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Toward Individualized Evidence‐Based Medicine: Five “N of 1” Trials of Methylphenidate in Geriatric Patients
Author(s) -
Jansen Inge H.M.,
Rikkert Marcel G.M. Olde,
Hulsbos Hans A.J.,
Hoefnagels Willibrord H.L.
Publication year - 2001
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1046/j.1532-5415.2001.49092.x
Subject(s) - apathy , medicine , geriatric depression scale , methylphenidate , randomized controlled trial , depression (economics) , placebo , clinical trial , rating scale , adverse effect , geriatrics , physical therapy , checklist , psychiatry , depressive symptoms , attention deficit hyperactivity disorder , anxiety , alternative medicine , psychology , developmental psychology , cognition , pathology , economics , macroeconomics , cognitive psychology
OBJECTIVES: To investigate the efficacy of methylphenidate in depressed or apathetic geriatric patients. DESIGN: Five “N of 1” trials (individual cross‐over, double‐blinded, randomized trials). SETTING: Department of Geriatrics, University Medical Center, Nijmegen, and two nursing homes in Nijmegen, the Netherlands. PARTICIPANTS: Patients suffered from depression due to a general medical condition (n = 2); depression resistant to antidepressive drugs (n = 1), chronic apathy due to mild and moderate severe dementia (n = 2). INTERVENTION: Methylphenidate (5 mg bid) and placebo (both for two subsequent days) in 5 weeks of randomized treatment blocks. MEASUREMENTS: Montgomery Åsberg Depression Rating Scale (MADRS), Apathy Evaluation Scale (AES)‐clinician, the AES‐informant, Barthel index and a semiquantitative checklist of adverse effects. RESULTS: Among the three depressed patients, two showed significant improvement on the MADRS ( P = .089 and P = .001; α = 0.10), one patient's apathy showed significant improvement on AES‐clinician and ‐informant ( P = .077 and P = .086). One apathetic patient's trial was stopped because AES could not be completed. None of the patients showed significant changes in the Barthel index. No side effects developed. CONCLUSION: “N of 1” trials are useful in evaluating efficacy of methylphenidate in depressed or apathetic geriatric patients. Single‐patient trials can be a useful tool in pharmacotherapeutic decision‐making in frail older subjects.