Concomitant Dementia Research Articles

Beyond the sum of their parts: The combined association of dementia and chronic pain with self-care limitations in older Australians

BackgroundThe purpose of this study was to investigate the association between dementia, chronic pain and self-care limitations. Additionally, the study sought to explore the relationship of co-occurring dementia and chronic pain with self-care limitations. MethodsCross-sectional data derived from the Survey of Disability, Ageing and Carers (SDAC) was used to conduct this study. The pooled association between dementia, and chronic pain, with self-care limitations was assessed using ordered logistic regression model. Furthermore, the study also examined the group comparison of interaction effects between co-occurring dementia and chronic pain with self-care limitations. ResultsThe ordered logistic regression analysis indicated that people with dementia had significantly higher odds of experiencing greater self-care limitations (adjusted odds ratio [aOR]: 15.12, 95 % confidence interval [CI]: 12.50–18.29) compared to people without dementia. Similarly, chronic pain was independently associated with increased self-care limitations (aOR: 5.98, 95 % CI: 5.49–6.52) compared to people without chronic pain. Additionally, interaction effect analysis revealed that the co-occurrence of dementia and chronic pain substantially heightened the likelihood of self-care limitations (aOR: 66.54, 95 % CI: 52.27–84.69) relative to people without either condition. ConclusionsDisability was higher among older Australians with dementia and chronic pain, and this risk can be increased if the two conditions co-exist. A continuous, aligned, and personalised healthcare approach is needed to establish self-care priorities, especially in groups of people with the greatest need.

Lithium Therapy in Old Age: Recommendations from a Delphi Survey.

While lithium (Li) has been well established for the treatment of bipolar disorder, geriatric patients require special attention when it comes to issues of drug safety. Declining renal function, amongst other medical conditions, and polypharmacy may pose increased risks. Only a few previous studies have addressed the management of Li in geriatric patients. Twenty-four German medical experts on geriatric medicine and Li treatment participated in a Delphi survey, consisting of two rounds of questionnaires and a final formulation of treatment recommendations. Three major issues of Li therapy were outlined: initiation of treatment, monitoring of ongoing therapy, and withdrawal due to medical reasons. Final recommendations were consented to at a threshold of at least 80% expert agreement. Final consensus was achieved on 21 clinical recommendations. The approved recommendations covered aspects of necessary laboratory checks, concomitant medication, and target Li serum concentration in geriatric patients. Concerning the termination of Li therapy, an agreement was reached on the appropriate time span for tapering and on potential alternatives to Li. No consensus was achieved on whether concomitant dementia or frailty should be considered contraindications for Li treatment and the appropriate threshold of the estimated glomerular function rate for withdrawing Li. According to the view of German experts, Li may be used in geriatric patients, but it should be monitored carefully. However, the lack of consent in several specific treatment situations underlines the need for research on specific issues of Li therapy.

Study Outcomes Among Patients with Parkinson’s Disease Treated for Psychosis Residing in the Long-Term Care Setting and Newly Initiating Pimavanserin or Off-Label Atypical Antipsychotics

