Abbreviated Mental Test Research Articles

1209 A TEACHING PROGRAMME TO IMPROVE RATES OF DELIRIUM SCREENING ON THE MEDICAL TAKE

Abstract Introduction NICE Clinical Guideline CG103 states that adults aged 65 and older should be screened for delirium within 48 hours of emergency hospital admission. The Geriatric Medicine Research Collaborative (GeMRC)'s World Delirium Day data from 2019 showed an average screening rate of 27% nationally. After an inpatient fall on the Medical Assessment Unit resulted in hip fracture for a patient who had not been screened for delirium with the recommended 4 A's Test (4AT), we decided to collect data on screening rates and devised a way of improving these. Method Baseline data was collected examining patient notes of adults over 65 years currently on the Medical Assessment Unit who had been seen by a doctor. The intervention was a teaching session on delirium for the junior doctors on the ward, focusing on the adverse prognostic features of delirium and importance of clear diagnosis with onward communication to the patient's GP. Repeat data collection was done following this. Results 55% of all patients on the ward throughout data collection were over 65 years of age. A total of 79 patient notes were examined. The baseline rate of delirium screening with a completed 4AT pre-intervention was 25%. Post-intervention this increased to 41.3%. Without further education this fell to 26.9%. Most of the unscreened patients showed incomplete 4ATs or only the Abbreviated Mental Test (AMT) section completed. Conclusion Integrating delirium teaching into departmental teaching on Acute Medical Units can increase the rates at which delirium is diagnosed, which is important for the patient's clinical trajectory and prognosis, both for their inpatient stay and long term. Further work is required to show sustained improvement. Future work may include assessing the rate of documented diagnosis out of those who clinically fit the criteria.

Comparing the Diagnostic Value of Four Dementia Tests in the Amnestic and Healthy Elderly.

This study aimed to compare the diagnostic value of four questionnaires for the diagnosis of neurocognitive disorders (NCDs) in the elderly. In this project, people older than 60 years who lived in Tehran were investigated. A total of 99 literate cases were enrolled in the study, and four questionnaires, including functional assessment staging tool (FAST), abbreviated mental test score (AMTS), mini-mental state examination (MMSE), and modified Persian test of elderly for assessment of cognition and executive function (PEACE) were completed for them. They were then referred to a neuropsychiatrist, and the status of their cognition and neurobehavior was determined. The specialists were blinded to the results of the tests. Of the 99 participants studied, 39 cases were healthy, eight cases had mild Alzheimer's disease, 38 had amnesic MCI, five cases had secondary dementia, and nine cases had mixed vascular dementia and Alzheimer's disease. The area under the ROC curve for distinguishing the healthy group from the rest of the population was 0.692, 0.629, 0.734, and 0.751 for the FAST, AMTS, MMSE, and NBCSS questionnaires, respectively. MMSE and NBCSS tests had better diagnostic power than the other two tests to distinguish the healthy group from the rest of the population.

The Role of Frailty Scores to Predict the Outcomes in Non Operative Treatment of Valgus Impacted Neck of Femur Fractures.

The management of valgus-impacted neck of femur fracture is controversial between operative and conservative treatments. This study aimed to investigate the usefulness of the Clinical frailty Score for predicting the prognosis of patients who underwent non-operative treatment for the valgus-impacted neck of femur fracture (NOF). A single-centred retrospective review of patients admitted with valgus impacted NOF. Data were collected from patients' records, including demographics, Clinical Frailty Score (CFS), Nottingham Hip Fracture Score (NHFS) and Abbreviated Mental Test Score (AMTS). Patients were followed up to 24 months postoperatively. Fifty-eight patients who were treated non-operatively with a mean follow-up of 2.6 years met our inclusion criteria. Twenty-nine patients failed the non-operative treatment and required replacement surgeries, while 29 had successful outcomes (50%). There were no differences between the two groups' mean age and gender distributions (P 0.527 and 0.139, respectively). The successful group had significantly higher CFS (P 0.013), worse AMTS and higher mortality risk based on the NHFS (P 0.006 and P < 0.001, respectively). This study demonstrates that CFS, AMTS and NHFS can be used as predictors when considering non-operative treatment for the valgus-impacted neck of femur fracture. Patients who are frail, demented and high risk based on the NHFS have higher success rates with non-operative treatment.

