Cognitive Impairment In Elderly Patients Research Articles

Early temporal characteristics of elderly patient cognitive impairment in electronic health records

BackgroundThe aging population has led to an increase in cognitive impairment (CI) resulting in significant costs to patients, their families, and society. A research endeavor on a large cohort to better understand the frequency and severity of CI is urgent to respond to the health needs of this population. However, little is known about temporal trends of patient health functions (i.e., activity of daily living [ADL]) and how these trends are associated with the onset of CI in elderly patients. Also, the use of a rich source of clinical free text in electronic health records (EHRs) to facilitate CI research has not been well explored. The aim of this study is to characterize and better understand early signals of elderly patient CI by examining temporal trends of patient ADL and analyzing topics of patient medical conditions in clinical free text using topic models.MethodsThe study cohort consists of physician-diagnosed CI patients (n = 1,435) and cognitively unimpaired (CU) patients (n = 1,435) matched by age and sex, selected from patients 65 years of age or older at the time of enrollment in the Mayo Clinic Biobank. A corpus analysis was performed to examine the basic statistics of event types and practice settings where the physician first diagnosed CI. We analyzed the distribution of ADL in three different age groups over time before the development of CI. Furthermore, we applied three different topic modeling approaches on clinical free text to examine how patients’ medical conditions change over time when they were close to CI diagnosis.ResultsThe trajectories of ADL deterioration became steeper in CI patients than CU patients approximately 1 to 1.5 year(s) before the actual physician diagnosis of CI. The topic modeling showed that the topic terms were mostly correlated and captured the underlying semantics relevant to CI when approaching to CI diagnosis.ConclusionsThere exist notable differences in temporal trends of basic and instrumental ADL between CI and CU patients. The trajectories of certain individual ADL, such as bathing and responsibility of own medication, were closely associated with CI development. The topic terms obtained by topic modeling methods from clinical free text have a potential to show how CI patients’ conditions evolve and reveal overlooked conditions when they close to CI diagnosis.

Sarcopenia, frailty, cognitive impairment and mortality in elderly patients with non-valvular atrial fibrillation

ObjectivesTo determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors’ influence on survival. MethodsProspective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, hemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up. ResultsThe study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95% CI: 1.270–2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95% CI: 0.307–0.560) was associated with lower mortality. ConclusionsSarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Sarcopenia, fragilidad, deterioro cognitivo y mortalidad en pacientes ancianos con fibrilación auricular no valvular

ObjectivesTo determine the prevalence of sarcopenia, frailty and cognitive impairment in elderly patients with nonvalvular atrial fibrillation (NVAF) and the factors’ influence on survival. MethodsProspective, multicentre cohort study of patients older than 75 years with NVAF hospitalised in internal medicine departments in Spain. For each patient, we recorded the creatinine, haemoglobin and platelet levels, the scores on the CHA2DS2-VASc and HAS-BLED scales and Charlson index, as well as the use of oral anticoagulants. We measured sarcopenia with the SARC-F scale, frailty with the FRAIL scale and cognitive impairment with the Short Portable Mental State Questionnaire. We also conducted a 1-year follow-up. ResultsThe study included 596 patients with NVAF, with a mean age of 84.9 (SD: 5.2) years. Of these, 295 (49.5%) presented sarcopenia, 305 (51.2%) presented frailty, and 251 (42.1%) presented cognitive impairment. At the end of 1year, 226 (37.9%) patients had died. Mortality was greater for the patients with sarcopenia, frailty and cognitive impairment. In the multivariate analysis, sarcopenia (HR: 1.775; 95%CI: 1.270-2.481), age, comorbidity and a history of peripheral embolism were associated with increased mortality, and the use of oral anticoagulants at discharge (HR: 0.415; 95%CI: 0.307-0.560) was associated with lower mortality. ConclusionsSarcopenia, frailty and cognitive impairment are very common in elderly patients with NVAF and are frequently associated. Sarcopenia was associated with increased mortality.

