Item Cognitive Impairment Test Research Articles

#3042 Prevalence and associations of impaired cognitive function for people with chronic kidney disease: baseline findings from the NURTuRE-CKD cohort study

Abstract Background and Aims Chronic kidney disease (CKD) is known to be associated with impaired cognitive function, with lower estimated glomerular filtration rate (eGFR) associated with poorer cognitive performance [1]. Though CKD prevalence increases with age, the association with cognitive disorders is not entirely explained by age distribution. Cognitive impairment in CKD is multifactorial with potential biochemical, cardiovascular, medication and socio-economic mediators. As with other long-term conditions, self-management of kidney disease becomes more difficult in the context of cognitive impairment. The prevalence and associations of cognitive impairment in people referred to secondary care with CKD is not well described. This study therefore aimed to identify the prevalence and associations of impaired cognitive function among a referred population of people with CKD. Method The NURTuRE-CKD cohort recruited 2996 people with an estimated Glomerular Filtration Rate (eGFR) of 15-59 ml/min/1.73 m2 (CKD-EPI equation) or ≥60 ml/min/1.73 m2 with a urine albumin to creatinine ratio (uACR) of more than 30 mg/mmol referred to one of 16 secondary care nephrology clinics. Baseline data were collected between 2017-2019 including sociodemographic, anthropometric, biochemical, and clinical information and included the 6-item cognitive impairment test (6-CIT), a commonly used cognitive screening instrument. Other scores collected included the Hospital Anxiety and Depression score (HADS), EQ-5D-5L as a health-related quality of life (HRQoL) measure and Single Item Literacy Screener (SILS). Prevalence of impaired cognitive function (defined as 6-CIT score of 8 or more out of 28) was calculated and multivariable mixed effects logistic regression models used to identify associations with impaired cognitive function. The multivariable model was adjusted for known factors impacting cognitive impairment and recruitment region as a random effect. Results A total of 2743/2996 (91.6%) participants had complete 6-CIT data. Median age was 66 years and 41% were female. Median eGFR was 34 ml/min/1.73 m2. Prevalence of cognitive impairment was 8.7% (240/2743), rising from 5.3% in those <65 to 10.6% in those ≥65 years. eGFR was not associated with cognitive impairment on univariate analysis. After adjustment, greater likelihood of cognitive impairment was independently associated with older age, Asian and Black ethnicity (compared to white), and limited health literacy. Lower likelihood of cognitive impairment was associated with better HRQoL and higher education attainment (Figs 1 and 2). Conclusion Cognitive impairment was relatively common in this cohort of people with CKD. Similar associations for cognitive impairment with age and education in a CKD population had also been identified in CKD-REIN—a prospective cohort of CKD patients recruited from secondary care in France, though using a different cognitive function measure. Associations of limited health literacy, ethnicity, and HRQoL with cognitive impairment were identified risk factors that could aid clinicians in recognising high risk patients to prompt screening and improve management. Follow-up data will allow longitudinal analyses to explore associations between impaired cognitive function and health-related outcomes, between kidney function and change in cognitive function and risk factors for change in cognitive function, including the role of inflammatory markers. Limitations: this analysis only used baseline data so causality cannot be established, 6-CIT is a screening rather than diagnostic tool for cognitive impairment.

Prevalence of Cognitive Impairment among Iraqi Patients with Ankylosing Spondylitis

Abstract Background: Ankylosing spondylitis (AS) is the prototype of spondyloarthropathies and one of the common rheumatic diseases (RDs). Various degrees of cognitive impairment have been reported with most autoimmune RDs. Objectives: To estimate the prevalence of cognitive impairment in AS patients and its relationship to disease activity and functional limitations and the effect of various sociodemographic and clinical characteristics on cognitive function in AS patients. Materials and Methods: This case–control study comprised 100 patients with AS and 100 healthy subjects who were matched for age, gender, and educational level. Private interviews were conducted with participants to complete the questionnaire and evaluate cognitive function using the 6-item Cognitive Impairment Test (6-CIT) and the Montreal Cognitive Assessment (MoCA). Results: According to MoCA, 48% of AS patients and 16% of healthy controls were cognitively impaired (P = 0.001). By 6-CIT, 6% of the AS group had cognitive impairment, whereas all 100 controls had normal cognitive function (P = 0.029). There was a significant direct correlation between 6-CIT score with marital status (P = 0.020), BMI (P = 0.021), and Bath Ankylosing Spondylitis Disease Activity Index (P = 0.008) and inverse correlation with employment (P = 0.015), education (P = 0.008), and family income (P = 0.12). There was significant direct correlation between MoCA with employment (P = 0.009), education (P = 0.005), family income (P = 0.022), and use of non-steroidal anti-inflammatory drugs (NSAIDs) (P = 0.008) and inverse correlation with marital status (P = 0.002). Conclusions: Patients with AS have a higher degree of cognitive impairment than healthy individuals. It is associated with disease activity, lower socioeconomic status, being widowed, and obesity. Use of NSAIDs is associated with lower cognitive impairment.

