General Practitioner Assessment Research Articles

O01 LISTEN TO YOUR HEART AND MIND: A FEASIBILITY STUDY ON COMBINED SCREENING OF RAISED BLOOD PRESSURE, ATRIAL FIBRILLATION, COGNITIVE IMPAIRMENT AND HEARING LOSS

Background and Objective. Detection rates of hypertension continues to be suboptimal worldwide. The risk of hypertension increases substantially in older adults aged ≥65 years, a group also at increased risk of atrial fibrillation (AF), cognitive decline and hearing loss—all factors associated with hypertension. This pilot study aimed to 1) implement a combined screening strategy for these health conditions, and 2) assess feasibility and acceptability of the combined screening. Methods. Adults aged ≥65 years without a prior diagnosis of cognitive impairment and dementia were invited to attend a combined screening appointment through advertisements posted in university and community group newsletters and noticeboards. Participants underwent blood pressure (BP) and AF screening using an oscillometric BP monitor with AF detection (Microlife WatchBP Office 2G), cognitive assessment (General Practitioner Assessment of Cognition, GPCOG), and audiometric testing. A subset of participants was invited to participate in a post-study process evaluation interview. Results. Of the 35 participants (age 73±6 years, 51% females), 26 (74%) had hypertension (on antihypertensive medication: n=20; measured: n=6; unaware: n=2; uncontrolled: n=4). Possible AF was detected in two participants and seven had possible cognitive decline (GPCOG score <9). Hearing loss was detected in 13 participants. Interviews (n=16, 50% females) revealed that combined screening was acceptable and feasible as participants felt it was “convenient”, “saves time”, “a brilliant idea”, and that “… conditions are related and therefore appropriate to be together”. Most participants were already aware of their hypertension status, thus screening did not result in increased hypertension awareness except for one with uncontrolled hypertension who proceeded to purchase a home BP monitor. One participant with detected AF visited a cardiologist and confirmed non-AF arrhythmia. All interviewees found the appointment duration (approximately 60-75 minutes) was not too long nor too taxing. Conclusions. Combined screening in older adults with increased cardiovascular risk is feasible and acceptable and should be considered for future screening programs in older adults.

Development of a self-assessment tool to address the functioning of community-dwelling older adults in general practice: a validation study of the EFA23 questionnaire

BackgroundMultimorbidity is increasingly prevalent among ageing patients, leading to reduced daily functioning. To address the challenges posed by multimorbidity in older adults, a person- and context-centred approach is needed. This study aimed to develop a questionnaire as a self-assessment tool for older adults focusing on functioning in general practice based on the International Classification of Functioning, Disability and Health (ICF).MethodsA mixed-methods approach was employed in the development and validation of the German EFA23 (Erfassung Funktionaler Gesundheit im Alter – 23 Fragen; Assessing Functional Health in Old Age – 23 questions) questionnaire. Based on an ICF subset developed in a preparatory phase and consensus study, questionnaire items were formulated and tested in a qualitative pretest, followed by a validation study. A workshop with general practitioners (GPs) was held to develop a supplementary manual for GPs on how to interpret the questionnaire results and discuss them with the patients.ResultsA total of 69 items were developed and tested in the qualitative pretest with 15 respondents, resulting in 37 items for the validation study. The validation study, involving 237 older adults, showed the presence of one significant principal component. It demonstrated good internal consistency (Cronbach’s alpha = 0.967) and construct validity, showing positive correlations with established assessment tools. Descriptive statistics showed differences between the means of self-assessment by patients and an external GP assessment. The final EFA23 questionnaire consists of 23 items assessing limitations in functioning.ConclusionsThe EFA23 questionnaire can be used as a valid self-assessment instrument to measure functioning in older adults, supporting a person- and context-centred approach in general practice.

Application of Patient Version of General Practitioner Assessment of Cognition for Screening Elderly with Mild Cognitive Impairment in Community

Application of Patient Version of General Practitioner Assessment of Cognition for Screening Elderly with Mild Cognitive Impairment in Community

The Risk of Atrial Fibrillation and Previous Ischemic Stroke in Cognitive Decline.