Home blood pressure is associated with cognitive impairment among elderly patients with type 2 diabetes: KAMOGAWA-HBP study.

This cross-sectional study was designed to examine the association between home blood pressure and cognitive impairment in elderly patients with type 2 diabetes. Home blood pressure was measured in the morning and evening for 14 consecutive days in 749 patients with type 2 diabetes. A total of 231 patients were included in the study population. Cognitive function was evaluated using the Mini-Cog test, which is used as a screening for cognitive impairment in elderly patients. We performed a logistic regression analysis and measured the area under the receiver operating characteristic curve and estimated home blood pressure as a marker of cognitive impairment. The adjusted odds ratio (95% confidence interval) of evening systolic blood pressure for cognitive impairment was 1.24 (1.02-1.53). Evening systolic blood pressure showed the highest area under the receiver operating characteristic curve for cognitive impairment in both unadjusted and adjusted models. In all subgroup analyses except gender, home blood pressure showed higher area under the receiver operating characteristic curve than clinic blood pressure. Home blood pressure was associated with cognitive impairment in elderly patients with type 2 diabetes.

Anticholinergic drugs and cognitive impairment in the elderly

Impairment of cognitive function poses a major concern in elderly patients. A cholinergic deficit that accompanies the normal aging process is thought to contribute to cognitive decline. Most anticholinergic drugs block central muscarinic receptors, which mediate cognitive effects such as attention, learning, and short‐term memory. Even though the causes of cognitive impairment in elderly patients are multifactorial, anticholinergic drugs or drugs with anticholinergic properties contribute significantly to the development of cognitive impairment in these patients.

Prevention of frailty and cognitive impairment in elderly patients with heart failure

Prevention of frailty and cognitive impairment in elderly patients with heart failure

People with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often: observations from the COG-ID study

BackgroundPatients with type 2 diabetes have an increased risk of cognitive impairment which can lead to impaired diabetes self-management and an increased risk of diabetes-related complications. Routine screening for cognitive impairment in elderly patients with type 2 diabetes is therefore increasingly advocated. The aim of this study is to investigate whether people with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often than patients not suspected of cognitive impairment.MethodsPeople with type 2 diabetes ≥ 70 years were screened for cognitive impairment in primary care. Diagnoses in screen positives were established at a memory clinic. Information about acute health care use was collected for 2 years prior to and 2 years after screening and compared to screen negatives.Results154 participants (38% female, mean age 76.7 ± 5.2 years, diabetes duration 8.7 ± 8.2 years) were included, 37 patients with cognitive impairment, 117 screen negatives. A higher percentage of participants with cognitive impairment compared to screen negative patients used acute health care services; this difference was significant for general practitioner’s out of hours services (56% versus 34% used this service over 4 years, p = 0.02). The mean number of acute health care visits was also higher in those with cognitive impairment than in screen negatives (2.2 ± 2.8 versus 1.4 ± 2.2 visits in 4 years, p < 0.05; 1.4 ± 2.2 versus 0.7 ± 1.5 visits in 2 years after screening, p = 0.03). Factors that could have played a role in this increased risk of acute health care services use were a low educational level, the presence of depressive symptoms (CES-D score ≥ 16), self-reported problems in self-care and self-reported problems in usual activities.ConclusionsPeople with type 2 diabetes and screen-detected cognitive impairment use acute health care services more often.