Health-related Quality of Life of Elderly Men and Women After a Heart Attack

Background: The most common aging change is increased arteriosclerosis, which can prone the elderly to heart attacks. Physiological and psychological changes deteriorate the health-related quality of life (QoL) of the survivors of heart attacks. However, gender differences may affect the health-related QoL of the survivors. The present study aimed to compare the health-related QoL of elderly men and women after a heart attack in selected educational-therapeutic centers of Iran University of Medical Sciences in 2020. Methods: This was a cross-sectional study with descriptive comparative design conducted on 196 elderly patients (98 men and 98 women in each group) who were referred to the heart clinics of selected educational-therapeutic centers of Iran University of Medical Sciences in Tehran, Iran in 2020. The subjects were selected through continuous sampling. Data were collected by abbreviated mental test (AMT) and MacNew Heart Disease health-related QoL (HRQoL) questionnaire and analyzed by Chi-square test, independent t-test, analysis of variance, Pearson correlation coefficient, and multiple linear regression using SPSS software, version 26. The significance level was set at P≤0.05. Results: The Mean±SD age of elderly women and men was 72.59±7.87 and 69.6±8.24 years, respectively. The Mean±SD health-related QoL of the elderly women was 3.89±0.58 and that of elderly men was 4.16±0.82. The results of the independent t-test showed that the scores of health-related QoL and its dimensions were significantly higher in men than in women (P&lt;0.001). The results of the Pearson correlation coefficient revealed a negative and significant correlation between age and health-related QoL in elderly men (r=-0.253, P=0.012). The results of simultaneous multiple linear regression revealed that 26.8% of the changes in men’s health-related QoL were explained by their individual characteristics. Conclusion: Considering the lower health-related QoL of women compared to men after a heart attack, more support for women after a heart attack seems necessary. Further research is also recommended to find out the causes of this difference.

Interpersonal Cognitive Distortions Among the Community-dwelling Elderly in Tehran, Iran

Background &amp; Aims Interpersonal cognitive distortion (ICD) is one of the psychological problems in old age that causes a person not to have a correct and logical understanding of relations. Its continuation can lead to anxiety and depression. This study aims to determine the ICDs among the community-dwelling elderly in Tehran, Iran. Materials &amp; Methods In this descriptive-correlational study, participants were 200 older people dwelling in the urban parks in Tehran, Iran who were selected using a cluster sampling method from December 2020 to October 2021. Data collection tools included a demographic form, abbreviated mental test score (AMTS), and interpersonal cognitive distortion scale (ICDS). The collected data were analyzed in SPSS software, version 16 software using descriptive statistics (Mean±SD, No. (%)) and inferential statistics (Pearson correlation test, independent t-test, analysis of variance). Results The mean total score of ICD was 52.53±8.29 out of 95, which indicates the moderate level of ICD among the elderly. In terms of the dimensions of ICDS, the unrealistic relationship expectations had the highest mean score (2.91±0.57), while the dimension of interpersonal rejection had the lowest score (2.64±0.52). There was a significant relationship between the age of the elderly and their ICD (P=0.03). Conclusion Considering the existence of a significant relationship between ageing and cognitive distortions, The nurses working in healthcare centers in Mashhad should take it into account in interventions for the elderly.

The Efficacy of Melatonin and Clonidine in Preventing Emergence Delirium in the Elderly Undergoing Orthopedic Surgery, Neurosurgery, and General Surgery: A Placebo-controlled Randomized Clinical Trial