The Association between cognitive impairment and anthropometric indices among the elderly: birjand longitudinal aging study.

The population of older adults has been consistently on the rise. We aimed to assess the possible relationship between cognitive decline and anthropometric indices in older adults, using data from the Birjand longitudinal aging study (BLAS). In this cross-sectional research, the association between cognitive impairment as determined by two tests (Six Item Cognitive Impairment Test (6-CIT)) and (Mini-Mental State Examination (MMSE)) and anthropometric indices including waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), waist to hip ratio (WHR), body roundness index (BRI), and a body shape index (ABSI) were assessed among 1353 elderly ≥ 60 years old, participating in the BLAS cohort study (September 2018 to April 2019). Ordinal and binary logistic regression were used for analysis. According to the MMSE test, 58.3% of participants had cognitive impairment, while this frequency was 64.2% based on the 6-CIT test. A significant reverse association was observed between cognitive decline according to the 6-CIT test and BMI, WHR, and WC (P < 0.05). Cognitive impairment, according to MMSE, was inversely associated with WC and directly associated with WHtR and ABSI in the crude model, which disappeared after adjustment for confounders. BRI was not significantly related to any of the cognitive tests. According to BMI and WC, overweight and obesity could reduce the risk of cognitive impairment. Overall, the result of this study showed that the risk of cognitive decline decreased among the elderly as BMI, WC, and WHR increased. The online version contains supplementary material available at 10.1007/s40200-024-01404-8.

Using 6-CIT, P300 encephalography, and pro-inflammation assessments for screening age-related cognitive decline and exploring associated risk factors in Egyptian elderly

BackgroundThe elderly population is suffering from many mental health problems that are aggravated as a matter of age and cognitive decline is a serious one of them. The aim of the present work is to screen the cognitive performance among a sample of Egyptian elderly volunteers and to investigate the associated risk factors.ResultsA sample of 88 elderly volunteers from both genders was enrolled in the study according to the specified eligibility criteria after signing the approval consent. Medical history and socio-demographic data were collected from all participants in addition to basic clinical examination. Cognitive performance was assessed using the 6-Item Cognitive Impairment Test (6-CIT) while the endogenous event-related potentials (ERP) was measured using P300. The inflammatory biomarkers; TNF-α and COX-2 levels were assessed in serum using ELISA technique in addition to gene expression of TNF-α, PPAR-γ and CD-36 exploration using qRT-PCR. About half (51%) of the sample under investigation showed cognitive problems with scores on the 6-CIT exceeding the normal level. TNF-α serum levels showed positive correlation with P300 latency and correlated negatively with P300 reaction time. Furthermore, serum COX-2 levels correlated positively with P300 reaction time and negatively with P300 amplitude.ConclusionThe study population is showing early signs of cognitive decline that invites attention to the importance of spreading preventive measures against further deterioration. Inflammatory biomarkers under investigation and 6-CIT are suggested to be used in prediction of early stages of cognitive decline among the elderly population.