Study suggesting an association between periodontitis and periodontal inflammation and mild cognitive impairment in elderly patients has high risk of bias

Study suggesting an association between periodontitis and periodontal inflammation and mild cognitive impairment in elderly patients has high risk of bias

Multiple factor analysis of neuropsychology in elderly patients with depression

Objectives: To explore the multiple factors of neuropsychology in elderly patients with depression. Methods: 64 elderly patients with depression were selected as individuals. The Geriatric Depression Scale (GDS), neuropsychological scale score, and family support scale were used to analyze multiple factors of neuropsychology in elderly patients with depression. Results: Through GDS, neuropsychological scale, and family support scale, we can see that there is cognitive impairment in elderly patients with depression. It is closely related to the following three factors: the economic capacity of the family, their health status, and family support level. These factors play an important role in the depression of the elderly and are the main causes of depression in the elderly. Conclusions: There are many neuropsychological factors affecting depression in the elderly. In the prevention of the occurrence of depression in the elderly, the prevention of physical diseases should be done in time, and the harmonious family relationship should be maintained. At the same time, the economic situation of elderly families should be improved.

Dementia as a global problem of XXI century

Cognitive impairment in elderly patients with diabetes mellitus is an important medical and social problem. The article covers aspects of pathogenesis and treatment approaches of cognitive impairment and diabetes mellitus; in particular Tanacan as a treatment option for correction of cognitive status in patients with diabetes mellitus.

PO-221 Effects of different motor functional therapies on cognitive impairment in type 2 diabetes mellitus

Objective The clinical manifestations of diabetic cognitive dysfunction are decreased visual spatial ability, executive dysfunction, mental activity speed and attention, and decreased abstract logical reasoning. Cognitive dysfunction is irreversible. Timely and accurate assessment and diagnosis, early detection and intervention to delay disease progression are particularly critical. The Cognitive Assessment Scale plays an important role in screening for cognitive dysfunction in diabetes. To observe the effects of motor functional therapy on cognitive impairment and blood glucose, blood lipids, body weight, body composition, and maximal oxygen uptake in patients with type 2 diabetes.&#x0D; Methods A total of 63 elderly patients with type 2 diabetes mellitus in Chengdu community aged ≥65 years and educated for ≥12 years were enrolled in the motor function therapy group according to the simple mental state examination (MMSE) score (diabetes cognitive impairment, MMSE total score) ≥ 20 points, aerobic exercise group, n = 21) and functional function therapy group (diabetes cognitive impairment, MMSE total score ≥ 20 points, resistance exercise group, n = 21). The adult community of diabetes in Chengdu (normal cognitive function) with age ≥ 65 years, education time ≥ 12 years, and MMSE total score ≥ 24 points was used as the control group (n=21). Montreal Cognitive Assessment Scale (MOCA): MOCA is an assessment tool developed by Nasreddine and clinically proven to be used for rapid screening of MCI. There were no statistical differences in baseline data (age, gender, and hypertension incidence) among the 3 groups of patients. The LOTCA scale was used to evaluate the cognitive function of the subjects and to compare between groups. Sixty-three patients with type 2 diabetes were randomly divided into aerobic exercise intensity group (50% VO2max) (n=21), resistance exercise intensity group and control group (n=21). Both the aerobic exercise group and the resistance exercise group underwent a 12-week moderate-intensity exercise three times a week. The resistance middle strength group was trained 2 groups each time, each group was 25 minutes, the group rested for 5 minutes, 55 minutes in total, and the aerobic medium intensity group continued to exercise for 55 minutes. All patients underwent fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), body weight, and fat weight (FW) before and after training. , lean body mass (LBM), maximal oxygen uptake (VO2max) determination; measure the energy expenditure of word movement and the total energy expenditure of the entire exercise process.&#x0D; Results There were no significant differences among the three groups before the test (P&gt;0.05). All the indexes of the medium-intensity resistance exercise group and the medium-intensity aerobic exercise group were significantly different from the control group (P&lt;0.05). After the MOCA score test There was an improvement in the score before the trial, and the total score of LOTCA was significantly different among the three groups. In addition to perceptual sub-items (item identification), the aerobic exercise group and the resistance exercise group LOTCA scale in perceptual sub-projects (incomplete object recognition), visual motion organization and its sub-projects (copying two-dimensional graphics, building blocks) The design and puzzle) project scores were higher than before the test, close to the control group score. The scores of the two groups of exercise therapy in the thinking operation and its sub-projects (Riska organized shape classification, picture arrangement B and geometric reasoning) and attention-focused items were lower than the control group. Compared with the resistance exercise, there was a significant difference in the maximum oxygen uptake between aerobic exercise and resistance exercise (P&lt;0.05). Compared with the total exercise energy consumption in the first 6 weeks, the aerobic exercise group was superior to the resistance exercise group. The total exercise energy expenditure was compared in the last 6 weeks, and the resistance exercise group was superior to the aerobic exercise group.&#x0D; Conclusions Elderly patients with type 2 diabetes may have cognitive impairment earlier. In the absence of differences in exercise, the aerobic exercise group and the resistance exercise group improve cognitive impairment, blood sugar, blood fat, body weight, and body composition in patients with type 2 diabetes. There is no significant difference. Compared with MMSE, LOTCA has the advantage of identifying early cognitive impairment in elderly patients with type 2 diabetes and distinguishing the severity of the damage.&#x0D;