AbstractIntroductionPsychosis is a common feature of Parkinson’s Disease (PD), with an estimated 50% of PD patients experiencing psychosis (i.e., hallucinations [H] or delusions [D]) at some time during the course of their illness. Pimavanserin (PIM) is the only medication approved in the US for the treatment of H&D associated with Parkinson’s disease psychosis (PDP); however, off-label atypical antipsychotics (AAP) are continuously used. Currently, there are very few real-world studies which evaluate the patient characteristics and clinical outcomes among PD patients residing in the long-term care (LTC) setting within the US, newly initiated on PIM or other AAPs to treat psychosis.MethodsA national LTC database consisting of diagnoses (DX), pharmacy orders (RX), and EHR data linked with the Minimum Data Set (MDS) was used to identify PD patients with a PD DX and 1 PD RX from 01/01/2017 to 09/30/2021 retrospectively. Patient groups were created: PIM group (patients with a PIM RX); AAP group (patients with an AAP RX [and no PIM RX]); and no treatment (No Tx) group (no PIM or AAP RX). All patients were required to have at least 100 days in LTC to be labelled as a resident (≤7 days between discharge and admission were included as LTC stay). Psychosis diagnosis was required at any time for the AAP and No Tx groups. Other medical causes of psychosis beyond PD were not excluded. The index dates were the first RX identified during the study time period for the PIM and AAP groups; and the psychosis DX date for the No Tx group. Incident treatment patients were defined as having no history of PIM or AAP in the 6 months prior to the index date. Patient/clinical characteristics, treatment patterns, and study outcomes were reported using means (SD) and frequencies during the post index period.ResultsThere were: PIM group (N=3,120; N=870 incident), AAP group (N=5,880; N=2,396 incident), and No Tx group (N=1,802). The PIM and AAP groups had an average of 415 days and 383 days between the admitting date and the date of RX. The mean age among all groups was 76–77 years and 48–50% were female. PIM group patients were observed to be sicker with higher rates of concomitant dementia, depression, diabetes, and hypertension versus the AAP group or No Tx group. Initial treatments in the AAP group were mostly quetiapine (49%), risperidone (21%), or olanzapine (12%). The descriptive analysis during the 6 months post index showed the outcomes for the incident AAP group to have: higher proportion of falls and aggression events; higher incidence of new DX (physical changes, anxiety disorders, cognitive decline, insomnia, depression, and anticholinergic effects); and higher proportion of new medication orders (anticonvulsants, antidepressants, and benzodiazepines) compared with the incident PIM group.ConclusionsIn this descriptive LTC retrospective analysis, incident PIM patients were shown to have better outcomes versus the AAP group. These findings are subject to study limitations.FundingAcadia Pharmaceuticals Inc.

The Prevalence and Related Factors of Eating Disorders and Eating Attitudes Among Balikesir University Students

Objective: Eating disorders are classified as psychiatric diseases that include deterioration in eating behaviors and attitudes and has negative effects on the physical and mental health of the individual. The main objective of the study is to elaborate the psychosocial and psychopathological factors related to eating disorders among university students.
 
 Methods: We have enrolled 199 female and 201 male volunteer students at Balıkesir University Faculty of Medicine. Participants were evaluated with a semi-structured questionnaire prepared by our institution regarding clinical experience and available information sources and according to DSM-V diagnostic criteria. Eating Attitude Scale, Ortho-15 Scale, Maudsley Obsessive Compulsive Question List, Rosenberg Self-Esteem Scale and Body Perception Scale were administered to all participants. Individuals with previously known or concomitant dementia, delirium, mental retardation, psychotic disorder diagnosis, depression with psychotic symptoms, and bipolar depression were not included in the study.
 
 Results: The OCD sub-dimension and cleaning sub-dimension differed significantly according to the gender variable (p

Prognostic factors for mortality in bullous pemphigoid: A systematic review and meta-analysis.

ObjectiveTo systematically evaluate the prognostic factors for mortality in bullous pemphigoid.MethodsPubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc and Wanfang Database were searched to collect literature on the prognostic factors for mortality in bullous pemphigoid. The quality of studies was assessed by Newcastle–Ottawa Quality Assessment Scale. Two researchers extracted relevant data and scored study quality independently. The hazard ratio (HR) was calculated using the random effects model. Study heterogeneity was assessed using both Cochran’s Q test and I2 statistics. The causes of heterogeneity were assessed by subgroup analysis and/ or sensitivity analysis when heterogeneity was significant. When ten or more studies were included as outcome indicators, publication bias was evaluated by funnel plot and Egger’s test.ResultsOut of a total of 1,546 articles retrieved, 15 studies involving 2,435 patients were included. The meta-analysis showed that the mortality of patients with bullous pemphigoid increased with positive bullous pemphigoid 180 antibody (HR = 1.85, 95%CI: 1.25~2.75, P = 0.002); concomitant dementia (HR = 2.26, 95%CI: 1.43~3.59, P<0.001); stroke (HR = 2.09, 95% CI: 1.23–3.55, P = 0.007); heart disease (HR = 1.96, 95% CI: 1.41–2.73, P<0.001) and diabetes mellitus (HR = 2.39, 95% CI: 1.55–3.69, P<0.001). Sex, positive indirect immunofluorescence and hypertension were not associated with prognosis.ConclusionPositive bullous pemphigoid 180 antibody, dementia, stroke, heart disease and diabetes mellitus were the prognostic factors for mortality in bullous pemphigoid.

