Impairment In Elderly Patients Research Articles

Thin basement membrane nephropathy: is there genetic predisposition to more severe disease?

Sirs, For a patient who presents with isolated microscopic hematuria, three different disease entities that enter the differential diagnosis are: (a) immunoglobulin A (IgA) nephropathy, with no family history, that may also express itself with macroscopic hematuria; (b) Alport syndrome, which may present with episodes of macroscopic hematuria during childhood and should most frequently be explained by a family history of chronic kidney disease (most frequently X-linked, 85% and, less frequently, of autosomal recessive inheritance); (c) thin basement membrane nephropathy (TBMN), which invariably leads to benign familial microscopic hematuria (BFMH), with family history and infrequent episodes of macroscopic hematuria, while it is normally not expected to be accompanied by severe kidney disease, apart from low-grade proteinuria. TBMN as a heritable condition has been attributed to heterozygous mutations in the collagen type IV, alpha 3 and alpha 4 (COL4A3/COL4A4) genes on chromosome 2q36– 37, by nearly 50%. It should not be a surprise if closer look and improved techniques prove that COL4A3/COL4A4 mutations account for an even higher portion of TBMN cases that presently have been overlooked. The term TBMN, with only few exceptions, has largely been used as a synonym for benign familial microscopic hematuria, which nearly always is the only symptom, with excellent prognosis [1–3]. Those few exceptions are worth concentrating on, in view of a recent publication from my laboratory, which provides voluminous exceptional data from a population on the island of Cyprus [4]. In that report we described 13 families with the dual diagnosis of TBMN and focal segmental glomerulosclerosis (FSGS), while, in ten of them, we identified three heterozygous mutations in the COL4A3/COL4A4 genes. Combination of that data with more recent work concludes that, in a total of 59 patients over the age of 51 years, approximately two in three had developed proteinuria and chronic kidney disease, while about one in three had progressed to end-stage kidney disease (ESKD), as evidenced by the need for hemodialysis or kidney transplantation [4, 5 and unpublished results]. Older publications had attested to similar exceptions as regards the prognosis of TBMN, reporting on relatively small numbers of patients, a few of whom had presented also with additional glomerular pathologies that included proteinuria, FSGS and chronic kidney disease, occasionally also ESKD. As early as 1985, Dische et al. [6] reported on 14 TBMN patients aged 11–51 years, several of whom had progressive disease including hypertension and renal impairment, while one had reached ESKD. Nieuwhof et al. [7], in a prospective 12-year follow-up study of 19 patients with TBMN and microscopic (18/19) or macroscopic hematuria (1/19), were the first to clearly associate TBMN with late-onset renal impairment in elderly patients. In 13.5% of their patients focal global glomerulosclerosis was detected, while six first-degree relatives reached ESΚD, prompting the authors to conclude that TBMN predisposes to premature glomerular obsolescence, which, with sufficient time, leads to increased incidence of hypertension and late-onset renal insufficiency. Interestingly, the same authors mentioned that in a separate series of TBMN patients they had noted an increased proteinuria associated with FSGS in the renal biopsy. Based on their admittedly small patient cohort the authors commented that the prognosis of TBMN may not be as benign as generally Pediatr Nephrol (2009) 242:877–879 DOI 10.1007/s00467-008-1042-4

P03-107 The risk for mild cognitive impairment in elderly patients with metabolic syndrome