Objectives: Our study investigated the inverse relationship between cognitive decline (CD) and the presence of documented atrial fibrillation (AFib), ischemic stroke, heart failure, lower extremity peripheral artery disease, and diabetes mellitus. Methods: We conducted a retrospective cross-sectional study between December 2016 and November 2019. A total of 469 patients were enrolled who underwent cognitive evaluation with three cognitive tests (Montreal Cognitive Assessment-MOCA, Mini-Mental State Examination-MMSE, and General Practitioner Assessment of Cognition-GPCOG). We used the standard cut-off values, and the optimal thresholds were obtained from the receiver operating characteristic curves. Results: The standard cut-off level of the MOCA (<26 points) was associated with the presence of AFib (OR: 1.83, 95% CI: 1.11-3.01) and the optimal cut-off level with <23 points with ischemic stroke (OR: 2.64, 95% CI: 1.47-4.74; p = 0.0011). The optimal cut-off value of the MMSE (<28 points) was associated with the presence of ischemic stroke (OR: 3.07, 95% CI: 1.56-6.07; p = 0.0012), AFib (OR: 1.65, 95% CI: 1.05-2.60; p = 0.0287), and peripheral artery disease (OR: 2.72, 95% CI: 1.38-5.36; p = 0.0039). GPCOG < 8 points were associated with ischemic stroke (OR: 2.18, 95% CI: 1.14-4.14; p = 0.0176) and heart failure (OR: 1.49, 95% CI: 1.01-2.21; p = 0.0430). Conclusions: Our research highlighted the broader utility of cognitive assessment. The MOCA and MMSE scores proved to be associated with documented AFib. Higher cognitive test results than the standard threshold for CD of the MMSE, GPCOG, and lower MOCA scores represented risk factors for the presence of previous ischemic stroke.

Two-Year Longitudinal Study Reveals That Long COVID Symptoms Peak and Quality of Life Nadirs at 6-12 Months Postinfection.

Few longitudinal studies available characterize long COVID outcomes out to 24 months, especially in people with nonsevere acute coronavirus disease 2019 (COVID-19). This study sought to prospectively characterize incidence and duration of long COVID symptoms and their association with quality of life (QoL) from 1-24 months after mild-to-moderate COVID-19 using validated tools in a diverse cohort of unvaccinated people infected with SARS-CoV-2 in 2020. At 1-3, 6, 12, 18, and 24 months post-COVID-19, 70 participants had orthostatic vital signs measured, provided blood, and completed surveys characterizing symptoms, QoL, and return to pre-COVID-19 health and activities using validated tools (FLU-PRO+, Fatigue Severity Scale, Insomnia Severity Index, General Practitioner Assessment of Cognition, Patient Health Questionnaire Depression 8-Item, Generalized Anxiety Disorder 7-Item, 36-Item Short-Form Health Survey, EuroQol EQ-5D-5L). During the study period, 33% of participants experienced long COVID (had not returned to pre-COVID-19 health status and reported at least 1 symptom >90 days postinfection); 8% had not returned to their pre-COVID-19 health status 24 months postinfection. Long COVID symptoms peaked 6 months post-COVID-19, frequently causing activity limitations. Having long COVID was significantly associated with decreased QoL in multiple domains. Frequencies of orthostatic hypotension and tachycardia reflected levels reported in the general population. Within-person weight increased significantly between months 1 and 6. Long COVID was associated with pre-COVID-19 obesity and hyperlipidemia, but not with high-sensitivity C-reactive protein levels 1-3 months postinfection. Long COVID occurs in a significant proportion of unvaccinated people, even if the acute illness was not severe. Long COVID prevalence peaked 6-12 months post-COVID-19, and a small proportion of participants still reported not returning to their pre-COVID-19 health status 24 months post-COVID-19.

Dementia Screening in the Elderly with Chronic Disease Using the General Practitioner Assessment of Cognition

Dementia Screening in the Elderly with Chronic Disease Using the General Practitioner Assessment of Cognition

Impact of welding occupation on serum aluminium level and its association with physical health, cognitive function, and quality of life: a cross-sectional study.