Advanced cancer and concomitant dementia: access to specialized palliative care, emergency room, hospital care, and place of death

Background Dementia and advanced cancer are complex, life-limiting conditions that benefit from specialized palliative care (SPC) interventions at the end of life. The objective was to study possible differences in care for patients with concomitant advanced cancer and dementia (CA-DEM) or cancer only (CA) regarding access to SPC, acute hospital care, and place of death. Materials and methods A retrospective observational registry study on health care consumption data from the Stockholm Regional Council involving logistic regression analyses of age, sex, living arrangements, comorbidities, dementia diagnosis, and socio-economic status. Results Of the 12,667 persons aged ≥65 years who died from advanced cancer between 2015 and 2019, 605 had concomitant dementia. Of these, 76% of patients with CA and 42% of patients with CA-DEM had access to SPC (p<.0001). There were more admissions to palliative care for persons not living in nursing homes (p<.0001), women (p<.0001), socioeconomically privileged patients (p<.05), those with fewer comorbidities (p<.0001), and younger patients (<85 years) (p<.0001). Access to SPC reduced ER visits, hospitalizations, and acute hospital deaths for CA, whereas access to SPC only reduced hospital deaths in the CA-DEM group. Conclusions The probability of being admitted to SPC was lower in cancer patients with known dementia. Access to SPC reduced emergency room visits and acute admissions to hospitals for the whole group, and hospital deaths both for CA and CA-DEM.

Bolstered Neuronal Antioxidant Response May Confer Resistance to Development of Dementia in Individuals with Alzheimer's Neuropathology by Ameliorating Amyloid-β-Induced Oxidative Stress.

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease worldwide. It is characterized by cognitive decline and concomitant dementia, primarily resulting from progressive degeneration of cortical and hippocampal neurons. AD is definitively diagnosed postmortem by the analysis of two

The co-occurrence of dementia in those with epilepsy is associated with 30-day readmission – A population-based study

ObjectiveDementia and epilepsy often co-occur and are associated with poor health outcomes and increased healthcare utilization. The literature on the association between readmission and co-occurrence of dementia and epilepsy is scant. Our objective was to determine if dementia in patients with epilepsy >40 years old is associated with 30-day hospital readmission, in-hospital mortality, discharge disposition, and length-of-stay. MethodsThis retrospective cohort study used the 2014 Nationwide Readmissions Database, containing data from hospital discharges across the US and readmissions. Epilepsy and dementia were identified using previously validated ICD-9-CM codes. Primary outcome was 30-day readmission, analyzed with univariable and multivariable logistic regressions. Secondary outcomes were discharge disposition, in-hospital mortality, and length-of-stay, analyzed with univariable multinomial logistic, univariable logistic, and univariable ordinary least squared regressions, respectively. The top ten causes of readmission in each group were compared as well. All analyses accounted for survey weights, cluster, and stratum. ResultsPatients with epilepsy with dementia (n = 15,588) had longer hospital stays [15% (95%CI 10–20%)], and higher odds of readmission [OR 1.11 (95%CI 1.05–1.17)], transfer to another facility [OR 2.18 (95%CI 1.93–2.46)], and in-hospital mortality [OR 1.50 (95%CI 1.25–1.79)] compared to those without dementia (n = 186,289).The top two causes of readmission were septicemia (dementia: 14.81%; no dementia: 9.45%) and epilepsy/convulsions (dementia: 5.91%; no dementia: 6.25%). Other top 10 causes of readmissions in those with epilepsy and dementia which were not present in those without dementia included delirium (5.21%), urinary tract infections (4.98%), and aspiration pneumonitis (4.29%). SignificanceDementia in epilepsy is associated with worse outcomes, including higher in-hospital mortality and higher readmissions. Potentially preventable causes of readmission in those with epilepsy and dementia were identified, including septicemia, delirium, urinary tract infection, and aspiration pneumonitis. Future studies are needed to inform interventions aimed at decreasing premature mortality and reducing potentially preventable readmissions in this vulnerable population.