Endothelial Dysfunction Is Associated with Cognitive Impairment of Elderly Cardiovascular Disease Patients.

Cognitive impairment is frequently represented in elderly patients with cardiovascular disease (CVD); yet, the mechanism is uncertain. Recent studies have suggested the association between the vascular endothelial dysfunction and cognitive impairment. The aim of this study was to clarify the association between endothelial dysfunction and cognitive impairment in elderly patients with CVD.A total of 80 elderly patients (> 70 years old) with CVD were included. Patients who had already pharmacologically intervened for cognitive impairment were excluded. The endothelial dysfunction was assessed by the reactive hyperemia-peripheral arterial tonometry (RH-PAT). Cognitive impairment was diagnosed by the Mini-mental state examination.The RH-PAT index was significantly lower in cognitive impairment (median 1.60 [interquartile range (IQR) 1.34 to 1.89], n = 51) as compared with non-cognitive impairment (median 1.75 [IQR 1.55 to 2.30], n = 29, P = 0.005). By a multivariate analysis, the RH-PAT index was independently associated with cognitive impairment (odds ratio: 0.89; 95% confidence interval: 0.81 to 0.97; per 0.1, P = 0.044). In the receiver-operating characteristic analysis, the best cut-off of the RH-PAT index to identify cognitive impairment was 1.65 (area under the curve 0.67; P = 0.011) with limited the sensitivity (63%) and specificity (66%).A lower RH-PAT index was significantly associated with the presence of cognitive impairment in elderly CVD patients. Further studies are required to clarify the mechanism and the causal relationship between the endothelial dysfunction and cognitive impairment in patients with CVD.

Targeted Gene Editing of Glia Maturation Factor in Microglia: a Novel Alzheimer's Disease Therapeutic Target.

Alzheimer's disease (AD) is a devastating, progressive neurodegenerative disorder that leads to severe cognitive impairment in elderly patients. Chronic neuroinflammation plays an important role in the AD pathogenesis. Glia maturation factor (GMF), a proinflammatory molecule discovered in our laboratory, is significantly upregulated in various regions of AD brains. We have previously reported that GMF is predominantly expressed in the reactive glial cells surrounding the amyloid plaques (APs) in the mouse and human AD brain. Microglia are the major source of proinflammatory cytokines and chemokines including GMF. Recently clustered regularly interspaced short palindromic repeats (CRISPR) based genome editing has been recognized to study the functions of genes that are implicated in various diseases. Here, we investigated if CRISPR-Cas9-mediated GMF gene editing leads to inhibition of GMF expression and suppression of microglial activation. Confocal microscopy of murine BV2 microglial cell line transduced with an adeno-associated virus (AAV) coexpressing Staphylococcus aureus (Sa) Cas9 and a GMF-specific guide RNA (GMF-sgRNA) revealed few cells expressing SaCas9 while lacking GMF expression, thereby confirming successful GMF gene editing. To further improve GMF gene editing efficiency, we developed lentiviral vectors (LVs) expressing either Streptococcus pyogenes (Sp) Cas9 or GMF-sgRNAs. BV2 cells cotransduced with LVs expressing SpCas9 and GMF-sgRNAs revealed reduced GMF expression and the presence of indels in the exons 2 and 3 of the GMF coding sequence. Lipopolysaccharide (LPS) treatment of GMF-edited cells led to reduced microglial activation as shown by reduced p38 MAPK phosphorylation. We believe that targeted in vivo GMF gene editing has a significant potential for developing a unique and novel AD therapy.

