History Of Cognitive Impairment Research Articles

Qualitative Message Development to Motivate Quitting Smoking in Older Adults: Dementia May Motivate Quitting.

Compared to younger adults, older adults who smoke cigarettes are half as likely to make a quit attempt, but more likely to maintain abstinence using evidence-based smoking treatments (EBSTs), illustrating the need for motivational messages to promote cessation through EBSTs. It is unclear whether messaging regarding the association between smoking and dementia might motivate older adults to quit. We conducted 90-min semi-structured qualitative interviews and surveys via telephone with 24 U.S. older adults who smoke (ages 50-75) with no cognitive impairment history. Rapid content analysis revealed the most reported health-related concern of aging was dementia/cognitive loss/loss of functioning. However, most participants were unaware of the association between cognitive decline and smoking. Participants had seen previous smoking cessation advertisements, but most did not feel motivated to quit by them. The majority found a message about smoking raising dementia risk and quitting decreasing that risk to be motivational for cessation. Exact message content preference varied, but 2 broad categories arose: hope- and fear-based messages. Most participants stated willingness to use some cessation pharmacotherapy and half were willing to use cessation counseling. Participants preferred messages to come from older adults who were successful quitters. To our knowledge, this was the first study to explore potential motivational messages targeting older adult smokers, including the potential acceptability of a dementia-related message in this context. This work supports patient desire for targeted motivational messages for older adult smokers. Messages highlighting the link between smoking and dementia are perceived to be motivational for this group; future work should compare a hope- to fear-based messages.

P133: Impairment of Executive Functions in Dialysis Patients. Necessity of Evaluation Cognitive State in Advanced Chronic Kidney Disease

Introduction:Cognitive impairment is common and underdiagnosed in patients in hemodialysis (HD) can be moderate and severe. About 38% of patients in Dialysis has serious deficits in executive function and this affects patients of all ages.Material and methods:Based on the case of an 82-year-old patient in a HD program who enters from Nephrology to the Convalescence Unit for miscontrol of pain due to ganglion and liver recidivism after years of cystectomy by bladder neoplasia and having acute confusional syndrome (ACS) subsequently presented after treatmet with morphine MST and Tramadol. We performed an integral geriatric evaluation that showed a deterioration of the executive functions. Through medical literature we analyze this find of atypical pattern and its possible relationship to renal disease.Results:BI 100/100. No known history of cognitive impairment. Despite optimal pain control with fentanyl patch, pregabalin, paracetamol, metamizol and dexamethasone, without new episodes of ACS, we saw high difficulties in comprehension time schedule, spatial location, bad understanding of medical treatment, etc. Neuropsychological study showed MMSE 24/30; SKT subtest of immediate memory 1/12, null recognition without understanding the task. Memory Imparily Screen 5/8, Test clock 3/7. In summary there were deficits in executive functions such as complex attention, mental control, fluency and reasoning. Fluctuating memory abilities. Mild multiple cognitive impairment executive domain. Atypical Profile.Conclusions:There is a strong correlation between the decrease in GF and the degree of cognitive impairment. This worsens with the Dialysis due to hemodynamic changes. It is essential to evaluate the cognitive situation in all patients with CKD. Being the most affected cognitive domain, the function executive,it can avoid in these patients the correct assesment of established medications and dietary restrictions that are so important in the control of potassium, phosphorus and liquids that cause greater complications and even more mortality.

Clinical Reasoning: A 17-Year-Old Girl With Progressive Cognitive Impairment.

A 17-year-old girl presented with a long history of cognitive impairment, personality and behavioral changes, dysarthria, and paroxysmal lower-extremity weakness. She was initially suspected of having mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes because of stroke-like symptoms, such as episodic lower-extremity weakness, as well as abnormal brain MRI findings of generalized cerebral atrophy, extensive high-intensity lesions in the cortex and subcortical white matter on fluid-attenuated inversion recovery images, decreased N-acetyl aspartate/creatine ratio, and a lactate peak in the focal area on spectrum images. However, there were no relatives with similar presentations in the family of the patient. The whole mitochondrial genome and whole-exome sequencing did not suggest pathogenic mutations, and no abnormalities were found in the blood or CSF lactate levels. In this case, we detail the clinical manifestations, diagnostic workup, and imaging findings. This case highlights the importance of assessing cognitive function and the relevant differential diagnoses in an adolescent with cognitive impairment.