The Co-occurrence of Dementia in those with Epilepsy is Associated with 30-day Readmission - A Population-based Study (2413)

The Co-occurrence of Dementia in those with Epilepsy is Associated with 30-day Readmission - A Population-based Study (2413)

Assessment of and changes in behavioral and psychological symptoms among patients with concomitant dementia in sub-acute rehabilitation hospital wards

Assessment of and changes in behavioral and psychological symptoms among patients with concomitant dementia in sub-acute rehabilitation hospital wards

Moral reasoning and moral conflict in patients of the amyotrophic lateral sclerosis – Frontotemporal dementia spectrum

ABSTRACT The aim of this study was to investigate the moral reasoning and moral conflict in patients of the amyotrophic lateral sclerosis – frontotemporal dementia (ALSFTD) spectrum. Ten ALS patients without cognitive impairment, 10 ALS patients with cognitive or behavioral impairment, 10 ALSFTD patients and 23 controls were examined with neuropsychological and behavioral tests as well as with a set of eight well -designed moral dilemmas. The responses to the moral dilemmas were used as proxies to evaluate interpersonal moral reasoning. Reactivity to change, reaction time and arousal were used as markers of moral conflict. ALSFTD patients showed more “utilitarian” responses and less moral conflict than control participants. ALS patients without dementia showed a trend toward slower reaction time, which could be largely attributed to physical disability. No significant changes in arousal were found in ALS patients compared with control participants. Behavioral changes (apathy and dysexecutive symptoms) were partly responsible for the changes found in patients of the ALSFTD spectrum. Our results suggest that most ALS patients without dementia, but not those with concomitant dementia, would be able to deal with the conflict of complex moral decisions, such as end-of-life decisions, at least in mild to moderate stages of the disease.

Predicting in-hospital mortality for dementia patients after hip fracture surgery – A comparison between the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index

BackgroundConsiderable in-hospital mortality was reported in geriatric patients with dementia sustaining femoral neck or inter-trochanteric fracture. We intended to establish a predictive model of in-hospital mortality for dementia patients after hip fracture surgery. MethodsWe collected 8080 registrants ≧ 65 years old from the subset (LHID2000) of the National Health Insurance Research Database (NHIRD) that met the following inclusion criteria:1. Admitted with the ICD of hip fracture; 2. Underwent operation of hip fracture during the same hospitalization; 3. Co-existing diagnosis of dementia (ICD-9-CM codes 290). The co-morbidity was recorded according to validated Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) from the diagnoses of hospitalization. The main outcome measure was in-hospital mortality that was defined as death being reported during hospitalization. The comparison of predictability was conducted by Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) among different predictive models. ResultsThe Charlson Comorbidity Index (CCI) score and Elixhauser Comorbidity Index (ECI) score showed similar ability in predicting in-hospital mortality (AUC = 0.653, 95% CI = 0.611–0.695 for CCI; AUC = 0.624, 95% CI = 0.582–0.665 for ECI, p = 0.0717). By adding age grouping (≥80 yrs = 1, 65–80 yrs = 0) and gender difference (Male = 1, Female = 0), these two models were shifted to models CCI_new1 and ECI_new1. Consequently, the AUC greatly increased in the CCI_new1 (AUC = 0.682, 95% CI = 0.643–0.722). It therefore provided better prediction of in-hospital mortality than ECI_new1 (AUC = 0.651, 95% CI = 0.611–0.691) (p = 0.0444). ConclusionsUtilizing the CCI with addition of grouping for age and gender provides a better prediction for in-hospital mortality than the ECI among elderly patients with concomitant dementia and hip fracture who underwent surgical intervention.