Intercostal nerve block improves postoperative pain and cognitive impairment in elderly patients with esophageal cancer

Intercostal nerve block improves postoperative pain and cognitive impairment in elderly patients with esophageal cancer

Cognitive impairment in elderly depressed and dementia patients in relation to plasma lipids

Objective The aim was to study the relation between plasma lipid severity of cognitive impairment in elderly patients with depression and dementia. Background Cognitive functions are related to changes in lipid profile. Materials and methods Two groups of participants were studied: group A (patient group) included 60 patients subdivided into two subgroups: 30 patients who currently have dementia as a whole without taking into consideration the different kinds of dementia, but after exclusion of vascular dementia, and 30 patients with depressive disorders. Group B (control group) included 30 normal participants selected from among volunteers matched to the patient group for age, sex, education, sociodemographic, and economic status. They were subjected to the following: a psychological assessment that included the geriatric depression scale, the Wechsler memory scale − revised short form, and plasma lipid concentration assessment (overnight fasting blood was collected from each participant by standard venipuncture). Results The results of the study clarified that dementia patients showed more statistically significant impairment in cognitive functions than depressed patients in terms of the Wechsler memory scale − revised. The mean values of the blood cholesterol level, low-density lipoprotein, and high-density lipoprotein in the depressed group were significantly higher than those of the dementia and control groups. Conclusion There is a relation between cognitive impairment in depressed and dementia patients and plasma lipid concentration.

A Risk Factor Analysis of Cognitive Impairment in Elderly Patients with Chronic Diseases in a Chinese Population.

BackgroundThis study analyzed the risk factors of cognitive impairment (CI) in elderly patients with chronic diseases.Material/MethodsIn total of 385 elderly patients with chronic diseases were selected and assigned into CI and normal groups. The activities of daily living (ADL), global deterioration scale (GDS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), patient-generated subjective global assessment (PG-SGA), and mini nutritional assessment (MNA) were performed to analyze the differences between the 2 groups. Logistic regression analysis was conducted for risk factors of CI in elderly patients with chronic diseases.ResultsThere were differences in age, education level, type 2 diabetes mellitus, multifocal cerebral infarction, hearing, and eyesight between CI and normal groups. Patients in the CI group showed more CD4+ cells, more admission times, and higher GDS scores than the normal group. Also, MMSE and MoCA scores revealed differences in total score, directive force, attention and calculating ability, language, delayed memory, reading comprehension, writing, and visual-spatial ability between the 2 groups. The number of B and CD8+ cells, ADL, and MNA scores were protective factors, while cerebral infarction history, number of CD4+ cells, admission times, GDS score, and age were risk factors of CI in elderly patients with chronic diseases.ConclusionsOur study provides evidence that cerebral infarction history, number of CD4+ cells, admission times, GDS score, and age are risk factors of CI in elderly patients with chronic diseases.

The prevalence of undiagnosed pre-surgical cognitive impairment and its post-surgical clinical impact in elderly patients undergoing surgery for adult spinal deformity.