Serum Vitamin D Status and Cognitive Function in Iranian Older Adults: Evidence from the Birjand Longitudinal Aging Study

BackgroundThere is evidence of the role of vitamin D deficiency in cognitive decline. However, the results of studies regarding the relationship between the reduction of vitamin D concentrations and cognitive impairment are heterogeneous. ObjectivesWe aimed to answer the question of whether vitamin D deficiency is associated with cognitive decline in older adults. MethodsIn this cross-sectional study, the baseline data of the Birjand Longitudinal Aging Study (BLAS) were analyzed. Of 1420 participants in the BLAS, 1219 participants aged ≥60 y old were included in the present study. Serum concentrations of 25-hydroxyvitamin D [25(OH)D] were measured by the enzyme-linked immunosorbent assay method. The 6-item Cognitive Impairment Test (6-CIT), Mini-Mental State Examination (MMSE), Category Fluency Test (CFT), and Abbreviated Mental Test Score (AMTS) were used to assess cognitive function. Multiple logistic regression analysis, adjusted for potential confounders, was employed to estimate the association between cognitive function and 25(OH)D concentrations. ResultsAmong study participants, 905 (74.24%) had sufficient vitamin D concentrations (≥20 ng/ml), 209 (17.15%) had insufficient vitamin D concentrations (12–20 ng/ml), and 105 (8.61%) had vitamin D deficiency (<12 ng/ml). There was no significant correlation between serum 25(OH)D concentrations and scores of 6-CIT (P = 0.279), AMTS (P = 0.181), MMSE (P = 0.118), and CFT (P = 0.259). Also, the prevalence of cognitive impairment had no significant relationship with vitamin D status. Finally, in the multiple logistic regression analysis, there was no association between the insufficient or deficient concentrations of 25(OH)D and impaired cognitive function both before and after adjustment for various cofounders. ConclusionsThe present study found no significant association between vitamin D status and cognitive impairment.

Cognitive impairment and depressive symptoms in severe COVID‐19 elderly survivors: Preliminary results from 1‐year follow‐up assessment

AbstractBackgroundStudies have pointed towards the presence of neuropsychiatric sequelae after COVID‐19 infection, yet in the midst of the biggest health threat of this generation there are relatively few long‐term studies which have endeavored to identify such complications, known to have a negative impact on quality of life. In this context, this study aims to identify cognitive impairment (CI) and depressive symptoms in severe COVID‐19 elderly survivors, 1‐year after hospital discharge and also to analyse the association between CI and depressive symptoms.MethodThis study is part of the longitudinal MAPA project still ongoing at a University Hospital in Porto, Portugal. Patients with &gt;60 y.o., admitted into Intensive Care Medicine Department (ICMD), due to COVID‐19 (1st wave), were included. Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss or inability to communicate at the follow‐up assessment. Participants were evaluated 1‐year after hospital discharge, with a research protocol, which includes Patient Health Questionnaire (PHQ‐9; depressive symptoms) and Six Item Cognitive Impairment Test (6CIT; CI).ResultThirty‐eight patients were included (median age = 71years). Mostly were male (66%), married (66%) and with low education (58% = 0‐4years). About 53% had previous psychiatric history (none had clinical registry of CI or dementia). Most patients (71%) needed deep sedation and invasive mechanical ventilation (71%). CI and depressive symptoms were observed in 18.4% of the sample, for both. Patients with depression had more CI (42.9%vs12.9%), however this difference was not statistically significant.ConclusionThese findings showed that an important proportion of severe COVID‐19 elderly survivors suffers from depressive symptoms and CI, 1‐year post‐discharge, which are in line with other studies. These results underline the need to better clarify the long‐term relationship between depression and CI in severe COVID‐19 survivors.

Comparison of the Six Item Cognitive Impairment Test (6CIT) to Commonly-Used Short Cognitive Screening Instruments in a Memory Clinic Population.