GABAPENTIN FOR BEHAVIORAL AND PSYCHIATRIC SYMPTOMS OF DEMENTIA: RENEWING THE CALL FOR AN INTERVENTION STUDY

Introduction Behavioral and Psychiatric Symptoms of Dementia (BPSD) increase patient mortality, healthcare costs and caregiver burnout. While behavioral interventions are the most effective treatment for BPSD, many patients are not able to regulate their agitation using only behavioral interventions, and therefore require pharmacotherapy. Various agents such as risperidone, quetiapine and trazodone have shown positive data for treating both BPSD and decreasing related caregiver burnout, but many of these agents are associated with significant increases in morbidity and mortality, as well as intolerable side effects. Several case reports describe using gabapentin, an anti-epileptic and FDA-approved treatment for neuropathic pain, as an off-label treatment for BPSD. BPSD in some patients may be driven by unreported neuropathic pain, which gabapentin can treat effectively. Additionally, gabapentin has known anxiolytic properties that can theoretically improve BPSD. A 2018 systematic review by Supasitthumrong et al highlights data supporting the use of gabapentin as a treatment for BPSD, but noted there has yet to be a definitive trial establishing gabapentin as an effective intervention for BPSD. We delineate two cases of patients with BPSD who were treated with gabapentin to highlight the need for a randomized controlled trial so that guidelines can be established for the treatment of BPSD with gabapentin. Methods Approximately 3000 CL psychiatry consultations placed between March 2017-May 2019 for patients admitted to the inpatient medicine service at the West Roxbury VA Medical Center in West Roxbury, MA, were reviewed. In the first round of screening, records were filtered based on patient problem lists for the presence of a neurocognitive disorder, any chronic pain condition and prescription of gabapentin. Seventy-one patients met criteria based on the initial screening. In the second round of review, records were further filtered for the utilization of gabapentin for the treatment of BPSD. Two patients met these criteria and the cases were further reviewed for psychiatry recommendations, as-needed behavioral medication utilization, behavioral scales and behavioral reports. Results The first case is an 82-year-old male with Alzheimer's dementia, who had unsatisfactory treatment of agitation with trazodone and quetiapine 25mg twice daily. Subsequently, for over a month, he was treated with gabapentin on a gradual dose increase from 100mg twice daily to three times daily. A favorable sustained response was achieved as no additional as needed medications for agitation were required and the patient scored well on both Cohen-Mansfield Agitation Inventory (6/14) and Rating Anxiety in Dementia Scale (6). Following this intervention, subsequent episodes of agitation were limited to delirium, especially during UTIs. The second case is a 97-year-old male with mixed Alzheimer's and vascular dementia who continued to have breakthrough agitation despite being treated with trazodone 25mg nightly. He was started on gabapentin 200mg daily for three weeks, in the setting of a fall that resulted in a wrist injury. After this intervention, he continued to require quetiapine at doses up to 25mg daily, as well as haloperidol at doses up to 7mg daily to manage breakthrough agitation. This behavioral pattern and intervention lasted for three weeks until the patient's BPSD was stabilized and he was discharged to an acute rehabilitation facility. Conclusions In the two cases presented, treating BPSD with gabapentin resulted in mixed findings. While the first case shows gabapentin as a potentially efficacious and well-tolerated treatment for BPSD, it is difficult to elucidate the role gabapentin played in the second patient's improved behavioral regulation. There are many potential factors that may contribute to these discrepant findings. The first patient with Alzheimer's Dementia was followed for months while the second patient with mixed dementia patient was only followed for three weeks. Next, it is unclear whether gabapentin is equally efficacious in Alzheimer's dementia versus concomitant Alzheimer's and vascular dementia. Additionally, the age difference of 17?years may have also contributed to the 97-year old's limited response to gabapentin. Also, the first patient received a total gabapentin dose of 300mg while the second patient received 200mg. Lastly, the second patient presented in the context of pain due to a fall while the first patient did not. This case series magnifies the challenges of using gabapentin for BPSD without specific indications or established dosing recommendations. While gabapentin may be an effective treatment for BPSD, we present these cases to highlight the need for an interventional randomized controlled trial investigating gabapentin as a treatment for BPSD. This research was funded by: None

