention to prospectively test the potential causal relationship between anticholinergics and cognition in primary care older adults. Methods: This cluster randomized clinical trial will be conducted to evaluate the impact of an anticholinergic deprescribing intervention compared to usual care on outcomes of cognition and safety in primary care older adults. Participants will include those aged 65 years and over, receiving primary care in the greater Indianapolis area, using a strong anticholinergic within the last 2 weeks or with evidence of high-risk exposure in the past year. Those excluded will have a diagnosis of Alzheimer's disease or related dementia, or serious mental illness. The trial plans to enroll 344 participants who will be cluster-randomized at the level of primary care physician to avoid contamination. Participants will complete outcome assessments every 6 months up to 2 years by blinded outcome assessors. The primary outcome of the study is a composite measure of cognition that includes domains assessing executive cognitive function, language, and memory. Secondary outcomes include patient-reported measures of pain intensity, depression, anxiety, sleep disturbance, and health-related quality of life. Discussion: The R2D2 trial will be the largest and longest prospective randomized trial testing the impact of an anticholinergic-specific deprescribing intervention on cognition in primary care older adults. Results could influence deprescribing methodology and provide new insight on the relationship between anticholinergics and cognition.
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    Remember Stuff: A Pilot Feasibility Trial Of Dyadic-Focused Technology To Support People With Adrd
    (Oxford University Press, 2022) Manoharan, Sneha; Schroeder, Matthew; Slaven, James; Higbie, Anna; Mullholand, Mary Ellen; Fowler, Nicole; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
    Technology to support caregivers of people with Alzheimer’s disease or related dementias (ADRD) with tasks may be the next frontier for caregiving research. This single-arm 90-day pilot trial tested the usability, feasibility, and acceptability of a software system called RememberStuff® (R/S) by Eperture. We also tested R/S’s impact on caregiver burden. R/S includes a web-based portal where caregivers add information to a touch screen used by patients. R/S is organized around four main features– Calendar, Messaging, Activities, and Remember, a personalized task list. We collected data from dyads at baseline, 30-, 60-, and 90-days. Measures included the Healthy Aging Brain Care (HABC) monitor, System Usability Scale (SUS), and satisfaction scales indicating caregiver’s willingness to use and behavioral intention. We approached caregivers of patients with ADRD seen in primary care clinics. Of the 469 participants reached, 278 (59.28%) refused, 156 (33.26%) were ineligible due to nursing home placement and 35 dyads were enrolled (7.46%). Among enrolled participants, 65.7% completed data up to 90 days. 73.5% of the caregivers lived with the patients. Mean caregiver age was 59.1 years; 67.7% are female; 88.2% are white. Willingness to use R/S was consistent across time from 30 days (M=3.9, SD=0.7) through 90 days (M=3.8, SD=1.1), while usability decreased (30 days M=57.7, SD=7.5 to 90 days M=54.9, SD 8.7). Caregiver’s overall HABC monitor also decreased from baseline (M=29.0, SD=13.1) to 90 days (M=27.2, SD=12.2) indicating less burden at 90 days. These findings support the feasibility of R/S technology to support caregivers of people with ADRD.