Background: Emergence delirium (ED) is a complication after surgeries due to general anesthesia. Objectives: This study aimed to evaluate the efficacy of melatonin and clonidine, which are hypothesized to have a curative effect on ED. Methods: This randomized, placebo-controlled, double-blind, three-way parallel clinical trial was performed in Imam Reza Hospital in Birjand, Iran in 2019 - 2020 who were selected using convenience sampling. The inclusion criteria were age &gt; 65 years and preoperative Abbreviated Mental Test (AMT) score ≥ 8. The exclusion criteria were suffering from any chronic diseases. Participants were divided into 3 groups: Placebo, clonidine, and melatonin groups who received placebo, 100 μg clonidine, and 5 mg melatonin, respectively. A first dose was administered at bedtime before surgery, a second dose 90 minutes before the procedure. An AMT and Mini-mental State Examination (MMSE) were administered to determine ED. Results: This study included 150 patients with a mean and standard deviation of 74.6 ± 6.8 years. According to AMT and MMSE, there was no significant difference in the level of ED between groups on the first, second, and third days after surgery (P &gt; 0.05). Emergence delirium levels in the clonidine and melatonin groups were lower than in the placebo group. According to AMT and MMSE, ED was not significantly correlated gender, age, and type of surgery. Emergence delirium was significantly associated with postoperative bleeding and electrolyte disturbance (P &lt; 0.05). Conclusions: Melatonin and clonidine did not affect the occurrence of ED in the elderly undergoing surgery, but these medications could slightly reduce their occurrence.

498 Junior Doctor Checklist for the Management of Neck of Femur Fracture: A Quality Improvement Project

Abstract Aim Patients admitted with Neck of Femur (NOF) fracture are often complex and frail. Junior doctors in our institution are first on call and have minimal orthopaedic experience. Anecdotal experience has shown that patients are often inadequately optimised. For example, fluids not prescribed, and anticoagulants not reversed which could lead to further complications and delay to surgery, affecting patient outcomes. Therefore, we developed a junior doctor checklist to improve the quality of care for patients with NOF fracture. Method A plan-do-study-act (PDSA) methodology was utilized in designing this project. Data was collected prospectively from 50 patients presented with NOF fracture pre and post intervention. Clerking proforma, drug chart and electronic systems were reviewed. Outcome measures were prescription of analgesia, fluids, anti-emetics and laxatives, completion of venous thromboembolism (VTE) prophylaxis, abbreviated mental test (AMT), group and save and reversal of anticoagulation, if available. Intervention included production of a checklist outlining the management plan which was distributed to junior doctors. Results Areas for improvement identified from pre intervention cycle were prescription of fluids, anti-emetics, laxatives, and anticoagulant reversal, with a compliance of 56%, 44%, 42% and 50%. Other parameters had a compliance of &amp;gt;90% pre and post intervention. Post intervention compliance was 90% for fluids, 66% for anti-emetics, 74% for laxatives and 80% for anticoagulant reversal. Conclusion Introduction of a checklist is effective in improving the quality of care for patients with neck of femur fracture. More interventions incorporating the PDSA methodology will be carried out to strive for further quality improvement.

The discriminant validity of single-question assessments of subjective cognitive complaints in an Asian older adult population.

ObjectiveTo compare the discriminant validity of three different single-question assessments of subjective cognitive complaints (SCC) for dementia in a community-based older adult population in Singapore.MethodsEligible older adults aged ≥60 were recruited into phase I for identifying those who require further assessment using the Abbreviated Mental Test (AMT) and progressive forgetfulness question (PFQ). Participants who failed either tests entered phase II and were administered various single-question assessments of SCC, such as the 8th question on the patient Ascertain Dementia 8 (AD8-8pt), informant AD8 (AD8-8info), and the 10th item on the Geriatric Depression Scale (GDS-10), followed by the Montreal Cognitive Assessment (MoCA) and a formal neuropsychological battery to identify the participant’s cognitive status by a research diagnosis and DSM-IV criteria. Differences in characteristics among diagnostic groups were compared. All discriminatory indices (sensitivity, specificity, positive, and negative predictive values, overall accuracy) for these single-question assessments and their combinations with the MoCA were calculated and reported to confirm their discriminant validity in identifying the existence of subjective complaints and objective impairment.ResultsA total of 3,780 participants were assessed at phase I, of which 957 entered and completed phase II. Of whom, 911 were dementia-free and 46 had dementia. The MoCA (13/14) displayed good sensitivity (95.6%), specificity (81.5%), and overall accuracy (82.1%) for dementia detection. The GDS-10 and AD8-8pt showed poor discriminant validity, while the AD8-8info had the highest specificity (83.2%) and the greatest overall accuracy (82.5%) for dementia. Compensatory combination of the AD8-8info with MoCA, the sensitivity and positive predictive values were optimized (100%), while the conjunctive combination of two tools achieved excellent specificity (96.3%) and overall accuracy (94.8%) in discriminating dementia patients.Conclusion and implicationsCombining a reliable single-question SCC assessment with an objective tool can efficiently discriminate dementia patients from healthy older adults in the community.