Risk factors related to contralateral hip fracture following hip fracture in elderly patients: a meta analysis and review

Objective To evaluate the factors related to contralateral hip fracture in the elderly patients with hip fracture by meta analysis. Methods Pubmed, Cochrane, CBMdisc, CNKI Chinese Journal Full Text Database and Wan Fang Database were searched for publications at home and abroad from January 2005 to April 2018 on factors related to contralateral hip fracture after hip fractures in the elderly. The publication quality was strictly evaluated before the data were extracted concerning gender and age(>65 years) of the patients, concomitant osteoporosis (Singh sign ≥4), primary fracture type, concomitant Parkinson disease, concomitant stroke, concomitant senile dementia, concomitant cataract, concomitant rheumatoid arthritis, concomitant diabetes, type of internal fixation for primary fracture and therapeutic compliance. Revman5.0 was used to perform the statistical analysis and the OR value and 95% CI were calculated fore each index. Results A total of 17 studies were included involving 1,504 patients with contralateral hip fracture among 13,717 elderly patients with hip fracture. The factors related to the refracture of the contralateral hip were the age of the patients (OR=-3.55, 95% CI:-5.60~-1.50, P<0.001), osteoporosis (OR=2.38, 95% CI: 1.36~4.17, P=0.002), Parkinson disease (OR=4.54, 95% CI: 2.74~7.53, P<0.001), stroke (OR=0.33, 95% CI: 0.18~0.59, P<0.001), senile dementia (OR=0.43, 95% CI: 0.29~0.62, P<0.001), cataract (OR=0.37, 95% CI: 0.22~0.63, P< 0.001), rheumatoid arthritis (OR=0.32, 95% CI: 0.21~0.50, P<0.001), diabetes (OR=0.65, 95% CI: 0.47~0.91, P=0.01), type of internal fixation for primary fracture (OR=0.51, 95% CI: 0.30~0.85, P=0.01), and therapeutic compliance (OR=0.36, 95% CI: 0.21~0.64, P<0.001). However, the refracture of the contralateral hip was not related to gender (OR=1.07, 95% CI: 0.45~2.56, P=0.88), smoking (OR=0.86, 95% CI: 0.40~1.86, P=0.70), fracture type (OR=0.97, 95% CI: 0.60~1.57, P=0.90), or hypertension (OR=0.70, 95% CI: 0.41~1.21, P=0.20). Conclusions In elderly patients with hip fracture, the risks for contralateral hip fracture may be advanced age, concomitant osteoporosis, Parkinson disease, stroke, senile dementia, cataract, rheumatoid arthritis and diabetes, type of internal fixation for primary fracture, and poor therapeutic compliance. However, no sufficient evidence has suggested that gender, smoking, type of hip fracture or concomitant hypertension might be associated with the contralateral hip fracture. Key words: Elderly; Hip fracture; Meta-analysis; Contralateral hip fracture; Related factors

Prevalence and clinical correlates of dementia among COVID-19-related deaths in Italy.