There is an occupational health concern about welders' inhalation of toxic aluminium fumes. We investigated whether serum aluminium level (SAL) and demographic variables can significantly predict physical health parameters, cognition, and quality of life (QoL) among welders. The cross-sectional study involved 100 age- and location-matched men (50 welders and 50 non-welders). SAL obtained using a graphite furnace atomic absorption spectrometer, and data collected using blood pressure and body mass index (BMI) apparatuses, biodata form, pain rating scale, General Practitioner Assessment of Cognition, WHOQoL-BREF, and Nordic musculoskeletal symptoms (MSS) questionnaire were analysed using independentsamplest test, chi-square, Pearson's correlation, and hierarchical linear regression. Welders had significantly higher SAL (mean difference [MD] = 1.77µg/L, p < 0.001), lower QoL (MD = 3.92, p = 0.039), and higher prevalence of MSS on the neck (χ2 = 10.187, p = 0.001), shoulder (χ2 = 9.007, p = 0.003), upper back (χ2 = 6.832, p = 0.009), and knee (χ2 = 12.190, p < 0.001) than non-welders. There was a significant bivariate association between SAL, systolic blood pressure (β = 0.313, p = 0.002), and BMI (β = 0.279, p = 0.005), but not pain intensity, cognition, or QoL. SAL remained a significant predictor of systolic blood pressure after adjustment for physical health and QoL parameters (β = 0.191, p = 0.044). The association between SAL and social QoL became significant after adjustment for physical health and other QoL domains (β = - 0.210, p = 0.032) and demographic variables (β = - 0.233, p = 0.046). Welders had significantly higher SAL, musculoskeletal symptoms, blood pressure, and lower QoL than non-welders. SAL was associated with adverse physical health parameters and social-related QoL, not cognition. We recommend routine aluminium bioavailability and physical health checks among welders.

General practitioner assessment and management of insomnia in adults.

Sleep disturbance is among the most prevalent presentations in Australian general practice. Insomnia, the most common sleep disorder, is associated with impaired daytime, social and occupational function, reduced quality of life and substantially increased risk of future depression. Guidelines from Australian and international general practice, sleep and medical societies strongly recommend cognitive behavioural therapy for insomnia (CBT-i) as the first-line treatment for chronic insomnia. This is because CBT-i targets the underlying causes of insomnia, results in sustained improvements and commonly improves comorbid conditions such as depression and pain. This article aims to provide an overview of evidence-based assessment, management and referral options for insomnia in Australian general practice. Access to brief insomnia assessment andevidenced-based treatments are becoming increasingly available to Australian general practitioners. CBT-i can be delivered through self-guided online programs or by suitably trained general practitioners and psychologists.

General practitioners’ assessment of interventions applied to optimize laboratory test utilization: a cross-sectional survey study

General practitioners (GPs) in the Region of Southern Denmark were randomly allocated to a range of interventions to optimize their use of Vitamin D tests over one year. The aim of the current survey study was to investigate GPs assessment of the interventions. Using REDCap web-platform, we invited 638 GPs to participate in a survey about their experiences of guidelines, feedback reports, non-interruptive alerts, and interruptive alerts. The questions were customized for the different interventions. We received responses from only 131 GPs (21%), but no differences in gender, age, or type of GP clinic were observed between responders and invited GPs. Approximately half of the GPs found that guidelines were helpful, and a similar proportion of GPs read the feedback reports ‘often’ or ‘always′. The pop-up alerts were accepted when used for maximum three months for often-used tests. In contrast, alerts were accepted for long periods for rarely-used tests. The groups that were exposed to the interruptive alert found it ‘problematic’ that it appeared every time vitamin D was requested. Guidelines and feedback reports on tests numbers were accepted, but it was previously found, that they had little effect on improving the use of biochemical tests. Pop-up alerts in the requesting IT system can produce alert fatigue. Future research should focus on developing feedback reports that – when possible - also include relevant clinical information, and pop-up alerts should for often used tests be displayed only for weeks or a few months, but can be repeated.

Alzheimer's disease with frailty: Prevalence, screening, assessment, intervention strategies and challenges.

Alzheimer's disease (AD) is a neurodegenerative disorder that affects millions worldwide and is expected to surge in prevalence due to aging populations. Frailty, characterized by muscle function decline, becomes more prevalent with age, imposing substantial burdens on patients and caregivers. This paper aimed to comprehensively review the current literature on AD coupled with frailty, encompassing prevalence, screening, assessment, and treatment while delving into the field's challenges and future trajectories. Frailty and AD coexist in more than 30% of cases, with hazard ratios above 120% indicating a mutually detrimental association.Various screening tools have emerged for both frailty and AD, including the Fried Frailty Phenotype (FP), FRAIL scale, Edmonton Frailty Scale (EFS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT), and General Practitioner Assessment of Cognition (GPCOG). However, none has solidified its role as the definitive gold standard. The convergence of electronic health records and brain aging biomarkers heralds a new era in AD with frailty screening and assessment. In terms of intervention, non-pharmacological strategies spanning nutrition, horticulture, exercise, and social interaction, along with pharmacological approaches involving acetylcholinesterase inhibitors (AChEIs), N-methyl-D-aspartate (NMDA) receptor antagonists, and anti-amyloid beta-protein medications, constituted cornerstones for treating AD coupled with frailty. Technological interventions like repetitive transcranial magnetic stimulation (rTMS) also entered the fold. Notably, multi-domain non-pharmacological interventions wield considerable potential in enhancing cognition and mitigating disability. However, the long-term efficacy and safety of pharmacological interventions necessitate further validation. Diagnosing and managing AD with frailty present several daunting challenges, encompassing low rates of early co-diagnosis, limited clinical trial evidence, and scarce integrated, pioneering service delivery models. These challenges demand heightened attention through robust research and pragmatic implementation.