Short cognitive screening instruments (CSI) are required to identify cognitive impairment in busy outpatient clinics. While the Six Item Cognitive Impairment Test (6CIT) is commonly used, its accuracy in those with mild cognitive impairment (MCI) and subjective cognitive decline (SCD) and against more widely-used CSIs is less well established. To examine the diagnostic accuracy of the 6CIT against the Montreal Cognitive Assessment (MoCA) and Quick Mild Cognitive Impairment (Qmci) screen across the cognitive spectrum in a memory clinic population. In total, 142 paired assessments were available (21 with SCD, 32 MCI, and 89 with dementia). Consecutive patients underwent a comprehensive assessment and were screened using the 6CIT, Qmci, and MoCA. Accuracy was determined from the area under receiver operating characteristic curves (AUC). The median age of patients was 76 (±11) years; 68% were female. The median 6CIT score was 10/28 (±14). The 6CIT was strongly, negatively, and statistically significantly correlated with the Qmci (r = -0.84) and MoCA (r = -0.86). The 6CIT had good accuracy for separating cognitive impairment (MCI or dementia) from SCD, (AUC:0.88; 0.82-0.94), similar to the MoCA (AUC:0.92; 0.87-0.97, p = 0.308), but statistically lower than the Qmci (AUC:0.96; 0.94-0.99, p = 0.01). The 6CIT was faster to administer, median time 2.05 minutes versus 4.38 and 9.5 for the Qmci and MoCA, respectively. While the Qmci was more accurate than the 6CIT, the shorter administration time of the 6CIT, suggests it may be useful when assessing or monitoring cognitive impairment in busy memory clinics, though larger samples are required to evaluate.

Identifying Delirium in Persons With Moderate or Severe Dementia: Review of Challenges and an Illustrative Approach

Delirium and dementia are common causes of cognitive impairment among older adults, which often coexist. Delirium is associated with poor clinical outcomes, and is more frequent and more severe in patients with dementia. Identifying delirium in the presence of dementia, also described as delirium superimposed on dementia (DSD), is particularly challenging, as symptoms of delirium such as inattention, cognitive dysfunction, and altered level of consciousness, are also features of dementia. Because DSD is associated with poorer clinical outcomes than dementia alone, detecting delirium is important for reducing morbidity and mortality in this population. We review a number of delirium screening instruments that have shown promise for use in DSD, including the 4-DSD, combined Six Item Cognitive Impairment Test (6-CIT) and 4 'A's Test (4AT), Confusion Assessment Method (CAM), and the combined UB2 and 3D-CAM (UB-CAM). Each has advantages and disadvantages. We then describe the operationalization of a CAM-based approach in a current ECT in dementia project as an example of modifying an existing instrument for patients with moderate to severe dementia. Ultimately, any instrument modified will need to be validated against a standard clinical reference, in order to fully establish its sensitivity and specificity in the moderate to severe dementia population. Future work is greatly needed to advance the challenging area of accurate identification of delirium in moderate or severe dementia.

Prevalence of Neurological Manifestations in Individuals Affected with Skeletal Fluorosis in Endemic Villages of Nalgonda District

Background: Fluorosis is a prevailing public health problem in many parts of the country. It is mainly caused by excessive intake of fluorides through drinking water. The effects are mainly on bones and teeth, producing skeletal and dental fluorosis respectively, which often are irrevers-ible. Nalgonda district in Telangana state was known for highest fluorosis cases. So, we aimed to study the prevalence of headache, lethargy, impaired memory and insomnia and to determine the severity of these conditions.Methodology: A community-based cross-sectional study was conducted in Marriguda and narayanapuram mandals of Nalgonda district. 85 patients were recruited for the study. The data was collected using ‘Headache Impact Test-6 version 1.1’ for headache, ‘Regensburg Insomnia Scale’ for insomnia, ‘Fatigue Assessment Scale’ for lethargy and ‘Six Item Cognitive Impairment Test (6CIT)’ for impaired memory. Results: It was found that a total of 48.2% of individuals suffered from headache, 48.2% of individuals had insomnia, 57.6% of them complained of lethargy and 43.5% of them had impaired memory. Males were more prone to these manifestations except insomnia where females were more affected. Conclusion:Our study reported that the most prevalent neurological manifestation was lethargy and impaired memory is the least prevalent manifes-tation. Males were found to be more prone to developing these manifestations than females except in the case of insomnia.

Developing Algorithm Based on Activity and Mobility for Pressure Ulcer Risk Among Older Adult Residents: Implications for Evidence-Based Practice.