Objective:Recent studies suggest that the metabolic syndrome and inflammation affect cognitive decline in old age due to vascular risk factors that might cause leukoaraiosis. It is not known which components of the metabolic syndrome are mostly involved.Material and method:There were included 60 subjects aged 65-90 years divided in two groups: group A-30 subjects diagnosed with metabolic syndrome according to NCEP-ATP-III criteria; group B-30 subjects used as control for the study group. Inflammation was assessed by measuring the C-reactive protein (CRP) plasma levels. Cognitive assessments included general cognition exam using Mini-Mental State Examination. the subjects underwent head CT-scan in order to observe the presence of the leukoaraiosis. the mild cognitive impairment (MCI) was considered when the MMSE score was between 28-21points.Results:In group A 25 of the subjects presented MCI, while in group B only 13. in group A hyperglycemia was most strongly associated with cognitive function being identified in 80% of the subjects, followed by inflammation (CRP levels>1mg/L), present in 76.6% of the subjects. the subjects from group B presented hyperglycemia in 20% of the cases and high CRP levels in only 16.6% of the subjects. Leukoaraiosis was present in 60% of the subjects in group A, and in 23.3% in group B.Conclusions:Subjects with metabolic syndrome had a poorer cognitive performance than subjects without metabolic syndrome at general cognition exam. in those subjects with metabolic syndrome hyperglycemia and inflammatory status were most frequently encountered when considered the association with cognitive impairment and was noticed a higher incidence of leukoaraiosis.Acknowledgment:The work reported in this paper was supported by grant PNCDI2-41-057/2007 from the Romanian Ministry of Education and Research.

Visual Impairment in Elderly Patients Receiving Long-term Hemodialysis

Visual impairments are associated with low quality of life, impairment of daily activities, and accidental falls. As dialysis patients are increasingly older and more disabled, we sought to assess visual impairments within an elderly dialysis population. Based on data from the general population, we hypothesized that more than 30% of dialysis patients 65 years or older would have visual impairment manifested by loss of visual acuity, depth perception, or contrast sensitivity. Single-center cross-sectional study. Patients established on hemodialysis therapy, age older than 65 years. The proportion of elderly hemodialysis patients with impairments in visual acuity, contrast sensitivity, and depth perception. Lighthouse Near Visual Acuity Test, Lea Screener contrast sensitivity test (Goodlite, MA, USA), Titmus Stereotest, Folstein Mini-Mental Status Examination. 152 of 159 patients (95.6%) had visual acuity levels less than age-expected values. Under North American (American Medical Association, edition 4) guidelines for disability compensation, 62 patients (39.0%) fulfilled criteria for legal blindness. Sixty patients (37.0%) had poor contrast sensitivity and 48 (30.6%) failed the Housefly component of the Titmus Stereotest. Failing the Housefly component was associated with a lower Folstein Mini-Mental Status Examination score (23.4 +/- 4.2 v 25.1 +/- 3.5; P = 0.01). This study is limited by the cross-sectional study design and abbreviated test protocol used for vision assessment. Results of this study suggest that elderly hemodialysis patients have a high frequency of visual impairment. Formal low vision assessment and low vision rehabilitation may be useful in elderly dialysis patients. Additional study is required to determine whether the absence of depth perception in this patient group is associated with deteriorating cognitive function.

1.1 Platelet Activation and Cognitive Impairment in Elderly Patients with Metabolic Syndrome

1.1 Platelet Activation and Cognitive Impairment in Elderly Patients with Metabolic Syndrome

Erratum: Informant based measures may overestimate cognitive impairment in elderly patients

AbstractInternational Journal of Geriatic Psychiatry 2007; 22: 1169–1170. DOI: 10.1002/gps.1900If has come to our attention that this Letter to the Editor was published without an accompanying Table. We now publish below, the entire Letter as first intended.We apologise for this anomaly.

Platelet Activation and Cognitive Impairment in Elderly Patients with Metabolic Syndrome

Platelet Activation and Cognitive Impairment in Elderly Patients with Metabolic Syndrome

