Assessment Of Cognitive Status Research Articles

Psychological and clinical factors associated with emotional distress related to type 2 diabetes mellitus

IntroductionStress and coping with diabetes can affect the severity of disease directly, through pathophysiological processes or indirectly, through the patient's own perception of disease by deteriorating adherence to therapy and daily functioning.ObjectivesTo investigate emotional distress related to T2DM according to demographic, clinical, psychological, metabolic and anthropometric characteristics.MethodsEighty-two in- and outpatients of both sexes (<65 years) with endocrinologist-diagnosed T2DM, duration ≥5 years, treated with either oral therapy, insulin or both, were included in this cross-sectional study. The Beck Depression Inventory (BDI) was employed for assessment of severity of depressive symptoms. The Mini Mental State Examination (MMSE) was used for assessment of cognitive status. The Problem Areas in Diabetes (PAID) (subscale related to emotional problems associated with T2DM) was applied for assessment of emotional distress. Clinical characteristics of the illness were obtained from medical records. Laboratory and anthropometric measures (Body mass index, Waist circumference) were also performed. The level of significance in statistical analyses (Student's t-test, Pearson's correlation) was P = 0.05.ResultsThe PAID (emotional distress) subscore was significantly higher in patients with psychiatric heredity (P = 0.028) in relation to these without (Student's t-test). Considerable positive correlation between PAID subscore and BDI score (r = 0.588) (P = 0.000), and negative correlation between PAID subscore and MMSE score (r = −0.201) (P = 0.050) were also found (Pearson's correlation).ConclusionsPsychological factors: psychiatric heredity, higher intensity of depression and poor cognitive functioning were significantly associated with emotional distress related to the illness in patients with type 2 diabetes mellitus.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cognition and adaptive functioning in older people attending drug and alcohol services.

Substance use disorders in older adults are expected to increase dramatically in the coming years. Given the increased susceptibility to cognitive deficits in older substance users (defined here as aged 50+ years due to the accelerated health decline observed in this population), it is important to consider the functional correlates of cognitive impairment in these older adults. This study details the cognitive status of older individuals attending outpatient drug and alcohol (D&A) treatment services and seeks to determine of the association of cognitive impairment to self-reported daily functioning. Ninety nine clients aged 50 years or over attending outpatient D&A treatment services in Sydney, Australia participated. Cognition was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R). Recent substance use (Australian Treatment Outcome Profile), physical and mental health (SF12, Geriatric Depression Scale), social isolation (Lubben Social Network Scale), and activities of daily living (Bayer ADL Scale) were also assessed. Nearly two-thirds of participants screened positive for cognitive impairment on the ACE-R; 41% and 65% of clients met the cut-off scores for mild cognitive impairment (MCI) and more severe cognitive impairment, respectively. Self-reported seizure history was a predictor of cognitive impairment. The results suggest that cognitive impairment in this group is common. The assessment of cognitive status for this older group of patients should not only include the identification of cognitive impairment but also encompass mental health and social functioning. A greater understanding of the needs of this cohort will also enable better co-ordination with other health and welfare services tailored to this population.

Neuroinflammatory, Neurodegenerative and Structural Brain Biomarkers of the Main Types of Post-Stroke Cognitive Impairment in Acute Period of Ischemic Stroke