Comparison of Analgesic Effects of Intravenous and Intraperitoneal Magnesium Sulphate in Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Study

Background: Postsurgical pain following laparoscopic cholecystectomy is often associated with delayed recovery and discharge from the hospital. Magnesium sulphate as an adjuvant has shown a potential role as an anti-analgesic drug perioperatively. However, the data on the effectiveness and safety of magnesium sulphate delivered via two distinct routes (intravenous and intraperitoneal) for postoperative pain management is scant.&#x0D; Methods: This prospective randomized controlled trial was conducted on 80 adult patients. Group A (n=40) received 30ml intravenous magnesium sulphate(50mg/kg) and 30ml 0.25% bupivacaine intraperitoneal infiltration. Group B (n=40) received 30ml intraperitoneal infiltration of magnesium sulphate(50mg/kg) along with 0.25% bupivacaine and 30ml intravenous 0.9% normal saline infusion. Postoperative pain-free duration, pain scores (visual analog score), need of rescue analgesia, intraoperative hemodynamics and postoperative complications were noted.&#x0D; Results: The Visual analogue scores at 1,2,4 and 6 postoperative hours were 1.75±0.78, 1.33±0.66, 0.60±0.50, 0.45±0.55 in Group B and 2.13±0.61, 1.65±0.62, 1.28±0.88, 0.73±0.51 in Group A respectively (P-value-0.02,0.03,0.00 and 0.02). The time of the first request for rescue analgesia in Group A was 37.09± 5.54 and in Group B 52.00±4.30 (P value-0.00). Mean heart rate, systolic and diastolic blood pressure were significantly lower in Group A compared to Group B (P-value&lt;0.05). Extubation and emergence time was significantly higher in group A compared to Group B (P-value -0.00). The Abbreviated mental test (AMT)-4 cognition scores were similar in both groups while Alert, Voice, Pain and Unresponsive (AVPU) sedation score was higher at the first postoperative hour in Group A (1.30± 0.46) compared to Group B (1.10 ± 0.30) (P value- 0.026).&#x0D; Conclusion: Intraperitoneal magnesium is a safe and efficient means of controlling postoperative pain. Additionally, it decreases the time required for emergence and extubation as compared to intravenous delivery. Intravenous magnesium has better hemodynamic control in perioperative period.

Frailty as a Predictor of In-Hospital Outcome in Patients with Myocardial Infarction.

(1) Background: Frailty is a condition associated with aging, co-morbidity, and disability. We aimed to investigate the relationship between frailty and in-hospital outcome in patients with myocardial infarction (MI), including the occurrence of delirium, hospital-acquired pneumonia (HAP), and length of hospital stay. (2) Methods: We analyzed 55 patients ≥ 75 years old with ST-elevation and non-ST-elevation MI. Assessment with Abbreviated Mental Test Score (AMTS), Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Clinical Frailty Scale (CFS) was performed. (3) Results: In ROC analysis, IADL and CFS presented good predictive values for the occurrence of delirium (AUC = 0.81, p = 0.023, and AUC = 0.86, p = 0.009, respectively). For predicting HAP, only AMTS showed a significant value (AUC = 0.69, p = 0.036). In regression analyses, all tests presented significant predictive values for delirium. For predicting HAP, only IADL and CFS presented significant values (in an analysis adjusted for age, gender and type of MI). Frail patients (≥5 points in CFS) had longer hospital stays (10 days IQR: 8–17 vs. 8 days IQR: 7–10; p = 0.03). (4) Conclusions: While recognizing the limitations of our study associated with the relatively low sample size, we believe that our analysis shows that frailty is a predictor of poorer in-hospital outcomes in patients with MI, including higher rates of delirium, HAP and longer hospital stay.

Clinical and neurocognitive outcomes after transcatheter aortic valve implantation (TAVI) with cerebral protection: initial experience with a novel dual-filter device in Southeast Asia.

Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients with severe aortic stenosis. A novel dual-filter system to reduce cerebral embolism during TAVI recently became available. We aimed to assess the feasibility, safety, and clinical and neurocognitive outcomes of TAVI with cerebral protection in Asian patients. 40 consecutive patients undergoing TAVI with cerebral protection were enrolled. All procedures were performed via femoral access using the self-expanding Evolut R/PRO or Portico, or the balloon-expandable SAPIEN 3 bioprostheses. Baseline characteristics, procedural and clinical outcomes were recorded. Cognition was assessed at baseline and 30 days using the abbreviated mental test (AMT). The mean age of the patients (75% male) was 76.4 ± 8.4 years. TAVI was uncomplicated in all patients. The filter device was successfully deployed in 38 (95.0%) patients without safety issues. There was no stroke or death at 30 days, and the survival rate at nine months was 95.0%. There was no overall cognitive change (baseline vs. 30-day AMT: 9.2 ± 1.1 vs. 9.0 ± 1.5, p = 0.12), and only 1 (2.5%) patient developed impaired cognition at 30 days. Patients with a decreased AMT score at 30 days were significantly older than those without (82.1 ± 4.5 vs. 74.4 ± 7.7 years, p = 0.019). All patients with decreased AMT scores were aged ≥ 76 years. In this early Asian experience of TAVI under cerebral protection, the filter device was successfully deployed in 95% of patients, with 100% procedural success. There were no filter-related complications and no stroke or mortality at 30 days. Overall cognition was preserved, although increased age was associated with a decline in AMT score.

The longitudinal association between cognitive impairment and incident visual impairment in a multiethnic Asian population: a prospective cohort study.

The relationship between baseline cognitive impairment (CI) and incident visual impairment (VI) in Asians is unclear. To determine the associations between baseline CI with incident VI and visual acuity (VA) at 6-year follow-up in multiethnic Asians. Cohort. Population-based. Two thousand three hundred and twenty-four adults aged ≥60years from the Singapore Epidemiology of Eye Diseases Study (response rate 64%). CI was defined using the validated Abbreviated Mental Test (AMT). VA was objectively measured using a LogMAR chart. Any incident VI was defined as having no VI (Snellen's VA better than or equal to 20/40) at baseline but present (VA worse than 20/40) at 6-year follow-up. VI severity was defined according to the International Classification of Diseases, 11th Revision. Associations were assessed using logistic and linear regression models. Of the 2,324 participants, 248 had CI at baseline. Presence of baseline CI was associated with more than twice the odds of any incident VI, incident mild and moderate-severe VI (OR [95% confidence interval]: 2.48 [1.55-3.90], 2.07 [1.17-3.55], and 2.61 [1.36-4.93], respectively) and worse VA (β [95% confidence interval]: 0.026 [0.006-0.046]) at 6-year follow-up. The leading causes of incident VI were cataract and under-corrected refractive error. Older adults with CI had more than double the odds of VI development and poorer VA than their cognitively intact counterparts, and most causes of incident VI were correctable. Strategies such as targeted vision screening and early intervention for early detection and management of vision loss in patients with cognitive decline are warranted.

Cognitive Assessment by Telemedicine: Reliability and Agreement between Face-to-Face and Remote Videoconference-Based Cognitive Tests in Older Adults Attending a Memory Clinic.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has spurred the rapid adoption of telemedicine. However, the reproducibility of face-to-face (F2F) versus remote videoconference-based cognitive testing remains to be established. We assessed the reliability and agreement between F2F and remote administrations of the Abbreviated Mental Test (AMT), modified version of the Chinese Mini-Mental State Examination (mCMMSE), and Chinese Frontal Assessment Battery (CFAB) in older adults attending a memory clinic.MethodsThe participants underwent F2F followed by remote videoconference-based assessment by the same assessor within 3 weeks. Reliability was evaluated using intraclass correlation coefficients (ICC; two-way mixed, absolute agreement), the mean difference between remote and F2F-based assessments using paired-sample t-tests, and agreement using Bland-Altman plots.ResultsFifty-six subjects (mean age, 76±5.4 years; 74% mild; 19% moderate dementia) completed the AMT and mCMMSE, of which 30 completed the CFAB. Good reliability was noted based on the ICC values—AMT: ICC=0.80, 95% confidence interval [CI] 0.68–0.88; mCMMSE: ICC=0.80, 95% CI 0.63–0.88; CFAB: ICC=0.82, 95% CI 0.66–0.91. However, remote AMT and mCMMSE scores were higher compared to F2F—mean difference (i.e., remote minus F2F): AMT 0.3±1.1, p=0.03; mCMMSE 1.3±2.9, p=0.001. Significant differences were observed in the orientation and recall items of the mCMMSE and the similarities and conflicting instructions of CFAB. Bland–Altman plots indicated wide 95% limits of agreement (AMT -1.9 to 2.6; mCMMSE -4.3 to 6.9; CFAB -3.0 to 3.8), exceeding the a priori-defined levels of error.ConclusionWhile the remote and F2F cognitive assessments demonstrated good overall reliability, the test scores were higher when performed remotely compared to F2F. The discrepancies in agreement warrant attention to patient selection and environment optimization for the successful adaptation of telemedicine for cognitive assessment.