Performance of a condensed protocol to assess limbic-predominant age-related TDP-43 encephalopathy neuropathologic change.

Limbic-predominant age-related TDP-43 encephalopathy neuropathologic change (LATE-NC) is a dementia-related proteinopathy common in the elderly population. LATE-NC stages 2 or 3 are consistently associated with cognitive impairment. A condensed protocol (CP) for the assessment of Alzheimer disease neuropathologic change and other disorders associated with cognitive impairment, recommended sampling of small brain portions from specific neuroanatomic regions that were consolidated, resulting in significant cost reduction. Formal evaluation of the CP for LATE-NC staging was not previously performed. Here, we determined the ability of the CP to identify LATE-NC stages 2 or 3. Forty brains donated to the University of Washington BioRepository and Integrated Neuropathology laboratory with known LATE-NC status were resampled. Slides containing brain regions required for LATE-NC staging were immunostained for phospho-TDP-43 and reviewed by 6 neuropathologists blinded to original LATE-NC diagnosis. Overall group performance distinguishing between LATE-NC stages 0-1 and 2-3 was 85% (confidence interval [CI]: 75%-92%). We also used the CP to evaluate LATE-NC in a hospital autopsy cohort, in which LATE-NC was more common in individuals with a history of cognitive impairment, older age, and/or comorbid hippocampal sclerosis. This study shows that the CP can effectively discriminate higher stages of LATE-NC from low or no LATE-NC and that it can be successfully applied in clinical practice using a single tissue block and immunostain.

Frequency of delirium and its associated factors among COVID-19 inpatients in Iran.

Delirium has been presented as the leading cause of sudden change in the mental state of patients with coronavirus disease 2019 (COVID-19). Given that the delayed diagnosis of such a dysfunction is often associated with excess mortality, it seems essential to devote vastly more attention to this significant clinical characteristic. This cross-sectional study was performed on 309 patients [viz. 259 cases hospitalized in general wards and 50 individuals admitted to the intensive care unit (ICU)]. For this purpose, a Demographic-Clinical Information Questionnaire, the Confusion Assessment Method (CAM), the Confusion Assessment Method for the ICU (CAM-ICU), the Richmond Agitation-Sedation Scale (RASS) and face-to-face interviews were completed by a trained senior psychiatry resident. The data analysis was further done with the SPSS Statistics V22.0 software package. Out of 259 patients admitted to the general wards and 50 cases in the ICU due to COVID-19, 41 (15.8%) and 11 (22%) individuals were diagnosed with delirium, respectively. As well, a significant relationship was observed between the incidence rate of delirium and age (p< 0.001), level of education (p< 0.001), hypertension (HTN) (p= 0.029), a history of stroke (p= 0.025), a history of ischemic heart disease (IHD) (p= 0.007), a history of psychiatric disorders, a history of cognitive impairment (p< 0.001), use of hypnotic and antipsychotic medications (p< 0.001) and a history of substance abuse (p= 0.023). Among 52 patients with delirium, only 20 cases had received psychiatric consultation by consultation-liaison psychiatry service for the possibility of delirium. In view of the high frequency of delirium among COVID-19 inpatients, their screening for this important mental state should be a priority in clinical settings.

Abstract P6-05-13: The Psychological Impacts of COVID-19 on Breast Cancer Patients in China