Post-stroke cognitive impairment is a clinically heterogeneous condition, some types of which cannot be fully differentiated neuropsychologically that necessitates the active search for biomarkers. Analyze parameters of neuroinflammation and neurodegeneration in combination with neuroimaging markers in patients with different types of post-stroke cognitive impairment in acute ischemic stroke. In 72 patients we performed the assessment of cognitive status and distinguished 3 types: normal cognition, dysexecutive, and mixed cognitive impairment. In each group we determined the concentration of cytokines (IL-1β, IL-6, TNFα, IL-10) in liquor and serum, β-amyloid 1−40 in liquor and a number of MRI morphometric parameters and fractional anisotropy. In all groups of patients we detected higher level of IL-10 in serum compared with the control. Patients with dysexecutive cognitive impairment had higher concentration of IL-1β, IL-10 in liquor, IL-6 level in serum, lower fractional anisotropy of ipsilateral thalamus compared with patients with normal cognition and largest size of infarct. Patients with dysexecutive and mixed cognitive impairment had the higher area of leukoareosis and ventricular volume, reduced fractional anisotropy of contralateral cingulum compared with patients with normal cognition. Patients with mixed cognitive impairment characterized by lower fractional anisotropy of contralateral fronto-occipital fasciculus compared with patients with dysexecutive cognitive deficit. Serum and cerebrospinal fluid concentrations of cytokines studied in combination with MRI parameters particularly fractional anisotropy seems to be informative biomarkers of pathogenic types of PSCI.

Low Cerebrospinal Fluid Amyloid-Beta Concentration Is Associated with Poorer Delayed Memory Recall in Women

Background: Data on the association of memory performance with cerebrospinal fluid (CSF) biomarkers of Alzheimer's disease (AD) are inconsistent. The Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery (CERAD-NB) is a commonly used validated cognitive tool; however, only few studies have examined its relationship with CSF biomarkers for AD. We studied the correlation of pathological changes in CSF biomarkers with various CERAD-NB subtests and total scores. Methods: Out of 79 subjects (36 men, mean age 70.5 years), 63 had undergone an assessment of cognitive status with CERAD-NB and a CSF biomarker analysis due to a suspected memory disorder, and 16 were controls with no memory complaint.Results: In women we found a significant correlation between CSF amyloid-beta (Aβ_1-42) and several subtests measuring delayed recall. Word List Recall correlated with all markers: Aβ_1-42 (r = 0.323, p = 0.035), tau (r = -0.304, p = 0.050) and hyperphosphorylated tau (r = -0.331, p = 0.046). No such correlations were found in men. Conclusions: CSF biomarkers correlate with delayed memory scores in CERAD-NB in women, and women may have more actual AD pathology at the time of the investigations than men.

Addenbrooke's cognitive examination test for brief cognitive assessment of adolescents suffering from migraine with aura.

The aim of this study was to assess the role of the Addenbrooke's cognitive examination test (ACE-R) in the evaluation of cognitive status in migraineurs interictally. A total of 44 adolescent patients and 44 healthy controls, matched by age and gender, have undergone ACE-R testing. Migraineurs were additionally questioned about migraine aura features and presence of higher cortical dysfunctions (HCD) during an aura. According to the questionnaire results, patients were subsequently divided into HCD and Non-HCD group. ACE-R scores of migraine patients were significantly lower than in healthy controls (93.68±3.64 vs 96.91±2.49; t=4.852, p<0.001). Also, subscores of memory and verbal fluency were significantly higher in the control population. There was no correlation of HCD occurrence with cognitive examination score, although Non-HCD subgroup achieved better score (93.13±3.91 vs 94.29±3.30; t=1.053, p=0.298). Findings have shown that migraineurs get lower ACE-R test scores, with a tendency to have a poorer outcome in more complex aura. Also, our study has revealed that the ACE-R test is an easily administered test for brief assessment of cognitive status in migraineurs. Future perspectives could be further evaluation of ACE-R test in larger sample size and the impact of migraine with aura on cognitive function in adolescents.

A Serious Game for Clinical Assessment of Cognitive Status: Validation Study.

BackgroundWe propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening.ObjectiveThe objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations.MethodsWe carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM).ResultsAfter a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=–.339, P <.001) and MMSE (r=–.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments.ConclusionsThis research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making.