Factors influencing mobility among people post-surgery for hip fractures: A cross-sectional study.

After hip fracture surgery, patients often experience complications and a decline in mobility, leading to physical disability and increased dependency on caregivers. This may result in reduced independence, institutionalization, and higher mortality rates. However, there is limited research on mobility and its influencing factors in patients undergoing hip fracture surgery in Thailand. This study aimed to determine the factors influencing mobility in patients with fractured hips within one year after surgery. A cross-sectional study was conducted involving 143 randomly selected participants who had undergone hip fracture surgery between August 2022 to February 2023. Mobility and its influencing factors were measured using standardized questionnaires, including the De Morton Mobility Index, Parker Mobility Scale, Charlson Comorbidity Index, General Practitioner Assessment of Cognition, Groningen Orthopedic Social Support Scale, Fatigue Severity Scale, Pain Rating Scale, and Pittsburgh Sleep Quality Index. Descriptive statistics and multiple regression were utilized for data analysis. The mean mobility score for the patients was 48.86 out of 100 (SD = 17.89). The study found that comorbidity (β = -0.156, p = 0.009), cognitive function (β = 0.310, p <0.001), social support (β = 0.145, p = 0.010), pain (β = -0.176, p = 0.004), fatigue (β = -0.249, p <0.001), and sleep (β = -0.169, p = 0.009) collectively influenced mobility in patients after hip fracture surgery, explaining 61.8% of the variance (R2 = 0.618; F = 36.598; p <0.001). The study's results provide valuable insights for nurses to target these modifiable factors to enhance patients' mobility. However, it is essential to note that patients with comorbidity and poor cognitive function may face difficulty maintaining mobility. Nurses should be attentive to these patients and provide appropriate management. Additionally, early rehabilitation should be initiated promptly to optimize outcomes.

Prevalence of Cognitive Impairment among Elderly in Primary Health Care Centers in Cairo, Egypt

Abstract Background Cognitive impairment (CI) in the elderly is a growing worldwide public health problem. Symptomatic CI is under-diagnosed, even though early detection in dementia care is of great significance and allowing the person to be involved in future care planning. Objectives To measure the prevalence of CI among elderly patients attending primary health care centers in Elsharabya, Egypt and to identify different risk factors associated with CI. Methods A cross-sectional study was performed among 154 elderly using an interview questionnaire including socio-demographic data, Saint – Louis – University – Mental – Status (SLUMS), Test your memory (TYM)) and General practitioner Assessment of Cognition (GPCOG) questionnaires. Results 51.3% of the studied elderly suffered from mild CI compared to 32.5% suffered from marked CI by SLUM. 68.8% suffered from CI by TYM. 83.3% and 13.0% of them were classified as CI by patient assessment and caregiver interview of GPCOG respectively. The most significant factors associated with CI were being older, non-married, and low educational levels. Conclusions and Recommendations The prevalence of CI is high among the studied elderly. Early identification of CI is important to delay the progression to Alzheimer’s disease and achieve a better quality of life.

Screening for Dementia in Audiology Clinics – Advantages, Pitfalls, and Recommendations

Screening for Dementia in Audiology Clinics – Advantages, Pitfalls, and Recommendations

Cognition and cardiovascular comorbidities among older adults in primary care in West India.