Abstract Background: Approximately 30% to 50% of breast cancer patients experienced mental distress prior to the advent of COVID.The delayed access to cancer treatment due to the outbreak of COVID -19 pandemic posed a unique challenge to breast cancer patients and caused a significant level of mental distress among them. In the current research, we examined the psychological impacts of COVID on breast cancer patients in China using Symptom Checklist-90-R (SCL-90-R). Method: Participants were breast cancer patients at the outpatient clinic of Xijing hospital. The study was conducted virtually, and the questionnaires were distributed via Wenjuanxing, the Chinese alternative of Qualtrics. The researchers were healthcare workers affiliated with Xijing hospital, and the survey was sent to a breast cancer patient support group which included 1399 cancer patients and 6 healthcare workers. The initial sample consisted of 199 participants who signed an informed consent form to participate in the study. The inclusion criteria were as follows: 1) diagnosed with breast cancer, 2) aged 18 years or above, and 3) had no history of cognitive impairment or previous diagnosis of psychiatric disorders. The validated Mandarin version of the SCL-90-R (Wang, 1984) was then given to the participants to evaluate their psychological status.Categorical variables were summarized as numbers and percentages; continuous variables were described as mean (M) ± standard deviation (SD). Data were analyzed using IBM SPSS Statistics Version 26. Results: Participants (N = 195) filled out the SCL-90 questionnaire in February, 2020. All participants were female breast cancer patients treated at Xijing hospital, among which 16.41%, 36.41%, 19.49%, and 28.21% had respectively received treatment for less than a year, 1-3 years, 3-5 years, and 5 years or more. 64.62% of the patients were at stage I; 0.77% were at stage II and III; 4.62% were at stage IV according to TNM classification. The molecular type of participants is as follows: 47.2% of ER+ HER2-, 31.8% of HER2+, and 21.0% of Triple negative.Participants whose treatments continued to be delayed, on average, reported an elevated general psychopathology score (M = 1.48, SD = 0.47) compared to participants whose treatments were resumed (M = 1.30, SD = 0.34), and the difference was statistically significant, t(193) = 2.96, p = .003, d = 0.44, 95%Cl [0.06, 0.30]. The one-way ANOVA revealed a marginally significant effect of length of treatment delay on general psychopathology score, F(4, 190) = 2.09, p = .08, η^2 = .04. Follow-up multiple comparison analysis showed that participants who had their treatment delayed for 3 weeks to 1 month (M = 1.70, SD = 0.70) reported significantly higher general psychopathology scores than participants whose delay in treatment was less than 1 week (M = 1.34, SD = 0.40), p = .05. General health status (p &amp;lt; .001) and current treatment status (p = .02) are the only two variables that were statistically associated with general psychopathology score.Poorer perceived health status and current delay in treatment were associated with higher general psychopathology score, Additionally, younger age was associated with higher interpersonal sensitivity (p = .01) and hostility (p = .006). Conclusions: We found that breast cancer patients at an advanced stage were more likely to experience psychological symptoms with longer treatment delay, and whose treatments continued to be delayed reported elevated psychological symptoms than individuals whose treatment were resumed, regardless of treatment type. Additionally, a treatment delay of more than three weeks might have exacerbated breast cancer patients’ psychological symptoms, whereas a short-term delay of less than three weeks was less likely to have a significant effect on one’s mental well-being. Table 1. Demographic Characteristics and Health Status of The Participants. Table 2A: Multiple Regression analysis for SCL-90 dimensions. Table 2B: Multiple Regression analysis for SCL-90 dimensions. Citation Format: Yijia Wang, Yuqing Yang, Changjiao Yan, Jixin Yang, Hongliang Wei, Wen Ma, Nanlin Li. The Psychological Impacts of COVID-19 on Breast Cancer Patients in China [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-13.

Unilateral endophthalmitis after immediate sequential bilateral cataract surgery in a cognitively impaired patient: diagnosis and treatment

Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a reasonable approach for cataract surgery in patients needing general anesthesia, such as those with cognitive impairment. To our knowledge, this is the first reported case of unilateral acute-onset postoperative endophthalmitis in a patient with cognitive impairment after ISBCS, with emphasis on diagnostic and treatment challenges. Patient and Clinical Findings: A 64-year-old woman with a history of cognitive impairment, seizure disorder, and no prior ocular surgery presented with dense visually significant cataracts and visual acuity of fix and follows in both eyes. Diagnosis, Intervention, and Outcomes: Patient underwent ISBCS under general anesthesia and without intracameral antibiotics or corneal sutures. The patient returned with unilateral acute-onset endophthalmitis 2 weeks postoperatively. Because of the patient's limited ability to comply with treatment, and lack of emergency general anesthesia needed for vitreous cultures, intravitreal vancomycin injection (1 mg/0.1 mL) was empirically given, with clinical resolution of the infection and visual acuity of fix and follows. Conclusions: Acute-onset postoperative endophthalmitis in the setting of cognitive impairment is challenging because emergency general anesthesia may not be available, and the patient can tolerate only limited interventions. In this patient, empiric intravitreal vancomycin injection without cultures led to a satisfactory clinical outcome.