Cognitive predictors of skilled performance with an advanced upper limb multifunction prosthesis: a preliminary analysis

Purpose The objectives were to 1) identify major cognitive domains involved in learning to use the DEKA Arm; 2) specify cognitive domain-specific skills associated with basic versus advanced users; and 3) examine whether baseline memory and executive function predicted learning. Method Sample included 35 persons with upper limb amputation. Subjects were administered a brief neuropsychological test battery prior to start of DEKA Arm training, as well as physical performance measures at the onset of, and following training. Multiple regression models controlling for age and including neuropsychological tests were developed to predict physical performance scores. Prosthetic performance scores were divided into quartiles and independent samples t-tests compared neuropsychological test scores of advanced scorers and basic scorers. Baseline neuropsychological test scores were used to predict change in scores on physical performance measures across time. Results Cognitive domains of attention and processing speed were statistically significantly related to proficiency of DEKA Arm use and predicted level of proficiency. Conclusions Results support use of neuropsychological tests to predict learning and use of a multifunctional prosthesis. Assessment of cognitive status at the outset of training may help set expectations for the duration and outcomes of treatment.Implications for RehabilitationCognitive domains of attention and processing speed were significantly related to level of proficiencyof an advanced multifunctional prosthesis (the DEKA Arm) after training.Results provide initial support for the use of neuropsychological tests to predict advanced learningand use of a multifunctional prosthesis in upper-limb amputees.Results suggest that assessment of patients’ cognitive status at the outset of upper limb prosthetictraining may, in the future, help patients, their families and therapists set expectations for theduration and intensity of training and may help set reasonable proficiency goals.

Predictors of moderate cognitive disorders in patients with coronary heart disease and type 2 diabetes mellitus

To study predictors of moderate cognitive disorders (MCD) in patients with coronary heart disease (CHD) and type 2 diabetes mellitus (DM2). The study included 54 men with CPD andDM2 (mean age 56.8 ± 4.5 years). Standard medical examination was supplemented by the assessment of cognitive status, characteristics of lipid and carbohydrate metabolism. Factors allegedly influencing MCD development included the patients' age, education level, stenosis of carotid arteries, LV ejection fraction, arterial hypertension, insulin and HbAlc levels, HOMA and QUICKI indices, lipid metabolism, concentrations of total, HDL and LDL cholesterol, fructosamine, triglycerides, severity of coronary lesions (Syntax scale), trait and state anxiety. Fructosamine level and HOMA index were the most important characteristics responsible for MCD in patients with CPD and DM2. The data obtained demonstrate the significance of fructosamine level and HOMA index in the development of MCD in patients with CPD and DM2.

Вплив структурно-функціонального стану серця на розвиток когнітивних порушень у хворих на артеріальну гіпертензію

&lt;p&gt;&lt;strong&gt;Резюме. &lt;/strong&gt;У 35 хворих на артеріальну гіпертензію досліджено вплив структурно-функціонального стану серця на стан когнітивних функцій. Оцінку когнітивного статусу проводили за допомогою короткої шкали оцінки психічного статусу (MMSE) та Монреальської шкали (MOCA). Стійкість уваги та швидкість сенсомоторних реакцій досліджували за таблицями Шульте. Якість життя пацієнтів оцінювали за фізичним і психічним компонентом за допомогою опитувальника SF-12. Всім хворим проводили ехокардіографічне обстеження з оцінкою товщини міжшлуночкової перетинки, товщини задньої стінки лівого шлуночка, кінцевого діастолічного розміру лівого шлуночка, розміру аорти і лівого передсердя, розмірів правого шлуночка і фракції викиду лівого шлуночка. Виявлено, що у хворих на АГ зниження фракції викиду лівого шлуночка визначає вираженість когнітивних розладів і сприяє погіршенню якості життя таких пацієнтів. Розвиток когнітивних порушень залежить також від розмірів лівого передсердя, товщини міжшлуночкової перегородки і задньої стінки лівого шлуночка та КДР лівого шлуночка. Не виявлено суттєвого впливу на когнітивний статус розмірів діаметра аорти та правого шлуночка.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Ключові слова&lt;/strong&gt;: артеріальна гіпертензія, когнітивні функції, якість життя, структурно-функціональний стан серця.&lt;/p&gt;