288 Do Frailty Assessments Improve Outcomes for Emergency Laparotomy Patients? A Quality Improvement Project

Abstract Aim Our aim of the project is to increase completion rates of frailty assessments in emergency laparotomies to improve patient outcomes. Method This QI project focused on completion of the Rockwood Clinical Frailty Score (RCFS), Comprehensive Geriatric Assessment (CGA), Abbreviated Mental Test Score (AMTS), memory screening, place of residence and care level in patients over 65 years undergoing emergency laparotomies. Criteria was generated using British Geriatric Society recommendations and local hospital guidance. A year was sampled pre-intervention with the criteria, time clerked and grade. Data was assessed for admission and mortality statistics, and re-admission rates. A presentation to surgical juniors relating to frailty, frailty assessments and guidelines was used as an intervention. The data was re-sampled to identify changes post-intervention. Results Fifty-four laparotomy patients were sampled. 28% had a completed RCFS, 15% had a CGA, 67% had a place of residence, 41% had level of care documented, 13% had a memory screen and 7% had an AMTS. The small sample size restricted data analysis, however, there was a general decrease in length of admission and time to medically fit with increased frailty score completion. Post-intervention, completion of the RCFS, CGA, place of residence and care level increased. Completion of memory screening and AMTS decreased. Compliance increased in FY1s, SHOs and registrars. Conclusions The intervention had a positive impact: the average number of frailty criteria completed per patient increased by 39%, Foundation Year trainees now have frailty teaching, and the clerking booklet was reviewed. A re-audit is planned to ensure ongoing improvement.

Mental disorders elderly in rural areas during COVID-19 pandemic in Bali Indonesia

Detection of mental disorders in the elderly are using the Abbreviated Mental Test (AMT) screening/questionnaire, Depression Anxiety Stress Scale (DASS), Geriatric Depression Scale (GDS), Pittsburgh Sleep Quality Index (PSQI) and Visual Analog Scale (VAS) and/or or based on structured interviews. The elderly who had complete screening and interview data were included in the study sample, i.e., 85 people. From 85 elderly as a participant, 65 people (76.4%) had a good cognitive, 10 (11.7%) moderate cognitive, and 5 severe cognitive (5.8%), but their daily activities were still good. The results of the screening GDS showed 70 people with mild depression (82.4%), moderate depression in 13 people (15.3%) and 2 people with severe depression (2.3%). The results of the screening with DASS show 15 elderly people with depression (17.5%), 55 people with anxiety (65%) and 15 people experiencing stress (17.5%). Screening for elderly sleep quality with the PSQI for elderly showed 60 people with disrupted sleep quality (70.5%) and 15 people with good sleep quality (17.6%). A 68 people elderly (80%) complained of mild pain and 17 people (20%) with moderate pain by screening using the VAS, where the location of the pain varied in the body and leg areas.

SELECTED PROBLEMS IN THE REHABILITATION OF PATIENTS IN A NURSING AND CARE INSTITUTION.