Integration of a pharmacist-led pharmacogenomic service in a geriatric clinic: Barriers and outcomes

ObjectivesThe primary objective was to identify the proportion of patients who successfully completed PGx testing. Secondary objectives included determining the proportion of patients with actionable PGx results, determining the proportion of patients with a baseline medication intervention within 6 months of successfully completing PGx testing, and identifying barriers for not completing testing. DesignThis was a single center, non-interventional, retrospective cohort study, approved by the institutional review board. Setting and participantsPatients included were 65 years of age or older and referred for PGx testing from geriatric outpatient clinics between May 1, 2019 and July 31, 2020. Outcome measuresThis study aimed to assess the implementation of pharmacist-led pharmacogenomics (PGx) in the care of community-dwelling older adults in an outpatient clinic. Little is known about the acceptance and impact of this type of service within this population. ResultsOf the 67 patients included, majority were female (78%), white (76%), and an average age of 78 years ± 5.98 SD. Majority were insured by Original Medicare or Medicaid (61%), had a history of cognitive impairment (84%), had a referring diagnosis of anxiety (40%) or depression (67%), and were prescribed a selective serotonin reuptake inhibitor (69%) at baseline. Majority successfully completed PGx testing (72%), with 72% having actionable PGx findings and 83% having a pharmacological intervention made thereafter. Nineteen patients did not complete testing (28%), with the primary barrier being not having an appointment scheduled (63%). ConclusionThis study demonstrated majority of older adults were accepting of PGx testing and majority of findings were relevant to clinical care of anxiety, depression, or cognitive impairment.

Barriers to patient recruitment in a poststroke neurorehabilitation multicenter trial in Brazil

There is a high demand for stroke rehabilitation in the Brazilian public health system, but most studies that have addressed rehabilitation for unilateral spatial neglect (USN) after stroke have been performed in high-income countries. Therefore, the aim of this study was to analyze USN patient recruitment in a multicenter noninvasive brain stimulation clinical trial performed in Brazil and to provide study design recommendations for future studies. We evaluated the reasons for exclusion of patients from a multicenter, randomized, double-blinded clinical trial of rehabilitation of USN patients after stroke. Clinical and demographic variables were compared between the included and excluded patients. A descriptive statistical analysis was performed. Only 173 of the 1953 potential neglect patients (8.8%) passed the initial screening. After screening evaluation, 87/173 patients (50.3%) were excluded for clinical reasons. Cognitive impairment led to the exclusion of 21/87 patients (24.1%). Low socioeconomic status led to the exclusion of 37/173 patients (21.4%). Difficulty obtaining transportation to access treatment was the most common reason for their exclusion (16/37 patients, 43.3%). The analyzed Brazilian institutions have potential for conducting studies of USN. The recruitment of stroke survivors with USN was restricted by the study design and limited financial support. A history of cognitive impairment, intracranial stenting or craniectomy, and lack of transportation were the most common barriers to participating in a multicenter noninvasive brain stimulation trial among patients with USN after stroke.

Frailty, comorbidity and associations with in-hospital mortality in older COVID-19 patients: an exploratory study of administrative data.

Older adults have worse outcomes following hospitalisation with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed using machine learning algorithms. This was a retrospective study that used the Hospital Episode Statistics administrative dataset from 1st March 2020 to 28th February 2021 for hospital patients in England aged 65 years and over. The dataset was split into separate training (70%), test (15%) and validation (15%) datasets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domain of frailty identified using the Dr Foster Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, International Statistical Classification of Disease and Related Health Problems 10th edition codes recorded during the admission. Features were selected, pre-processed and inputted into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed, the first model included the demographic, hospital-related and disease related items described above and individual GFS domains and CCI items. The second model was as the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. In total 215,831 patients were included. The model containing the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model containing the HFRS had a similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures and pressure ulcers/weight loss. The most-important comorbidity items in the CCI were cancer, heart failure and renal disease. The physical manifestation of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who may need additional support during hospitalization with COVID-19.

A heterozygous mutation in NOTCH3 in a Chinese family with CADASIL.