Pre-existing cognitive impairment (CI) is emerging as a predictor of poor post-operative outcomes in elderly patients. Little is known about impaired preoperative cognition and outcomes after elective spine surgery in this patient population. The purpose of this study was to assess the prevalence of neuro CI in elderly patients undergoing deformity surgery and its impact on postoperative outcomes. Elderly subjects undergoing elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Pre-operative baseline cognition was assessed using the Saint Louis Mental Status (SLUMS) test. SLUMS consists of 11 questions, which can give a maximum of 30 points. Mild CI was defined as a SLUMS score between 21-26 points, while severe CI was defined as a SLUMS score of ≤20 points. Normal cognition was defined as a SLUMS score of ≥27 points. Complication rates, duration of hospital stay, and 30-day readmission rates were compared between patients with and without baseline CI. Eighty-two subjects were included in this study, with mean age of 73.26±6.08 years. Fifty-seven patients (70%) had impaired cognition at baseline. The impaired cognition group had the following outcomes: increased incidence of one or more postoperative complications (39% vs. 20%), higher incidence of delirium (20% vs. 8%), and higher rate of discharge institutionalization at skilled nursing or acute rehab facilities (54% vs. 30%). The length of hospital stay and 30-day hospital readmission rates were similar between both cohorts (5.33 vs. 5.48 days and 12.28% vs. 12%, respectively). CI is highly prevalent in elderly patients undergoing surgery for adult degenerative scoliosis. Impaired cognition before surgery was associated with higher rates of post-operative delirium, complications, and discharge institutionalization. CI assessments should be considered in the pre-operative evaluations of elderly patients prior to surgery.

DEMENTIA AS A GLOBAL PROBLEM OF XXI CENTURY

Cognitive impairment in elderly patients with diabetes mellitus is an important medical and social problem. The article covers aspects of pathogenesis and treatment approaches of cognitive impairment and diabetes mellitus; in particular Tanacan as a treatment option for correction of cognitive status in patients with diabetes mellitus.

Anticholinergic drugs and cognitive impairment

Impaired cognitive function poses a major concern for elderly patients, with age-related cholinergic deficit likely contributing to cognitive decline. Nevertheless, the cause of cognitive impairment in elderly patients is mostly multifactorial, with drug-induced adverse events also a possible etiologic factor. Benzodiazepines, opioids, tricyclic antidepressants, and anticholinergic drugs all have been implicated in the development of cognitive impairment.

Cognitive function and insulin resistance in elderly patients with type 2 diabetes

Purpose: To explore the relationship between cognitive impairment and insulin resistance (IR) in elderly patients with type-2 diabetes mellitus.Materials and methods: Two hundred and twelve elderly patients with type-2 diabetes were enrolled in this study and assigned into either the cognitive impairment group (n = 100) or the normal cognitive group (n = 112). Gender, age, education, body mass index (BMI), total cholesterol, triglyceride, low-density lipoprotein cholesterol, creatinine (Cr), fasting plasma glucose, fasting insulin (FINS) and homeostasis model of assessment for IR index (HOMA-IR) were compared between the two groups. Multifactorial logistic regression analysis was performed.Results: In cognitive impairment group, education level (33.00 vs 53.57%, p < 0.01) was lower, the level of BMI [(28.7 ± 4.5) kg/m2 vs (23.9 ± 3.7) kg/m2, p < 0.01], FINS [(21.8 ± 5.3) mU/L vs (12.9 ± 3.9) mU/L, p < 0.01], HOMA-IR [(6.9 ± 1.7) vs (3.9 ± 0.9), p < 0.01] were higher than the control group. In the logistic regression, education level (B = –0.996, p = 0.03), FINS (B = 1.120, p < 0.01) and HOMA-IR (B = 1.301, p < 0.01) were independent factors.Conclusions: Our study demonstrates that the education level, FINS and HOMA-IR were independent factors of cognitive impairment in elderly patients with type-2 diabetes. IR is an important risk factor and higher education level in a protective factor for the cognitive impairment in elderly patients with type-2 diabetes.