The aim of the study was to assess selected problems in the rehabilitation of patients staying at a nursing and care institution. Materials and methods: The study included 33 patients aged 55 to 96 years who were staying at the nursing and care institution in Lipsko. Study patients were examined over a period of 3 months using the standardised Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (I-ADL) scores, the Abbreviated Mental Test Score (AMTS) and the Timed Up and Go Test (TUG). Results: Standardised ADL testing showed that a considerable proportion of study patients (60%) aged 66-75 years had moderate disability. Standardised Lawton scale testing showed that the most difficult complex activities were home maintenance (96.97%), shopping (90.91%), cooking (87.88%), cleaning (87.88%) and doing laundry (78.79%). The standardised Timed Up and Go Test showed that a large proportion of study patients (71.43%) aged 66-75 years had considerable functional mobility limitations. The AMTS, which assessed the cognitive function, revealed normal results in 36.36% of study patients. Conclusions: 1. Study patients had significant functional disability. 2. The patients' sex did not influence the ability to perform complex activities of daily living. 3. Sociodemographic determinants did not influence cognitive functioning. 4. Physical therapy and rehabilitation in the elderly should be performed on a regular basis and in the entire society.

The Correlation and Agreement of Montreal Cognitive Assessment, Mini-Mental State Examination and Abbreviated Mental Test in Assessing the Cognitive Status of Elderly People Undergoing Hemodialysis.

Cognitive disorders are one of the most common disorders in elderly people with chronic renal failure. This study aimed to investigate the correlation and agreement of Montreal Cognitive Assessment (MoCA), Abbreviated Mental Test Score (AMTS), and Mini-Mental State Examination (MMSE) tests in assessing the cognitive status of elderly patients undergoing hemodialysis at Guilan University of Medical Sciences in north of Iran. This cross-sectional study was conducted on 84 elderly people undergoing hemodialysis. Inclusion criteria was having an age of 60 years old and older, hemodialysis treatment for at least 6 months, and having reading and writing skills. The Pearson correlation test, Intraclass Correlation Coefficient (ICC) test, and Bland-Altman plot were used for data analysis. The majority of samples were in the age group of 60-65 years (28.57%) and the majority of them were male (66.66%). The results showed a significant positive correlation between MoCA and MMSE (r = 0.69, p = 0.001), between MMSE and AMTS (r = 0.64, p = 0.001), and between MoCA and AMTS tests (r = 0.62, p = 0.001). The results also showed a weak agreement between MoCA and MMSE tests (ICC = -0.11, p = 0.633), between MMSE and AMTS tests (ICC = -0.007, p = 0.369), and between MoCA and AMTS tests (ICC = -0.001, p = 0.780). Based on the results, these tools seem to complement each other. The inconsistency between cognitive tests indicates a serious need to develop appropriate instruments for detecting cognitive disorders in elderly.

The Tuokko version of the Clock Drawing Test: A validation study in the Greek population

ABSTRACT Introduction The present study aims to be the first to validate the Tuokko version of the Clock Drawing Test (CDT) and estimate its cutoff score after its translation into the Greek language and administration in the Greek population. Methods One hundred and thirty-two individuals participated in this study [60 with Good Cognitive Health (GCH), 24 with Parkinson’s Disease (PD), 24 with Parkinson’s Disease Dementia (PDD) and 24 with Alzheimer’s Disease (AD)]. The CDT was administered to all participants. Additionally, the cognitive and mental status of the sample were estimated through the use of the Mini Mental State Examination (MMSE), Abbreviated Mental Test Score (AMTS), Arizona Battery for Communication Disorders of Dementia (ABCD), Instrumental Activities of Daily Living (IADL), the Neuropsychiatric Inventory (H-NPI) and the Geriatric Depression Scale −15 (GDS-15). Results Statistically significant differences were found between all groups on the CDT, with AD patients having lower scores than all subgroups in the study. The CDT showed a high internal consistency (Cronbach’s alpha = 0.832). The ROC analysis provided a cutoff point equal to 4.00 (AUC: 0.821, p < 0.001) between the Cognitively Unimpaired Group (CUG: GCH and PD group) and the Cognitively Impaired Group (CIG: PPD and AD patients), 5.00 (AUC: 0.845, p < 0.001) between the GCH group and the PDD group, and 4.00 (AUC: 0.780, p < 0.001) between the GCH group and the AD group. Finally, the cutoff point between the PD group and the PDD group was 4.00 (AUC: 0.896, p < 0.005), and 3.00 (AUC: 0.899, p < 0.001) between the PD group and the AD group. Significant positive Pearson’s correlations were observed between CDT and MMSE (r = 0.808, p < 0.001), CDT and AMTS (r = 0.688, p < 0.001), CDT and ABCD (r = 0.770, p < 0.001), CDT and the ABCD Visuospatial Construction subdomain (r = 0.880, p < 0.001); while a negative correlation was found between CDT and IADL (r = −0.627, p < 0.001) between the CUG and the CIG groups. Conclusion Given the results obtained, the CDT appears to be a clinically valid screening instrument for the assessment of visuospatial abilities, with high reliability in Greek populations with cognitive impairment.