Factors associated with anxiety, depression and cognitive impairment in elderly patients receiving HAART

of results Patient characteristics: age 56.8 years (mean, range 50– 85), male gender 82.8%, CD4 count 555/cmm (mean, SD +347), subjects with HIV-RNA 6) and depression (CDQ score>5) were observed in 66.9% and in 54.4% of patients. Cognitive impairment ( 2 age and gender adjusted NPT, or 1 adjusted NPT) was present in 46.8% patients. Cognitive performance was not influenced by anxiety and depression scores. Similarly, age, sex, risk factors, CDC stage, plasma HIV-RNA, duration of HAART exposure were not related to anxiety and depression scores. Patients aged >60 years had greater impairment at NPT than patients aged 50–60 years (mean NPT-Z4 score: -2.0 vs. -0.7; p = 0.002). Moreover, patients with ASQ scores consistent with anxiety had CD4 counts lower than patients reporting no anxiety (mean CD4 count/cmm 447 vs. 598; p = 0.026). Finally, EFV-treated patients were more likely to show summary scores consistent with absence of both depression (CDQ<5: 41.8% vs. 60.5%; p = 0.022) and anxiety (ASQ<6: 54.5% vs. 72.8%; p = 0.018) than PI-treated subjects.

Identifying and Treating Cognitive Impairments in Elderly Patients

Elderly patients with depression are at risk for developing mild cognitive impairment (MCI), and some patients with MCI may go on to develop Alzheimer's disease. This interactive Case and Comment follows Mr. P through the initial diagnosis and treatment of MCI and introduces measurements to predict his likelihood of converting to Alzheimer's disease.

Protection against Human Immunodeficiency Virus Type 1 Tat Neurotoxicity by Ginkgo biloba Extract EGb 761 Involving Glial Fibrillary Acidic Protein

Human immunodeficiency virus (HIV)-1 Tat protein is an important pathogenic factor in HIV-associated neuropathogenesis. Despite recent progress, the molecular mechanisms underlying Tat neurotoxicity are still not completely understood. However, few therapeutics have been developed to specifically target HIV infection in the brain. Recent development of an inducible brain-specific Tat transgenic mouse model has made it possible to define the mechanisms of Tat neurotoxicity and evaluate anti-neuroAIDS therapeutic candidates in the context of a whole organism. Herein, we demonstrate that administration of EGb 761, a standardized formulation of Ginkgo biloba extract, markedly protected Tat transgenic mice from Tat-induced developmental retardation, inflammation, death, astrocytosis, and neuron loss. EGb 761 directly down-regulated glial fibrillary acidic protein (GFAP) expression at both protein and mRNA levels. This down-regulation was, at least in part, attributable to direct effects of EGb 761 on the interactions of the AP1 and NF-kappaB transcription factors with the GFAP promoter. Most strikingly, Tat-induced neuropathological phenotypes including macrophage/microglia activation, central nervous system infiltration of T lymphocytes, and oxidative stress were significantly alleviated in GFAP-null/Tat transgenic mice. Taken together, these results provide the first evidence to support the potential for clinical use of EGb 761 to treat HIV-associated neurological diseases. Moreover, these findings suggest for the first time that GFAP activation is directly involved in Tat neurotoxicity, supporting the notion that astrocyte activation or astrocytosis may directly contribute to HIV-associated neurological disorders.

Informant based measures may overestimate cognitive impairment in elderly patients

International Journal of Geriatric PsychiatryVolume 22, Issue 11 p. 1169-1170 Letter to the Editor Informant based measures may overestimate cognitive impairment in elderly patients Dr H. F. A. Diesfeldt, Dr H. F. A. Diesfeldt PgD-De Stichtse Hof, Naarderstraat 81, NL-1251 BG Laren, The NetherlandsSearch for more papers by this author Dr H. F. A. Diesfeldt, Dr H. F. A. Diesfeldt PgD-De Stichtse Hof, Naarderstraat 81, NL-1251 BG Laren, The NetherlandsSearch for more papers by this author First published: 22 October 2007 https://doi.org/10.1002/gps.1900Citations: 7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue11November 2007Pages 1169-1170 RelatedInformation

Prevalence of hearing impairment in patients with mild cognitive impairment.