Introduction: Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal-dominant systemic vascular disease that primarily involves small arteries. Patients with CADASIL experience migraines, recurrent ischemic strokes, cognitive decline, and dementia. The NOTCH3 gene, which is located on chromosome 19p13.12, is one of the disease-causing genes in CADASIL. Herein, we investigate the genetic and phenotypic features in a Chinese CADASIL family with heterozygous NOTCH3 mutation. Methods and Results: In the family, the proband suffered from dizziness, stroke, and cognitive deficits. Brain magnetic resonance imaging (MRI) demonstrated symmetrical white matter lesions in the temporal lobe, outer capsule, lateral ventricle, and deep brain. Whole-exome sequencing identified a known missense mutation in the proband, c.397C>T (p.Arg133Cys), which was identified in his son and granddaughter using Sanger sequencing. The proband's younger brother and younger sister also have a history of cognitive impairment or cerebral infarction, but do not have this genetic mutation, which may highlight the impact of lifestyle on this neurological disease. Conclusion: We identified a known CADASIL-causing mutation NOTCH3 (c.397C>T, p.Arg133Cys) in a Chinese family. The clinical manifestations of mutation carriers in this family are highly heterogeneous, which is likely a common feature for the etiology of different mutations in CADASIL. Molecular genetic analyses are critical for accurate diagnosis, as well as the provision of genetic counselling for CADASIL.

One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery: prospective, multicentre observational study

BackgroundOlder patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the level of support for activities of daily living and mobility 1 year after colonic cancer surgery.MethodsThis was a multicentre, observational study conforming to STROBE guidelines. The prospective data included pre-and postoperative mobility and need for support in daily activities, co-morbidities, onco-geriatric screening tool (G8), clinical frailty scale (CFS), operative data, and postoperative surgical outcomes.ResultsA total of 167 patients aged 80 years or more with colonic cancer were recruited. After surgery, 30 per cent and 22 per cent of all patients had increased need for support and decreased motility. Multivariableanalysis with all patients demonstrated that preoperative support in daily activities outside the home (OR 3.23, 95 per cent c.i. 1.06 to 9.80, P = 0.039) was associated with an increased support at follow-up. A history of cognitive impairment (3.15, 1.06 to 9.34, P = 0.038) haemoglobin less than 120 g/l (7.48, 1.97 to 28.4, P = 0.003) and discharge to other medical facilities (4.72, 1.39 to 16.0, P = 0.013) were independently associated with declined mobility. With functionally independent patients, haemoglobin less than 120 g/l (8.31, 1.76 to 39.2, P = 0.008) and discharge to other medical facilities (4.38, 1.20 to 16.0, P = 0.026) were associated with declined mobility.ConclusionIncreased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicts an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should focus on anaemia correction, nutritional status, and mobility with detailed rehabilitation plan.

A demographic study to profile non-attenders at a single centre heart failure outpatient clinic

Abstract Funding Acknowledgements Type of funding sources: None. Background Nonattendance is a source of inefficiency increasing waiting lists with potential secondary effects on the health status of non-attenders. This is true for patients in heart failure (HF) management programmes with nonattendance reducing the opportunity for prevention intervention &amp;potentially increasing the risk of HF re-hospitalisation. Methods A retrospective analysis of trends of non-attendance of appointments to a single centre HF disease management programme over 36 months. Variables which influence missed appointments such as day of week &amp; comparison between the first &amp; second 6 months of the year were analysed. Patients who did not attend (DNA) their HF appointments (index cases) over 12 months (January–December 2021) were compared with a sample of patients who attended the same clinics (using a computer-generated randomisation technique). Variables which influence missed appointments were compared (age, gender, new/return status, history of cognitive impairment, non-English speaker, HF type, aetiology of cardiomyopathy, recent HF hospitalisation/need for IV diuretics &amp; disease burden measured by NYHA Classification, NTproBNP &amp; No. of comorbid conditions). Results In the 36 months studied there were 460 non-attenders (DNA rate 7.9%) out of 5,823 appointments. The DNA rate did not differ based on day of appointment (p=0.091)/ between the first &amp; second halves of the year (p=0.059). 138 DNA's were compared with 138 controls who attended the same HF service over a 12-month period in 2021. Mean LVEF was similar between index (35.2%) &amp;control cases (35.2%), NTproBNP did not differ significantly (2306 vs 2365) &amp; no. of comborbid conditions did not differ significantly between groups (7 +/- 2.7 vs 6.8 +/-2.6). DNA's had a higher NYHA class than attenders (p=0.02). Measures of disease burden-recent HF hospitalisation/need for IV diuretics, NTproBNP &amp; no. of comorbid conditions did not show statistical difference between index &amp;control groups. There was a trend towards non-English-speaking patients &amp; new referrals not attending appointments compared to the control group, however this did not reach statistical significance (p=0.06). Comparison of other variables such as gender, history of cognitive impairment/dementia, HF type, aetiology of cardiomyopathy did not influence attendance. (Table 1). Conclusion(s) Nonattendance to a HF management programme remained static annually with a mean DNA rate of 7.9% over the 3-year period studied. The present study did not identify any statistically significant clinical factors that influenced nonattendance, though there was a trend towards higher default rate for new patients &amp; non-English speaking patients. NYHA class was higher in non-attenders than attenders though other indirect measures of disease burden did not influence attendance. Non clinical factors should be further studied to identify factors which influence nonattendance in order to develop strategies to minimise non-attendance