Valoración del estado cognitivo en el adulto mayor: áreas más afectadas

Introducción: La alteración del estado cognitivo vuelve al adulto mayor dependiente, limita su autocuidado y genera cuidados a largo plazo. Objetivo: Valorar el estado cognitivo del adulto mayor, identificar las capacidades cognitivas más afectadas según género, edad y escolaridad. Metodología: Se realizó un estudio descriptivo transversal no probabilístico con enfoque cuan­titativo en una casa de rehabilitación y reposo en México D.F. La población fue de 78 adultos mayores de 60 años (41 mujeres y 37 hombres). Se valoró el estado cognitivo con ayuda del (Mini-Mental) cuyo objetivo es establecer un diag­nóstico presuntivo de las funciones cognitivas. Se utilizaron cuatro variables: estado cognitivo, género, edad y escolaridad. Resultados: De las 78 personas el 47.4% fueron hombres y el 52.6% mujeres, el 40.5% tienen de 60 a 69 años, el 32.1% obtuvo un título universitario, el 23.1% de la población mostro deterioro severo, el 44.9% deterioro leve. Las áreas más afectadas fueron: abstracción (cálculo) con 46.2% de dete­rioro severo, memoria a corto plazo con 47.4% de deterioro severo y lenguaje con 11.5% de deterioro. Conclusiones: Evaluar y detectar alteraciones cognitivas permitirá concientizar a la familia, buscar modelos de atención y cuidado fortaleciendo el bienestar del adulto mayor.

P300 event related potential application to cognitive status assessment of the patients with subclinical hypothyroidism

Disturbances of thyroid function are often accompanied by cognitive and affective disorders. Assessment of cognitive status in the patients with subclinical hypothyroidism represents a possibility for early diagnostics of cognitive impairment and timely introduction of necessary pharmacotherapy treatment. The aim of this study was to quantify whether there are P3 event related potential (ERP) deviations as electrophysiological markers of cognitive activity in patients with subclinical hypothyroidism. P300 potentials were examined in thirty patients with subclinical hypothyroidism and in 30 healthy subjects of the control group. P300 was recorded using the classic auditory oddball paradigm, with 20% of target and 80% of non-target stimuli. The results analysis showed a significantly longer latency P300 and reduced amplitude P300 in subjects with subclinical hypothyroidism compared to euthyroid subjects. There is also a statistically significant negative correlation between the results of a mini mental state examination and the P300 latency at Fz electrode (r= -0.47, p <0.01) and Cz electrode (r= -0.43, p =0.017). P300 ERP is important in the evaluation of patients with subclinical hypothyroidism, due to the sensitivity in the detection cognitive disorders.

Role of Co-existence of Multiple Chronic Conditions on the Longitudinal Decline in Cognitive Performance among Older Adults in the US

Background: The primary goal of this study was to examine the influence of the co-existence of multiple chronic conditions on the longitudinal decline in cognitive performance among elderly individuals of the nationally representative Aging Demographic and Memory Study. Methods: Retrospective longitudinal cohort study of individuals aged 70 years or above. Random effect ordinal logistic regression analysis was performed to assess the impact of co-existing chronic conditions on the longitudinal decline in cognitive function (transitioning from normal functioning to cognitive impairment (no dementia (CIND) to dementia) among older adults. Principal component factor analysis was conducted to identify the clusters of chronic health conditions. Results: About 35% of respondents had at least one of four cardiovascular risk factors (diabetes, hypertension, high cholesterol or heart problems). The odds of remaining in normal cognitive status (compared to CIND and dementia) were 56% lower for those who experienced an incidence of stroke at baseline compared to those who did not experience a stroke incidence. Cardiovascular risk factors were not associated with cognitive decline. Conclusions: The lack of significant impact of cardiovascular (CVD) risk factors on cognitive decline may be attributable to indirect but important pathways through which CVD factors are associated with a stroke incidence. The importance of this topic remains as the prevalence of dementia and other cognitive impairments is increasing worldwide, and our limited findings underscore the imperative need for longitudinal studies with a larger group of geriatric patients and wider use of brief assessments of cognitive status. Due to the complexity of managing chronic cardiovascular disease, establishment of a care coordination manager as a bridge between patients and other medical specialists may improve clinical outcomes and prevent cognitive decline.