Cardiovascular risk factors (e.g., diabetes and hypertension) are comorbidities associated with cognitive impairment. The present study was planned to study the relationship between cardiovascular risk factors and cognitive impairment using General Practitioner assessment of Cognition (GPCOG) scale, which is easy to use scale in the primary care. A total of 350 older adults (mean age=66.71 ± 6.53 years; M:F = 220:130) among 3000 who reported to the primary care center in West India were screened. Cardiovascular risk factors were assessed based on written medical records. GPCOG was used for cognitive screening of those over the age of 60 with subjective memory complaints. Frequency of cardiovascular (CV) risk factors in those with cognitive impairment was 46.2% (n = 162/350) and 29% (101/350) in those without cognitive impairment. A Chi-square test of proportion showed values to be statistically significantly different (Chi-square value = 22.04; P =< 0.001; 95% confidence interval [CI] = 10.0463-24.1076%). Odds ratio was found to be 1.6 (95% CI =2-2.1; P =< 0.05). A higher CV risk factors were observed among those with cognitive impairment compared to those cognitively normal older adults in the primary care.

General practitioner assessment of lifestyle risk factors for chronic disease: a cross-sectional study in urban, rural and remote South Australia.

The assessment and management of the SNAP lifestyle risk factors (smoking, nutrition, alcohol intake and physical activity) is fundamental to primary prevention of chronic disease. This study investigates the prevalence of SNAP assessments conducted in South Australian general practice, according to patient risk profiles, and across urban, rural and remote locations. A cross-sectional population-based survey was conducted in South Australia in 2017. Survey data included information on health characteristics, lifestyle risks and general practitioner (GP) assessments for 2775 participants, aged ≥18years, who visited a GP in the past 12months. The main outcome measure was assessment for two or more (≥2) SNAP risks in this time. Logistic regression models were used to estimate the prevalence of ≥2 SNAP assessments by remoteness area, using the Modified Monash Model (MMM) classifications for urban (MMM), rural (MMM3-4) and remote (MMM5-6), and adjusting for sociodemographic, SNAP lifestyle risks and clinical variables. Of the 2775 participants (mean age 49.1±18.7years; 52.7% women), 32% were assessed for ≥2 SNAP in the past 12months. The adjusted prevalence of assessments was higher in rural (43.8%; 95% CI 36.4-51.2%) than urban (29.7%; 95% CI 27.2-32.2%) or remote (34.7%; 95% CI 28.4-41.0%) areas. Depending on rurality, ≥2 SNAP assessments were 2.5-3.4times more likely among participants with existing cardiovascular disease, and two to seven times more likely among participants with three or four SNAP risk factors (P<0.05 in all cases). Greater attention to GP SNAP assessments is warranted to match the prevalence of SNAP risks across South Australia.

Patient uptake and outcomes following pharmacist-initiated referrals to general practitioners for asthma review

Uptake and outcomes of pharmacist-initiated general practitioner (GP) referrals for patients with poorly controlled asthma were investigated. Pharmacists referred at-risk patients for GP assessment. Patients were categorized as action takers (consulted their GP on pharmacist’s advice) or action avoiders (did not action the referral). Patient clinical data were compared to explore predictors of uptake and association with health outcomes. In total, 58% of patients (n = 148) received a GP referral, of whom 78% (n = 115) were action takers, and 44% (n = 50) reported changes to their asthma therapy. Patient rurality and more frequent pre-trial GP visits were associated with action takers. Action takers were more likely to have an asthma action plan (P = 0.001) at month 12, and had significantly more GP visits during the trial period (P = 0.034). Patient uptake of pharmacist-initiated GP referrals was high and led to GP review and therapy changes in patients with poorly controlled asthma.

A new model for general practice-led, regional, community-based, memory clinics

BackgroundDementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices.MethodsCross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both.ResultsEight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized.ConclusionStandardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.

Community Screening of Probable Dementia at Primary Care Center in Western India: A Pilot Project.