Spontaneous Development of Subdural Hemorrhage in a COVID-19 Patient Concurrently Admitted for Presumptive Neurosyphilis

COVID-19 most commonly affects the respiratory system; however, in the past two years, we have seen it affects multiple organ systems, including neurological, and continue to learn its effects. This article presents a 69-year-old female with a history of cognitive impairment with hallucinations, treatment for syphilis, and twice vaccination for COVID-19, who presented to the emergency department (ED) with altered mental status. She later developed a subdural hemorrhage (SDH) after testing positive for COVID-19 during admission.

174-OR: Identify Effect Modulators of Intensive Glucose Control in Preventing Cognitive Function Decline among Individuals with Type 2 Diabetes: A Revisit to the ACCORD MIND Trial

This study aimed to identify patient characteristics associated with the effectiveness of intensive glucose control (i.e., A1c&amp;lt;6.0% vs. A1c 7-8%) in preventing cognitive function decline (CFD) among individuals with type 2 diabetes (T2D) in the ACCORD trial. The Memory in Diabetes (MIND) study was sub trial of the ACCORD study, including 2,977 participants without a history of cognitive impairment or dementia. We applied the causal forest (CF) and causal tree (CT) algorithm to identify participant characteristics that modulate the effectiveness of intensive glucose control in preventing CFD from a list of 58 candidate variables (demographics, disease histories, medications, and biomarkers) at the study baseline. The study outcome was the change of cognitive function from the baseline to the 40th month, assessed through the Digit Symbol Substitution Test (DSST) , Rey Auditory Verbal Learning Test (RAVLT) , Mini-Mental State Examination (MMSE) , and Stroop test. A computer-driven approach identified a close relationship between renal function and the effectiveness of intensive glycemic control in preventing CFD: study participants with the urinary albumin less than 0.4 mg/dl (absolute function change (AFC) : 0.43 in MSSE) or urinary creatinine 120-200 mg/dl (AFC: 0.30 in RAVLT) had slower CFD associated with intensive glycemic control, while participants with GFR&amp;lt;60 (AFC:-0.51 in RVALT) , or GFR&amp;lt;90 (AFC:-1.7 in Stroop) had a faster CFD associated with intensive glycemic control. In addition, only participants with age below 60 years old benefited from the intensive glucose control (AFC:1.23 in DSST) in preventing CFD. All p&amp;lt;0.05. Our study tied renal function to the effectiveness of intensive glycemic control in preventing CFD. Clinicians may consider these individualized characteristics for better-targeted A1c goal setting, especially those at risk for CFD. Disclosure H.Kianmehr: None. J.Guo: None. V.Fonseca: Consultant; Abbott, Asahi Kasei Corporation, Bayer AG, Novo Nordisk, Sanofi, Research Support; Fractyl Health, Inc., Jaguar Gene Therapy, Stock/Shareholder; Abbott, Amgen Inc., BRAVO4Health, Mellitus Health. L.Shi: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.