The correlation between hearing and cognition is well established in dementia, but not in mild cognitive impairment (MCI).ObjectiveThe aim of the present study was to define the prevalence of hearing impairment in elderly patients with MCI and in controls.MethodsTwenty-nine patients with MCI and 24 control subjects were analyzed. We evaluated memory and hearing impairments through clinical tests, including the Mini Mental Status Examination, Clinical Dementia Rating (CDR) and Hearing Handicap Inventory for the Elderly Screening (HHIE-S). Audiometries were performed in 22 patients with MCI and 19 subjects in a control group.ResultsMCI patients showed more hearing complaints (68.9%) compared to the control group (25%) (p=0.001). No differences in the intensity of hearing complaints, measured by the HHIE-S, were detected. Nonetheless, differences between mean hearing threshold (MCI group=23.4±11.3dB and control group=16.0±10.1dB) (p=0.03) were identified.ConclusionsThere is a significant association between MCI and hearing impairment. Hearing impairment in MCI patients may be a contributory factor to cognitive decline. This may however be related to the same neuropathological process, due to lesions of cortical areas related to hearing. The early diagnosis of hearing impairment in MCI patients may offer a more appropriate approach to this disease.

Olanzapine and acute urinary retention in two geriatric patients

Background: Atypical antipsychotics are commonly used to treat behavioral disturbances in elderly demented patients. However, recent data have brought the tolerability of these drugs into question, as the majority of them have been associated with an increased risk for cerebrovascular events and death in this population. Specifically, increased risk has been found with olanzapine, aripiprazole, risperidone, and quetiapine. The other 2 atypical anti- psychotics, clozapine and ziprasidone, have not been studied in elderly populations. Although these medications are all classified as atypical antipsychotics, they exert varying degrees of blockade at dopamine, muscarinic, histaminic, and adrenergic receptors. Among these drugs, olanzapine has the greatest affinity for muscarinic receptors and, hence, may be associated with a greater risk for anticholinergic effects, including urinary retention. Objective: The aim of this report was to discuss the possibility that administration of olanzapine may provoke acute urinary retention (AUR) in some patients. Results: We describe the development of AUR leading to acute renal failure subsequent to olanzapine administration in 2 geriatric patients with benign prostatic hypertrophy (BPH). Conclusions: Given the cases presented, we recommend that clinicians measure electrolytes, blood urea nitrogen, and creatinine every 2 or 3 days for 1 or 2 weeks after initiating olanzapine treatment and after each dose increase. This is especially important for cognitively impaired elderly patients with BPH, as they may not be able to provide clear feedback regarding adverse effects of the medication. ( Am J Geriatr Pharmacother. 2007;5:241-246).

Comprehensive geriatric assessment (CGA) in elderly women with early breast cancer

19641 Background: Advancing age is a major risk factor for breast cancer. Long-term follow up is recommended after diagnosis and treatment of early breast cancer. With older age, the risk of comorbid conditions and functional impairment is increased. A useful tool in the management and follow-up of these elderly patients could be a CGA Methods: Purpose of the study: Descriptive, transversal study of the prevalence of other comorbidities and of the functional impairment in elderly patients on follow-up after curative treatment of early breast cancer. Patients: Women aged ≥ 70 years at time of diagnosis, with removed early breast cancer. Attended in a outpatient unit from January 2005 to June 2006. No disease recurrences were allowed. Methods: CGA was conducted in an oncology unit. The assessment used usual screening instruments (ADL, IADL, POMA, GDS, MMSE, MNA) as well as the performance status (PS). Co-morbidity was classified using the Charlson score. Results: 91 pts underwent CGA. Mean age at surgery of primary tumour: 76 (70–92). Mean age at time of CGA: 80 (71–95). &gt; 75% of patients had more than 84 years at time of GCA: Median follow up: 5 years (1–12). 47% PS 0. 9% PS 2. 83% were fully independent for ADL and 71% for IADL. IADL most affected was the ability to drive/use public transport. Median Charlson Score was 2 (1–6). ≥ 75% of patients had score ≥4. Most frequent comorbidity: cardiovascular disease (hypertension). Cognitive deterioration: 15%, depression: 16%. Only 28% were thin (BMI&lt; 22). 75% were polymedicated (&gt; 6 drugs). 28% had geriatric syndromes. 23% were “frail” (at least one of the following items): ADL &lt; 80; ≥ 3 comorbidities, performance status &lt; 60, ≥ 1 geriatric syndrome. Conclusions: Our results are better than reports from other geriatric teams using CGA, in terms on functional status and frailty. A high prevalence of comorbidity in our study, similar to other reports. A selection bias cannot be excluded, as the fitter patients are those that usually keep on with the follow-up. While those frail patients that do not due to their functional impairment are usually lost. Older patients with early breast cancer on follow-up have a high prevalence of comorbidity. However, in our serie, function and independence is maintained. No significant financial relationships to disclose.