The Road Ahead To Cure And Prevent Alzheimer's Disease: Implementing Prevention into Primary Care.

Most old adults receive their health care from their primary care practitioner; as a consequence, as the population ages, the manifestations and complications of cognitive impairment and dementia impose a growing burden on providers of primary care. Current guidelines do not recommend routine cognitive screening for older persons by primary care physicians, although the vast majority recommend a cognitive status assessment and neurological examination for subjects with a cognitive complaint. Also, no clinical practice guidelines recommend interventions in older adults with cognitive impairment in primary care settings. However, primary care physicians need to conduct a review of risks and protective factors associated with cognitive decline and organize interventions to improve or maintain cognitive function. Recent epidemiological studies have indicated numerous associations between lifestyle-related risk factors and incidental cognitive impairment. The development of biomarkers could also help in diagnosis, prognosis, selection for clinical trials, and objective assessment of therapeutic responses. Interventions aimed at cognitive impairment prevention should be pragmatic and easy to implement on a large scale in different health care systems, without generating high additional costs or burden on participants, medical and social care teams.

Intellectual ability in the duchenne muscular dystrophy and dystrophin gene mutation location.

Duchenne muscular dystrophy (DMD) is the most common form of muscular dystrophy during childhood. Mutations in dystrophin (DMD) gene are also recognized as a cause of cognitive impairment. We aimed to determine the association between intelligence level and mutation location in DMD genes in Serbian patients with DMD. Forty-one male patients with DMD, aged 3 to 16 years, were recruited at the Clinic for Neurology and Psychiatry for Children and Youth in Belgrade, Serbia. All patients had defined DMD gene deletions or duplications [multiplex ligation-dependent probe amplification (MLPA), polymerase chain reaction (PCR)] and cognitive status assessment (Wechsler Intelligence Scale for Children, Brunet-Lezine scale, Vineland-Doll scale). In 37 patients with an estimated full scale intelligence quotient (FSIQ), six (16.22%) had borderline intelligence (70<FSIQ ≤85), while seven (18.92%) were intellectually impaired (FSIQ <70). The FSIQ was not associated with proximal and distal mutations when boundaries were set at exons 30 and 45. However, FSIQ was statistically significantly associated with mutation location when we assumed their functional consequence on dystrophin isoforms and when mutations in the 5′-untranslated region (5′UTR) of Dp140 (exons 45–50) were assigned to affect only Dp427 and Dp260. Mutations affecting Dp140 and Dp71/Dp40 have been associated with more frequent and more severe cognitive impairment. Finally, the same classification of mutations explained the greater proportion of FSIQ variability associated with cumulative loss of dystrophin isoforms. In conclusion, cumulative loss of dystrophin isoforms increases the risk of intellectual impairment in DMD and characterizing the genotype can define necessity of early cognitive interventions in DMD patients.

School Function in Students With Down Syndrome

People with Down syndrome (DS) are predisposed to specific areas of relative developmental strength and challenge, but it is unclear whether and how this profile affects participation in school and community settings. In this study we characterized the nature of school participation and performance of functional tasks in the school context for 26 elementary students with DS (mean age = 7.86 yr; standard deviation = 1.75). Students participated in assessments of cognitive status and language development. Their teachers completed the School Function Assessment (Coster, Deeney, Haltiwanger, & Haley, 1998) questionnaire and a standardized questionnaire on executive functioning (EF). Students demonstrated a pronounced pattern of assistance- and adaptation-related needs across various domains of school function. The strongest predictor of school function was EF skills, as reported by teachers (adjusted R² = .47, p = .003). Findings from this study should inform future intervention and school-related planning for elementary school students with DS.