Multifactorial interventions to prevent falls in older adults

BACKGROUND: Falls are one of the most common syndromes in old age. An estimated 646,000 deaths from falls occur each year worldwide. Moreover, most fatal falls occur in people over 65 years of age. Most falls are the result of the interaction of several factors.&#x0D; AIMS: To examine the long-term effectiveness of multifactorial interventions in preventing falls in elderly and senile patients.&#x0D; MATERIALS AND METHODS: A sample of patients territorially attached to the Family Medicine Center of the North-Western State Medical University named after I.I. Mechnikov was established four years ago. Individual fall prevention programs were developed for all study participants (n = 260) because they had different falls risk factors. Patient follow-up was continued for 12 months. The results of the multifactorial intervention were evaluated after 12 months and after 3 years, 2 times in total, the last study in a random subsample of patients (n = 84). Aging asthenia screening, questionnaires, assessment of emotional status, and presence of sleep disturbances were performed to assess the risk of falls. The effectiveness of multifactorial interventions was assessed based on repeated assessment of risk factors for falls.&#x0D; RESULTS: Participants with a history of falls were significantly more likely to have symptoms of depression, anxiety, symptoms of frailty, visual and hearing impairment (p 0.05). On average, each participant in the group with falls had 6.1 2.1 risk factors for falls and 3.8 2.3 in the group without falls (p = 0.000). During the follow-up period after the interventions, the incidence of falls decreased 9-fold after one year (from 28.5% to 3.1%) and then increased to 23.8%. All patients who fell after the multifactorial intervention had a history of cognitive impairment and falls. In addition, in the group of patients with falls, fall risk factors such as low levels of physical activity, hearing impairment, and the presence of a traumatic environment at home were not eliminated. As a result of the interventions, fear of falls disappeared in 9 patients, 95% CI (2.35-65.89), p = 0.039.&#x0D; CONCLUSIONS: The study demonstrated a decrease in the effectiveness of multifactorial interventions to prevent falls at three years. A less persistent effect was seen in patients with a history of falls. A history of falls, symptoms of frailty, complaints of fear of falls, sleep disturbances, and anxiety symptoms were factors that increased the risk of falls. Individualized fall prevention programs resulted in decreased fear of falls.

Clinical features, risk factors and a prediction model for in-hospital mortality among diabetic patients infected with COVID-19: data from a referral centre in Iran

ObjectivesThe aim of this study was to identify risk factors of in-hospital mortality among diabetic patients infected with COVID-19. Study designThis is a retrospective cohort study. MethodsUsing logistic regression analysis, the independent association of potential prognostic factors and COVID-19 in-hospital mortality was investigated in three models. Model 1 included demographic data and patient history; model 2 consisted of model 1, plus vital signs and pulse oximetry measurements at hospital admission; and model 3 included model 2, plus laboratory test results at hospital admission. The odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported for each predictor in the different models. Moreover, to examine the discriminatory powers of the models, a corrected area under the receiver-operating characteristic curve (AUC) was calculated. ResultsAmong 560 patients with diabetes (men = 291) who were hospitalised for COVID-19, the mean age of the study population was 61.8 (standard deviation [SD] 13.4) years. During a median length of hospitalisation of 6 days, 165 deaths (men = 93) were recorded. In model 1, age and a history of cognitive impairment were associated with higher mortality; however, taking statins, oral antidiabetic drugs and beta-blockers was associated with a lower risk of mortality (AUC = 0.76). In model 2, adding the data for respiratory rate (OR 1.07 [95% CI 1.00–1.14]) and oxygen saturation (OR 0.95 [95% CI 0.92–0.98]) slightly increased the AUC to 0.80. In model 3, the data for platelet count (OR 0.99 [95% CI 0.99–1.00]), lactate dehydrogenase (OR 1.002 [95% CI 1.001–1.003]), potassium (OR 2.02 [95% CI 1.33–3.08]) and fasting plasma glucose (OR 1.04 [95% CI 1.02–1.07]) significantly improved the discriminatory power of the model to AUC 0.86 (95% CI 0.83–0.90). ConclusionsAmong patients with type 2 diabetes, a combination of past medical and drug history and pulse oximetry data, with four non-expensive laboratory measures, was significantly associated with in-hospital COVID-19 mortality.

The Relationship Between Frailty, Comorbidity and COVID-19 Mortality in Older COVID-19 Patients: Analysis of an Administrative Dataset Using Machine Learning Techniques