Adverse Drug Events in Cognitively Impaired Elderly Patients

Background/Aims: Adverse drug events (ADEs) are a frequent problem encountered in the elderly. The aim of this study was to elucidate the factors that influence ADEs in an elderly population with cognitive impairment. Methods: 242 patients were recruited from dementia clinics and assessed after 6 months for ADEs. The use of natural health products (NHPs) was also documented. Results: Backward logistic regression found that higher age (OR = 1.06; 95% CI 1.01–1.12), and greater cognitive impairment (OR = 0.94; 95% CI 0.90–0.98) were associated with an increased risk of developing an ADE while the use of NHPs (OR = 0.32; 95% CI 0.13–0.79) was associated with a decreased risk (χ² = 27.6, p < 0.001). Conclusion: Risk of ADEs increased with greater age and cognitive impairment but decreased with the use of NHPs.

Impairment of executive function in elderly patients with major unipolar depression: influence of psychomotor retardation

The results from several studies assessing the executive function in depressed patients compared to control subjects varied from significant impairment to normal performance. To assess the executive impairment in elderly patients with major unipolar depression and to evaluate the influence of psychomotor retardation and severity of depression in the executive deficits, the performance of 15 elderly patients with unipolar depression was compared to that of 15 elderly control subjects on executive tasks. The severity of depression was evaluated by the Montgomery and Asberg depressive scale and that of psychomotor retardation by the Widlöcher's scale. In depressed patients, deficits were found on tasks assessing cognitive flexibility (Modified card sorting test (MCST) and Trail making test B), planification and elaboration of strategies (cognitive estimates), motor initiation (graphic sequences), categorisation and hypothesis making (MCST) and interference resistance (Stroop test). However, depressed patients performed normally on the Hayling test assessing the inhibition processes. Intensity of psychomotor retardation was not correlated to the performance of executive tasks. Conversely, severity of depression was related to the scores of MCST (number of errors and perseverations), Stroop and Hayling tests (time taken to complete the end of the sentence). Unipolar depressed patients showed deficits in most tasks assessing executive function. However, inhibition processes appeared to be intact in depressed patients although their implementation was difficult. The severity of depression but not that of psychomotor retardation was associated with executive deficits.

The influence of beta-blockers on delayed memory function in people with cognitive impairment.

Adrenergic signaling is important for the retrieval of intermediate-term contextual and spatial memories. The role of norepinephrine in retrieval requires signaling through beta1-adrenergic receptors in the hippocampus. Environmental cues activate the locus ceruleus, the main adrenergic nucleus of the brain, when an environmental stimulus is memorable. This leads to norepinephrine activation in the hippocampus, which is important for retrieving memories. Although beta-blockers do not impair cognition in normal subjects, this article explores the possibility that central nervous system (CNS)-active beta-blockers could affect delayed memory in patients with cognitive impairment. The authors investigated the influence of beta-blockers on delayed memory function in cognitively impaired patients. There was a trend for worse delayed memory retrieval in patients who were on CNS-active beta-blockers. These data support the notion that common medications used in cognitively impaired elderly patients can worsen cognition and that careful selection of medications may help to maximize retrieval of newly formed memories.