Attention and information processing in end stage renal disease and effect of hemodialysis: a bedside study

The neurobehavioral syndrome of uremia in chronic kidney disease affects the functioning of the central nervous system. Cognitive impairment is one of the most important manifestations of this dysfunction. The process of hemodialysis is known to bring about conflicting changes in the cognitive status of patients. In the present study an assessment of cognitive status of patients with end stage renal disease was done in comparison to controls before and after a session of hemodialysis using simple bedside paper-pencil tests. Thirty patients of end stage renal disease on maintenance dialysis for at least one month with MMSE score >24 were assessed one hour before and one hour after hemodialysis using Digit Symbol Substitution Test, One Letter and Three Letter Cancellations tasks. Their results were compared to age and sex matched healthy controls. The patients with end stage renal disease had significantly lower performance in cognitive tests in comparison to controls. The performance improved 1 hour after hemodialysis in comparison to pre-dialysis values. However, the values after dialysis were significantly lower than in controls, thereby indicating that though the cognitive functions improved after hemodialysis, they did not reach the control levels. There was also a significant change in the biochemical parameters after dialysis. We conclude that patients with end stage renal disease suffered from cognitive impairment which improved on hemodialysis due to removal of metabolic waste products.

Influence of Combat Blast-Related Mild Traumatic Brain Injury Acute Symptoms on Mental Health and Service Discharge Outcomes

Assessment of acute mild traumatic brain injury (mTBI) symptoms after a combat blast could aid diagnosis and guide follow-up care. Our objective was to document acute mTBI symptoms following a combat blast and to examine associations between acute symptoms and mental health and service discharge outcomes. A retrospective cohort study was conducted with 1656 service personnel who experienced a combat blast-related mTBI in Iraq. Acute mTBI symptoms were ascertained from point-of-injury medical records. The associations between acute symptoms and posttraumatic stress disorder (PTSD), postconcussion syndrome (PCS), and type of service discharge were examined. Disability discharge occurred in 11% of patients, while 36% had a non-disability discharge and 52% had no recorded discharge. A PTSD and PCS diagnosis was made in 19% and 15% of the sample, respectively. The most common acute mTBI symptoms were headache (62.8%), loss of consciousness (LOC) (34.5%), and tinnitus (33.2%). LOC was predictive of PTSD (odds ratio [OR] 1.54; 95% confidence interval [CI] 1.18, 2.00) and PCS (OR 2.08; 95% CI 1.56, 2.77), while altered mental status (OR 1.53; 95% CI 1.07, 2.17) and previous blast history (OR 1.83; 95% CI 1.15, 2.90) also were predictive of PCS. While no acute mTBI symptoms were associated with discharge outcomes, injury severity was associated with disability discharge. LOC after blast-related mTBI was associated with PTSD and PCS, and injury severity was predictive of disability discharge. The assessment of cognitive status immediately after a blast could assist in diagnosing mTBI and indicate a need for follow-up care.

Basic geriatric assessment does not predict in-hospital mortality after PEG placement