Introduction: Older adults have disproportionally poor outcomes following hospitalisation with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the poorest outcomes. The aim of this study was to identify the key comorbidities and functional manifestations of frailty that were associated with in-hospital mortality in older patients with COVID-19.Methods: This was a retrospective study that used the Hospital Episode Statistics administrative dataset from 1st March 2020 to 28th February 2021 for hospital patients in England aged 65 years and over. Frailty was assessed using the Dr Foster Global Frailty Scale (GFS) and comorbidity using the Charlson Comorbidity Index (CCI). Exploratory analysis techniques were used to determine mortality according to the demographic, frailty and comorbidity profile of patients. Features were selected, pre-processed and inputted into a random forest classification algorithm to predict in-hospital mortality.Results: In total 215,831 patients were included. The frailty and comorbidity measures significantly improved the model’s ability to predict mortality in patients. The most important frailty items in the GFS were dementia/delirium, falls/fractures and pressure ulcers/weight loss. The most-important comorbidity items in the CCI were diabetes (without complications), pulmonary disease, heart failure and renal failure. The best-performing model had a predictive accuracy of 70% as well as an area under the curve of 0.78.Discussion: Frailty and comorbidity are associated with poorer COVID-19 outcomes in older adults, even after adjusting for chronological age. The physical manifestation of frailty and comorbidity particularly a history of cognitive impairment and falls, may be useful in identification of patients who may need additional support during their hospital stay.Funding: None to declare.Declaration of Interest: None to declare.

P-OT014. Neurobehavior disorders and chronic fatigue associated with autoimmune disease: a rare case of multiple sclerosis

Introduction . Neurobehavior disorders and chronic fatigue are symptoms that should be explored. The causes of neurobehavior disorders and chronic fatigue can be various, one of which is autoimmune causes. Among the autoimmune diseases that cause these symptoms, the most common is SLE and Multiple Sclerosis. To establish a diagnosis of multiple sclerosis, MRI examination can be done because of its very high sensitivity and specificity and then appropriate therapy is carried out on the patient. Results . A 26-year-old male with a history of cognitive impairment in the attention domain, memory, depression and chronic fatigue for 7 years came to the neurological clinic. Previous examination history was suspected of being SLE but on a more detailed examination, there was a suspicion of Multiple Sclerosis. Then, a cerebal MRI examination was performed and a suspicion of early multiple sclerosis was noted in juxtacortical frontal lobe bilaterally, bilateral occipitalis, periventricular right anterior horn, with white matter lesion score (Fazekas) 1. Conservative therapy with analgesics and corticosteroids in patients ended good results without significant complications. Conclusion . Neurobehavior disorders and chronic fatigue are symptoms of Multiple Sclerosis that must be considered, the cerebral MRI diagnostic approach can help make the diagnosis because of its high sensitivity and specificity.

Validation of E-PRE-DELIRIC in cardiac surgical ICU delirium: A retrospective cohort study.

The early prediction model for delirium in intensive care units (ICUs)-E-PRE-DELIRIC-has been created to predict delirium development during the length of stay in ICUs. However, there have been few early predictive models for delirium in the cardiac surgical ICU (CSICU), and the predictive ability of the E-PRE-DELIRIC among patients following cardiac surgeries is still unknown. To validate the performance of E-PRE-DELIRIC in CSICU. A retrospective cohort study. Data were retrospectively extracted from the electronic records for patients admitted in CSICU from January 2018 to December 2018 in a tertiary teaching hospital in China. Adult patients were included following the criteria of the E-PRE-DELIRIC model. Predictors, including age, history of cognitive impairment, history of alcohol abuse, urgent admission, use of corticosteroids, respiratory failure, blood urea nitrogen, and mean arterial pressure, at the time of ICU admission were retrieved, and delirium was assessed twice a day using the Confusion Assessment Method for the ICU. The performance of the E-PRE-DELIRIC model was evaluated by area under receiver operator characteristic curve, precision-recall curve (AUPRC), Hosmer-Lemeshow (HL) test, and calibration belt. Of the 725 patients included, 120 (16.6%) developed delirium. The AUROC was 0.54 (95% confidence interval [CI], 0.48-0.59), and the AUPRC was 0.18 (95% CI, 0.12-0.20). The HL test showed a significant difference between predicted probability and delirium occurrence (χ2 = 17.326, P = .027), and the overestimation chance of the E-PRE-DELIRIC score was 0.24 to 0.43. The E-PRE-DELIRIC model has poor-to-fair predictive value in this study; thus, its application among the CSICU patients is limited. Development of reliable and validated tools for early prediction of delirium in CSICU is required. Early prediction of delirium risk at CSICU admission is of vital importance and could provide timely information to caregivers. However, the E-PRE-DELIRIC model should be applied cautiously in the CSICU because of the significant probability of over-estimating the risk of developing delirium.