La population âgée hémodialysée : évaluer et prendre en charge le risque de déclin cognitif

Epidemiological data suggest a large prevalence of cognitive impairment in elderly patients on haemodialysis. They are frequently exposed to pathologies that affect the brain, and hold a plurality of risk factors for neurodegenerative and vascular dementia. Cognitive dysfunctions, because of their medical and socio-economical consequences, may led to discuss the indication for haemodialysis and its profit for the elderly patient. These facts highlight the advantage of a regular assessment of cognitive functions in this population. They also suggest the need in the future of a multidisciplinary intervention for these patients, for a better evaluation of interventions aimed on primary and secondary prevention of cognitive decline in the elderly group.

P3-133: Cognitive impairment in elderly patients with schizophrenia

P3-133: Cognitive impairment in elderly patients with schizophrenia

Comprehensive Geriatric Assessment for outpatients is important for the detection of functional disabilities and depressive symptoms associated with sensory impairment as well as for the screening of cognitive impairment

Background: The Comprehensive Geriatric Assessment (CGA) for inpatients is very useful to improve the outcomes of elderly patients. However, most of the elderly patients are provided their care by general practitioners in primary care settings without comprehensive assessment. Concise and practical assessment is necessary for the detection of geriatric problems and sufficient care in the outpatient clinic.Methods: The CGA was introduced in the outpatient clinic for elderly people in Kyoto University Hospital and 309 patients participated in the study, where cognitive impairment, depressive symptoms, activities of daily living, and self‐reported hearing and visual impairment were assessed.Results: In the patients studied, the most prevalent chief complaint was memory loss (19%). Among the patients complaining of memory loss, two‐thirds of the patients were diagnosed as cognitively impaired by the Mini‐Mental State Examination. Multiple logistic regression analysis showed that hearing and visual impairment was significantly associated with functional disabilities and that hearing impairment was significantly associated with depressive symptoms.Conclusions: Thus, the CGA for outpatients is useful for the detection of functional disabilities and depressive symptoms by asking about their sensory impairment as well as for the detection of cognitive impairment in elderly patients. Therefore, concise and practical assessment should be introduced in the primary care settings to improve the quality of life of elderly people.

Heart failure in elderly patients

Several structural and functional changes contribute to heart failure in elderly patients: an age dependent increase in sympathetic nervous activity, left ventricular wall diameter, myocardial fibrosis and apoptosis, micro- and macrovascular coronary sclerosis, aortic stiffness. As a consequence, diastolic, but also systolic heart failure is a frequent finding in elderly patients. The relation of systolic to diastolic heart failure is clearly shifted towards diastolic heart failure in elderly patients, especially in women. Mortality is increased with systolic dysfunction in elderly patients compared to younger heart failure patients. Mortality is less with diastolic dysfunction, but still higher compared to elderly without heart failure. In addition, morbidity is increased both with diastolic and systolic heart failure in elderly patients. Cognitive dysfunction is a frequent finding. After exclusion of specific cardiac and extracardiac reasons for dyspnoea, drug therapy of systolic heart failure in elderly is similar to younger patients. However, the physiological decrease of renal function and the more frequent renal impairment in elderly patients with heart failure needs to be considered. Guideline recommendations for drug therapy are based in most cases on studies conducted in younger systolic heart failure patients. A recent meta-analysis of randomized beta-blocker trials suggests improved survival with beta-blockers even in the elderly subgroup. Guidelines for the treatment of diastolic heart failure are available only recently. The term heart failure with normal left ventricular ejection fraction (LVEF) has been proposed instead of diastolic heart failure. Given the increased morbidity and mortality in elderly patients with heart failure and normal LVEF, therapy should include general measures, such as physical activity, weight reduction, volume restriction. Specific therapy includes optimal control of systolic and diastolic blood pressure, diuretics, nitrates, and frequency-control. However, randomized trials evaluating the efficacy of specific therapies in heart failure with normal LVEF are still missing.