September 2010

Back to school

Drug and Disease Updates
Feature Focus: DocAlert® Messages
DocAlert Messages: Subjective memory problems
FDA MedWatch Safety Alerts
Exclusive iPod touch® Offer From pdaMD
Free Clinical Apps for Your iPhone®
Get Relevant Clinical News on Your Mobile Device
Pregnancy & Baby Development App for iPhone
What's This Disease?

Too busy to keep up with the literature? All Epocrates mobile products on iPhone®, BlackBerry®, Palm® and Windows Mobile® devices come bundled with our free DocAlert service to help you stay on top of the latest developments.

DocAlerts are brief medical news alerts delivered to your mobile device. They are designed for quick scanning, and allow you to determine if you want more comprehensive information on the topic. Topics include clinical alerts, government safety alerts, and medically relevant tips on practice management. Don’t have Epocrates on your mobile device? Get it today.


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DocAlert Messages

Clinical Review
Subjective memory problems
Steve Iliffe, Louise Pealing
Correspondence to:
S Iliffe s.iliffe@ucl.ac.uk

Summary points

  • Subjective memory problems are much more common in later life than the objective problems that suggest minor cognitive impairment or dementia
  • Subjective memory problems are not simply a characteristic of the "worried well" and should be taken seriously
  • Depression is associated with subjective memory problems, as are older age, female sex, and low educational attainment
  • Depression is itself a risk factor for dementia, making the diagnostic task even more difficult
  Subjective memory problems are a poor predictor of dementia syndrome (loss of memory and one other aspect of cognition sufficient to cause impairment)
  When deciding whether to refer to specialist services, practitioners need to rely on rules of thumb to evaluate the extent and possible significance of symptoms or subjective memory loss

Are subjective memory problems associated with concurrent objective memory impairment?
Subjective memory problems were reported by 43% of those with known dementia and 38% of those with known mild cognitive impairment. Across the spectrum of cognitive impairment (mild cognitive impairment or dementia) 40% of patients had subjective memory problems compared with 17% in healthy adult controls. In this review the pooled sensitivity of subjective memory problems for prediction of dementia was 43% and the specificity was 86%. For mild cognitive impairment, the pooled sensitivity was 37% and specificity was 87%. In cross sectional community studies people with subjective memory problems only had 20-30% probability of concurrently having either dementia or mild cognitive impairment.

Drug and Disease
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  Even with direct questioning, 60% of those with dementia and 62% of those with mild cognitive impairment do not report simple memory problems, suggesting that loss of awareness of change occurs early in cognitive impairment. If general practitioners asked directly about problems with memory the majority of the patient group they were trying to identify would deny any difficulty, whereas 17% of healthy adults would answer positively.

Do subjective memory symptoms indicate other problems?
Older age, female sex, and low education level are more commonly associated with subjective memory problems in cross sectional community studies.  In studies where participants were volunteers or had referred themselves to memory clinics, those with subjective memory problems tended to be younger and their symptoms correlated with depression rather than objective memory problems on cognitive tests. Subjective memory problems were strongly associated with depression, neurotic personality trait, or both, even when there was no association with objective cognitive performance, in 26 studies in one review.

All five studies included in a systematic review reported an association between subjective memory problems and poorer quality of life. The Maastricht Aging Study also reported such an association that persisted over a period of nine years. These findings suggest that even if subjective memory problems are not a direct risk factor for dementia, they are not simply a characteristic of the "worried well" and should be taken seriously.

Link to free full-text BMJ article PDF with references and tables

BMJ 2010;340:c1425
© 2010 BMJ Publishing Group Ltd.


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FDA Medwatch Safety Alerts

Prescription drugs: Lamictal (lamotrigine), Qualaquin (quinine sulfate), Midodrine hydrochloride, Octagam (immune globulin IV) 5%, Stalevo (carbidopa/levodopa and entacapone)

OTC products: Novacare LLC Products: Recall, TimeOut Capsules, MasXtreme Capsules, Mr. Magic Male Enhancer, Prolatis’, Solo Slim, Solo Slim Extra Strength, Revivexxx Extra Strength

Medical devices: Huber Needles, Fingerstick Devices, INOMAX DS Drug-Delivery System Recall, 6 French Engage Introducers (St. Jude Medical) Recall, Combat Application Tourniquets (C-A-T), Inferior Vena Cava (IVC) Filters


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Exclusive iPod touch Offer From pdaMD

Purchase the best-selling bundle, the iPod touch with a one-year subscription to Epocrates® Essentials, and get a second year free.

With an abundance of useful features and programs, the iPod touch is the perfect handheld device for today's busy healthcare professional without the carrier commitment. Epocrates Essentials includes peer-reviewed disease content with evidenced-based treatment options, hundreds of diagnostic and laboratory tests, and the #1 mobile drug reference with prescription, OTC, and alternative medicines.

Go to pdaMD.com to purchase your bundle and learn more.


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FDA Medwatch Safety Alerts

Free Clinical Apps for your iPhone

These handy Epocrates MedTools® clinical applications are now available for download through the App Store™:

CardioMath is a calculator with over 50 commonly used formulas used in cardiovascular medicine, including valve area calculators, Duke Treadmill Score, Echo formulas, and more.
STAT Cholesterol Tool guides clinicians through the ATP III cholesterol guidelines and assists in the calculation of coronary heart disease risk.
GFR Calculator provides easy-to-use calculators for the MDRD, Abbreviated MDRD, and Cockcroft-Gault methods.
Seattle Heart Failure Risk Calculator provides estimates of one-, two-, and five-year survival rates and estimates the impact of specific interventions on survival.
BMI Tool assists clinicians in the diagnosis and treatment of obesity.



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Get Relevant Clinical News on Your Mobile Device

Epocrates Mobile Resource Centers feature articles that are carefully selected and commented on by physicians who are thought leaders in their fields. These resource centers help you stay current with clinical news, conference highlights, resources, and scientific abstracts. 

This month, we are highlighting our Allergy and Asthma resource centers.
Recent Asthma topics: "FDA Reviews Will Aid Patient Care" and "FDA Reacts to Tx-Related Deaths"
Recent Allergy topics: "Laser Tx for Pruritic Eczema" and "Shrimp Allergies May Wane"

These are just two of the 15 resource centers available to you.  Visit our site to learn more and for download instructions.


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Pregnancy & Baby Development App for iPhone

The free Pregnancy & Baby Development application is a comprehensive, customizable guide through the physical and emotional journey of pregnancy and childbirth. The app was created by Modality, to provide a new resource for your patients. This was done in collaboration with Epocrates to ensure content quality. The app also includes an expert introduction to the application by Dr. Deepak Chopra, underscoring the incredible bond between mother and child.

With content from the TheVisualMD.com, this app chronicles conception through the first year, with useful tools, tips, and references for parents-to-be.

This free app is available at www.itunes.com/appstore

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