title: Toward individualized evidence-based medicine: five "N of 1" trials of methylphenidate in geriatric patients.
abstract: OBJECTIVE
  To investigate the efficacy of methylphenidate in depressed or apathetic geriatric patients.
  
  
  METHODS
  Five "N of 1" trials (individual cross-over, double-blinded, randomized trials).
  
  
  METHODS
  Department of Geriatrics, University Medical Center, Nijmegen, and two nursing homes in Nijmegen, the Netherlands.
  
  
  METHODS
  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).
  
  
  METHODS
  Methylphenidate (5 mg bid) and placebo (both for two subsequent days) in 5 weeks of randomized treatment blocks.
  
  
  METHODS
  Montgomery Asberg 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; alpha = 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.
  
  
  CONCLUSIONS
  "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.
authors.affiliation: Department of Geriatric Medicine, University Medical Center, Nijmegen, The Netherlands.
authors.forename: I H
authors.initials: IH
authors.lastname: Jansen
authors.forename: M G
authors.initials: MG
authors.lastname: Olde Rikkert
authors.forename: H A
authors.initials: HA
authors.lastname: Hulsbos
authors.forename: W H
authors.initials: WH
authors.lastname: Hoefnagels
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D003863:Depression / Q000188:drug therapy*; D004311:Double-Blind Method; D004341:Drug Evaluation / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*
chemical_list: D008774:Methylphenidate