IntroductionWe aimed at exploring the proportion of patients dying with COVID‐19 and concomitant dementia in Italy, as well as their clinical characteristics and trajectories of care.MethodsThe proportion of COVID‐19‐related deaths occurring in people with dementia and the clinical characteristics of deceased individuals according to their dementia status were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n = 2621).ResultsA total of 415 individuals with dementia were identified in the study population, accounting for 15.8% of overall COVID‐19‐related deaths. Patients with dementia less frequently presented with cough, had lower chance of receiving supportive therapies and intensive care approaches, and showed a faster clinical worsening as compared with individuals with intact cognition.DiscussionDementia confers a relevant risk of adverse outcomes in case of SARS‐CoV‐2 infection and influences the clinical presentation, course and management of affected individuals.

How Do Common Comorbidities Modify the Association of Frailty With Survival After Elective Noncardiac Surgery? A Population-Based Cohort Study.

Older people with frailty have decreased postoperative survival. Understanding how comorbidities modify the association between frailty and survival could improve risk stratification and guide development of interventions. Therefore, we evaluated whether the concurrent presence of common and high-risk comorbidities (dementia, chronic obstructive pulmonary disease [COPD], coronary artery disease [CAD], diabetes mellitus, heart failure [HF]) in conjunction with frailty might be associated with a larger decrease in postoperative survival after major elective surgery than would be expected based on the presence of the comorbidity and frailty on their own. This cohort study used linked administrative data from Ontario, Canada to identify adults >65 years having elective noncardiac surgery from 2010 to 2015. Frailty was identified using a validated index; comorbidities were identified with validated codes. We evaluated the presence of effect modification (also called interaction) between frailty and each comorbidity on (1) the relative (or multiplicative) scale by assessing whether the risk of mortality when both frailty and the comorbidity were present was different than the product of the risks associated with each condition; and (2) the absolute risk difference (or additive) scale by assessing whether the risk of mortality when both frailty and the comorbidity were present was greater than the sum of the risks associated with each condition. 11,150 (9.7%) people with frailty died versus 7826 (2.8%) without frailty. After adjustment, frailty was associated with decreased survival (adjusted hazard ratio [HR] = 2.42; 95% confidence interval [CI], 2.31-2.54). On the relative (multiplicative) scale, only diabetes mellitus demonstrated significant effect modification (P value for interaction .03; reduced risk together). On the absolute risk difference (additive) scale, all comorbidities except for coronary disease demonstrated effect modification of the association of frailty with survival. Co-occurrence of dementia with frailty carried the greatest excess risk (Synergy Index [S; the excess risk from exposure to both risk factors compared to the sum of the risks from each factor in isolation] = 2.29; 95% CI, 1.32-10.80, the excess risk from exposure to both risk factors compared to the sum of the risks from each factor in isolation). Common comorbidities modify the association of frailty with postoperative survival; however, this effect was only apparent when analyses accounted for effect modification on the absolute risk difference, as opposed to relative scale. While the relative scale is more commonly used in biomedical research, smaller effects may be easier to detect on the risk difference scale. The concurrent presence of dementia, COPD, and HF with frailty were all associated with excess mortality on the absolute risk difference scale.

The Joint Impact of Age at Death and Dementia on Long-Term Care Use in the Last Years of Life: Changes From 1996 to 2013 in Finland.

Welfare states increasingly rely on aging in place policies and have cut back on institutional long-term care (LTC) provision. Simultaneously, the major determinants of LTC use, that is, dementia and living to very old age, are increasing. We investigated how increasing longevity and concomitant dementia were associated with changes in round-the-clock LTC use in the last 5 years of life between 1996 and 2013. Retrospective data drawn from national registers included all those who died aged 70+ in 2007 and 2013, plus a 40% random sample from 2001 (N = 86,554). A generalized estimating equations (GEE) were used to estimate the association of dementia and age with LTC use during three study periods 1996-2001, 2002-2007, and 2008-2013. Between the study periods, the total number of days spent in LTC increased by around 2 months. Higher ages at death and the increased number of persons with dementia contributed to this increase. The group of the most frequent LTC users, that is, people aged 90+ with or without dementia, grew the most in size, yet their LTC use decreased. The implications of very old age and concomitant dementia for care needs must be acknowledged to guarantee an adequate quantity and quality of care.