Analysis of Risk Factors and Consequences of Consecutive Proximal Femur Fractures in Elderly Patients.

BackgroundProximal femur fracture (PFF) carries significant morbidity, mortality, and cost implications to the health system. Subsequent contralateral fracture further decreases patient performance and increases the healthcare burden. This study aimed to identify and evaluate potential risk factors for consecutive PFF.MethodologyPilgrim Hospital PFF database from 2012 to 2019 was retrospectively analyzed. Patients over 60 years with low-energy fractures were included. Pathological and atypical fractures and polytrauma were excluded.ResultsThere were 114 patients (4.18%) with contralateral hip fractures out of a total of 2727 PFF patients; 80% were females. The mean age was 82 years for the first hip fracture and 85 years for the second. The average time interval between fractures was 36 months. The fracture pattern was the same on both sides in 74.3% of patients (P<0.0001). Out of 53 patients with cemented hip hemiarthroplasty (CHH) on one side, 31 patients (59%) had a second CHH for the contralateral side. Likewise, out of 48 patients who had dynamic hip screw fixation during the first admission, 33 patients (69%) had the same procedure on the contralateral side too.During the two consecutive admissions, the length of hospital stay was not significantly different (P=0.30), median American Society of Anesthesiologists (ASA) grades were 3, hyponatremia increased from 25% to 29% (P=0.5), mean decline in abbreviated mental test score (AMTS) was 0.4, deterioration of Clinical Frailty Score and Charlson morbidity index were from 4.5 to 5.9 (P<0.0001), and from 5.4 to 6.1, respectively, and institutional residency was increased from 23 to 46 (P>0.0014).ConclusionThe similarity of fracture pattern bilaterally requiring similar surgical procedures is comparable with other literature. Even though there is minimal or no change in the ASA, AMTS, and hospital stay between the two admissions, there is a significant decline in clinical frailty, mobility status, and an increase in residential dependency following a subsequent fracture. Our findings demonstrate the importance of emphasizing secondary preventive measures to prevent a consecutive fracture.

Cognitive impairment and pain relief following hip fractures: a case control study.

Hip fractures represent a significant workload of both emergency and orthopaedic departments within the National Health Service (NHS). Pain relief is key in treating hip fractures as highlighted by both National Institute of Clinical Excellence (NICE) and British Orthopaedic Association Standards for Trauma (BOAST) guidelines. However, the literature shows that patients with cognitive impairment tend to have inconsistent pain management, leading to worse outcomes. We conducted a case-control study looking at 296 patients who presented with hip fractures to a major trauma centre between 1 December 2019 and 30 May 2020. Cognition was assessed using pre-recorded Abbreviated Mental Test Scores (AMTS). There was no significant difference between pain relief provided to patients with or without cognitive impairment in both the pre-hospital (p = 0.208) and Accident & Emergency (A&E) (p = 0.154) setting. A larger proportion of patients in A&E did not receive any pain relief (18.6% versus 42.2%). Pre-hospital, the higher the pain score, the stronger the analgesia given (R = 0.435, p = 0.000). This relationship was present in both the cognitively impaired (R = 0.572, p = 0.000) and cognitively intact groups (R = 0.390 p = 0.000). Strength of analgesia and pain scores did not correlate in A&E (R = 0.014, p = 0.826). Cognition did not impact the time to analgesia both pre-hospital (p = 0.291) and in A&E (p = 0.332); however, patients waited significantly longer to receive pain relief in A&E (29.61 minutes versus 150.28 minutes). Fascia-iliaca blocks were administered to 58.4% of the cohort, with no significant difference noted between cognition status. Overall, cognition does not impact pain management both pre-hospital and in A&E. There is still room for improvement, particularly in the assessment of pain in the cognitively impaired. A possible solution is the utilisation of the Bolton Pain Assessment Tool, a validated pain assessment tool for the cognitively impaired that has been utilised in the trauma setting with good effect.