BackgroundPercutaneous endoscopic gastrostomy (PEG) is an established procedure for long-term nutrition. However, studies have underlined the importance of proper patient selection as mortality has been shown to be relatively high in acute illness and certain patient groups, amongst others geriatric patients. Objective of the study was to gather information about geriatric patients receiving PEG and to identify risk factors associated with in-hospital mortality after PEG placement.MethodsAll patients from the GEMIDAS database undergoing percutaneous endoscopic gastrostomy in acute geriatric wards from 2006 to 2010 were included in a retrospective database analysis. Data on age, gender, main diagnosis leading to hospital admission, death in hospital, care level, and legal incapacitation were extracted from the main database of the Geriatric Minimum Data Set. Self-care capacity was assessed by the Barthel index, and cognitive status was rated with the Mini Mental State Examination or subjectively judged by the clinician. Descriptive statistics and group comparisons were chosen according to data distribution and scale of measurement, logistic regression analysis was performed to examine influence of various factors on hospital mortality.ResultsA total of 1232 patients (60.4% women) with a median age of 82 years (range 60 to 99 years) were included. The mean Barthel index at admission was 9.5 ± 14.0 points. Assessment of cognitive status was available in about half of the patients (n = 664), with 20% being mildly impaired and almost 70% being moderately to severely impaired. Stroke was the most common main diagnosis (55.2%). In-hospital mortality was 12.8%. In a logistic regression analysis, old age (odds ratio (OR) 1.030, 95% confidence interval (CI) 1.003-1.056), male sex (OR 1.741, 95% CI 1.216-2.493), and pneumonia (OR 2.641, 95% CI 1.457-4.792) or the diagnosis group ‘miscellaneous disease’ (OR 1.864, 95% CI 1.224-2.839) were identified as statistical risk factors for in–hospital death. Cognitive status did not have an influence on mortality (OR 0.447, CI 95% 0.248-1.650).ConclusionIn a nationwide geriatric database, no component of the basic geriatric assessment emerged as a significant risk factor for mortality after PEG placement, emphasizing individual decision-making.

Managing delirium in the acute care setting: a pilot focus group study

Delirium frequently occurs in hospitalised older adults leading to poor outcomes and frequent adverse events. Proper recognition and management of delirium by acute care nurses can minimise the effects of negative sequelae associated with delirium. This pilot study used focus group methodology to: (i) describe acute care nurse's experience and knowledge regarding assessment and management of delirium in hospitalised older adults; (ii) illustrate potential facilitators and barriers to non-drug management of delirium; and (iii) to explicate the use of non-drug interventions by acute care nurses to manage delirium in hospitalised older adults. Qualitative, pilot study. A total of 16 nurse participants, working on medical, surgical and orthopaedic units from one acute care hospital participated in two focus groups. Main themes included the following: confusion is normal; our duty is to protect; and finding a balance. Nurses were able to identify non-pharmacological interventions for delirium and facilitators and barriers to using these in clinical practice. Findings from this pilot study illustrate the need for regular assessment of cognitive status in hospitalised older adults and nursing staff education regarding the use of non-pharmacological management of delirium. Based on their experience, nurses have a wealth of ideas for managing delirium. Areas for future research and policy are also highlighted. More research is needed on how to improve delirium management by acute care nurses to increase the efficacy and use of non-pharmacological interventions in the management of delirium in hospitalised older adults. To translate these findings into practice, nursing care needs to be guided by evidence-based guidelines to implement non-pharmacological strategies in the acute care setting.

Validation and diagnostic accuracy of the Alzheimer's questionnaire.

accurately identifying individuals with cognitive impairment is difficult. Given the time constraints that many clinicians face, assessment of cognitive status is often not undertaken. The intent of this study is to determine the diagnostic accuracy of the Alzheimer's questionnaire (AQ) in identifying individuals with mild cognitive impairment (MCI) and AD. utilising a case-control design, 300 [100 AD, 100 MCI, 100 cognitively normal (CN)] older adults between the ages of 53 and 93 from a neurology practice and a brain donation programme had the AQ administered to an informant. Diagnostic accuracy was assessed through receiver-operating characteristic analysis, which yielded sensitivity, specificity and area under the curve (AUC). the AQ demonstrated high sensitivity and specificity for detecting MCI [89.00 (81.20-94.40)]; [91.00 (83.60-65.80)] and AD [99.00 (94.60-100.00)]; [96.00 (90.10-98.90)]. AUC values also indicated high diagnostic accuracy for both MCI [0.95 (0.91-0.97)] and AD [0.99 (0.96-1.00)]. Internal consistency of the AQ was also high (Cronbach's alpha = 0.89). the AQ is a valid informant-based instrument for identifying cognitive impairment, which could be easily implemented in a clinician's practice. It has high sensitivity and specificity in detecting both MCI and AD and allows clinicians to quickly and accurately assess individuals with reported cognitive problems.