Parkinsonism in a population-based study of individuals aged 75+ years: The Pietà study

IntroductionParkinsonism is one of the most prevalent neurological syndromes in the elderly. There are only a few epidemiological studies focusing on parkinsonism in oldest-old individuals, particularly in Latin America. This study aims to investigate the prevalence and characteristics of parkinsonism in subjects aged 75 + years living in the community. MethodsThe Pietà study is a population-based investigation on brain aging conducted in Caeté, southeast Brazil. A sample composed of 610 community-dwelling individuals aged 75 + years (48.7% of the total population within this age range) underwent clinical, neurological, cognitive and functional assessments. ResultsThe sample comprised mostly women (61.5%), with mean age of 83.3 years and mean schooling of 2.5 years. Parkinsonism was identified in 65 subjects (crude prevalence = 10.7%). Parkinson's disease, Parkinsonism + dementia syndrome, drug-induced parkinsonism, vascular parkinsonism and Lewy-body dementia were identified in, respectively, 19 (29.2%), 19 (29.2%), 8 (12.3%), 4 (6.1%) and 1 (1.5%) subjects. In 14 individuals (21.5%), the etiology of parkinsonism could not be determined. The most important vascular risk factor was hypertension (64.6%). Cognitive evaluation disclosed dementia in 37 (56.9%) subjects. Mean Pfeffer's functional activities questionnaire score was 12.2 points and 22 (33.8%) subjects were impaired in basic activities of daily living. ConclusionParkinsonism was common in this oldest-old population, being associated with dementia and vascular risk factors, particularly hypertension. Different confounders, such as concomitant dementia and exposure to anti-dopaminergic drugs, were present in this population, challenging the definition of causes of parkinsonism.

Parkinson disease with and without Dementia: A prevalence study and future projections.

Limited population-based information is available on the co-occurrence of dementia and PD. However, projecting the prevalence of PD with and without dementia during the next 50 years is crucial for planning public-health and patient-care initiatives. The objective of this study was to project the prevalence of PD with and without dementia in the United States by 2060. We used the Rochester Epidemiology Project medical records-linkage system to identify all persons with PD with or without dementia residing in Olmsted County, Minnesota, on January 1, 2006. A movement disorders specialist reviewed the complete medical records of each person to confirm the presence of PD. We calculated the age- and sex-specific prevalence of PD with and without dementia and projected U.S. prevalence through 2060. We identified 296 persons with PD with and without dementia on the prevalence date (187 men, 109 women); the overall prevalence increased with age from 0.01% (30-39 years) to 2.83% (≥90 years). The prevalence of PD without dementia increased with age from 0.01% (30-39 years) to 1.25% (≥90 years). The prevalence of PD with dementia increased with age from 0.10% (60-69 years) to 1.59% (≥90 years). The prevalence was higher in men than in women for all subtypes and all age groups. We project by 2060 an approximate doubling of the number of persons with PD without dementia and a tripling of the number of persons with PD with dementia in the United States. The prevalence of PD with and without dementia increases with age and is higher in men than women. We project that the number of persons with PD in the United States will increase substantially by 2060. © 2018 International Parkinson and Movement Disorder Society.

Cognitive Improvement After Endovascular Treatment in a Case of Intracranial Dural Fistula With Concomitant Dementia

Dural fistulas associated with dementia are rarely reported and, among these, intracranial dural fistulas constitute an infrequent etiology. Moreover, dementia associated with dural fistulas occurs due to venous hypertension leading to ischemic neuronal dysfunction. This case report describes a male patient exhibiting unusual features of dementia with a concomitant dural fistula compromising the superior sagittal sinus. The fistula was completely occluded via endovascular embolization. Two months after the interventional therapy, clinical assessment revealed complete improvement of executive functions. Afterward, the patient returned to his daily activities without impairment.