Introduction Timely detecting dementia is an important goal of clinicians and public health professionals alike for better management and prevention of complications. Community screening of dementia could be a powerful strategy. Facilities for dementia screening at primary care level are virtually nonexistent and are a prominent implementation gap. Hence, a study was done to assess the feasibility of dementia screening at primary care using General Practitioner Assessment of Cognition (GPCoG) scale among older adults with subjective memory complaints. It was further aimed to assess the frequency of cardiovascular risk factors in those who met screening criteria for cognitive impairment. Materials and Methods Older adults coming to three urban primary care centers in western India for screening of noncommunicable diseases such as diabetes and hypertension (opportunistic screening) with subjective memory complaints were enrolled and screened for dementia using GPCoG. A Mini-Mental State Examination (MMSE) was done in patients who came alone for referral purpose in case the score levels in GPCoG examination met cutoff limits for informant interview. Written medical records were examined to assess status of comorbid vascular risk factors such as diabetes, hypertension, coronary artery disease, and cerebrovascular accidents. Results A total of 350 older adults (M:F = 276: 74; mean age ± 68 ± 6.7 years) were screened out of 3,000 older adults who reported during the study period. There were 161 older adults with GPCoG score less than or equal to 5 (56.14%) and 149 subjects with MMSE less than or equal to 24 indicating significant cognitive impairment (42.5%). There were very few ( n = 11, 3.14%) out of 350 people who came with caregivers; hence, MMSE was done along with for referral to healthcare providers. A total of 142 had comorbid diabetes/and or hypertension (40.5%). A total of 86 had diabetes alone (24.5%) and a total of 128 had hypertension (36.5%). Conclusion Current study results indicate that using a simple screening tool such as GPCoG, community screening of probable dementia, is feasible in primary care settings, as is indicated by significant yield of probable dementia cases (42.5%). These cases can be referred to appropriate centers for further workup, confirmation of diagnosis, and treatment. Also, detection of comorbid cardiovascular conditions, for example, diabetes and hypertension, that can be managed along with cognitive impairment/dementia for potential prevention/further deterioration, which can strengthen noncommunicable disease screening.

Delirium risk factors in hospitalized patient: a comprehensive evaluation of underlying diseases and medications in different wards of a large Urban Hospital Center in Iran

BackgroundDelirium is a neurobehavioral syndrome, which is characterized by a fluctuation of mental status, disorientation, confusion and inappropriate behavior, and it is prevalent among hospitalized patients. Recognizing modifiable risk factors of delirium is the key point for improving our preventive strategies and restraining its devastating consequences. This study aimed to identify and investigate various factors predisposing hospitalized patients to develop delirium, focusing mostly on underlying diseases and medications.MethodIn a prospective, observational trial, we investigated 220 patients who had been admitted to the internal, emergency, surgery and hematology-oncology departments. We employed the Confusion Assessment Method (CAM) questionnaire, The Richmond Agitation Sedation Scale (RASS), the General Practitioner Assessment of Cognition (GPCOG), demographic questionnaire, patient interviews and medical records. Multivariate logistic regression models were used to analyze the predictive value of medications and underlying diseases for daily transition to delirium.; demographics were analyzed using univariate analysis to identify those independently associated with delirium.ResultsTwo hundred twenty patients were enrolled; the emergency department had the most incident delirium (31.3%), and the surgery section had the least (2.4%); delirium was significantly correlated with older ages and sleep disturbance. Among multiple underlying diseases and the medications evaluated in this study, we found that a history of dementia, neurological diseases and malignancies increases the odds of transition to delirium and the use of anticoagulants decreases the incident delirium.ConclusionApproximately 1 out of 10 overall patients developed delirium; It is important to evaluate underlying diseases and medications more thoroughly in hospitalized patients to assess the risk of delirium.

Improving Diagnosis of Functional Cognitive Impairment in Younger Adults in Primary Care: Validation of Cognitive Screening Tools and the 4-Item Geriatric Depression Scale.

Cognitive decline is classically attributed to organic causes such as dementia; however, depression can play a role in cognitive decline. To evaluate cognitive screening tools and the 4-item Geriatric Depression Scale (GDS-4) for use in primary care to distinguish cognitive decline secondary to depression. Clinical data collected over 2.5 years for assessed patients in a secondary clinical service for younger adults. Cognitive screening tools (General Practitioner Assessment of Cognition, Addenbrooke's Cognitive Examination-III, Rowland Universal Dementia Assessment Scale, Salzburg Dementia Test Prediction) and GDS-4 were analyzed for their accuracy to differentiate patients with cognitive decline due to depression from those with subjective cognitive complaints. 180 young adults seen in a memory clinic setting (< 65 years) were included. These individuals either had a diagnosis of depression (n = 46) or no cognitive impairment on assessment (n = 134) despite having subjective cognitive complaints. All used cognitive tools had poor accuracy in differentiating cognitive decline secondary to depression from subjective cognitive complaints. The GDS-4 alone, however, was able to differentiate with high accuracy (AUC = 0.818) individuals who had cognitive problems secondary to depression. Cognitive screening tools used alone are ineffective in discriminating cognitive decline secondary to depression. Incorporating the GDS-4 into the screening process by primary practitioners could facilitate early identification and treatment of depression in younger people, avoiding unnecessary referrals memory services.