A pressure ulcer (PU) is a localized injury to the skin or underlying tissue usually over a bony prominence. The prevention PU per patient per day is costly; therefore, the detection of a PU at its earliest stage is imperative to afford timely interventions. Currently, there are very few clinically useful tools to assist with early PU detection and prevention. There were two primary aims of this study: (1) to investigate the relationship between activity, mobility, and PU development; and (2) to ascertain the next steps for delineating an algorithm based on activity and mobility for detecting PU risk among older adult residents in long-term care. This quantitative, prospective, descriptive, non-experimental study was conducted between July 2019 and March 2020 among 53 older adult residents who were followed for 4 consecutive days. Participants' Braden score, Elderly Mobility Scale (EMS) score, Movement Level, and 6-item Cognitive Impairment Test score were assessed. Further, the sacrum and heels were assessed daily using a non-invasive subepidermal moisture (SEM) scanner and visual skin assessment (VSA). SEM values > 0.5 were considered as indicative of the presence of an SEM-PU. The incidence rate of VSA-PU was 15.1% (N=8). There was an incidence of 87.5% (N=42) of SEM-PU damage. According to the Braden subscale, Mobility Braden, most of the participants (62.2%, N=33) were assessed as having no limitations/slightly limited mobility, while the EMS indicated that most of the participants (67.9%, N=36) were classed in an independent category. From the 42 SEM-PUs observed, 62% (N=26) occurred among the low movers, and 38% (N=16) occurred among the high movers. Using traditional methods for the assessment of movement does not provide insight into the protective nature of the movement. Given that both low- and high-moving patients can develop tissue damage, it is important to focus on the assessment of movement using more objective measures and algorithms, which enable real-time assessment of the protective nature of the movement. This would enable development of person-centered PU prevention strategies to reduce the burden of this significant healthcare problem.

Factors Associated With Walking in Older Medical Inpatients

ObjectiveTo identify patient characteristics on admission and daily events during hospitalization that could influence older medical inpatients walking activity during hospitalization. DesignA cohort study. SettingAcute hospitalized care. ParticipantsPremorbidly mobile, nonsurgical, nonelective inpatients (50% women) aged ≥65 years (N=154), with an anticipated ≥3-day inpatient stay were recruited consecutively within 48 hours of hospital admission. Of the 227 patients screened, 69 did not meet study criteria and 4 refused. InterventionsNot applicable. Main Outcome MeasuresAge, comorbidities (Cumulative Illness Rating Scale), cognitive status (6-item Cognitive Impairment Test), falls history and efficacy (Falls Efficacy Scale-International), physical performance (short physical performance battery), and medications were recorded within 2 days of admission. Walking activity (step count) was recorded for 7 days or until discharge. Daily events (procedures, falls, fear of falling, ordered bedrest, devices or treatments that hindered walking [eg, intravenous fluids, wall-mounted oxygen therapy], patient- and nurse-reported medial status, fatigue, sleep quality, physiotherapy, or occupational therapy intervention) were measured on concurrent weekdays. Their associations with daily (log) step count were estimated using linear mixed-effects models, adjusted for patient-characteristics measured at admission. ResultsApproximately half of the variability in step count was described at the within-patient level. Multivariable models suggested positive associations with Wednesdays (+25% in step count; 95% confidence interval, 4-53), admission physical performance (+15%, 8-22), improving medical status (+33%, 7-64), negative associations with devices or treatments that hinder walking (−29%, −9 to −44), and instructed bedrest (−69%, −55 to −79). ConclusionDay-to-day step count fluctuated, suggesting considerable scope for intervention. Devices or treatments that hinder walking should be reviewed daily and walking activity should become a clinical priority. Admission physical performance may identify vulnerable patients.

CAM-ICU may not be the optimal screening tool for early delirium screening in older emergency department patients: a prospective cohort study.

Delirium is a frequent problem among older patients in the emergency department (ED) and early detection is important to prevent its associated adverse outcomes. Several screening tools for delirium have been proposed for the ED, such as the 6-Item Cognitive Impairment Test (6-CIT) and the Confusion Assessment Method-ICU (CAM-ICU). Previous validation of the CAM-ICU for use in the ED showed varying results, possibly because it was administered at different or unknown time points. The aim was to study the prevalence of delirium in older ( ≥ 70 years) ED patients using the CAM-ICU and 6-CIT. A prospective cohort study was carried out in one tertiary care and one secondary care hospital in the Netherlands. Patients aged 70 years and older attending the ED were included. Delirium screening was performed within 1 h after ED registration using the CAM-ICU. The 6-CIT was determined for comparison using a cut-off point of at least 14 points indicating possible delirium. A total of 997 patients were included in the study, with a median age of 78 years (interquartile range 74-84). Delirium as assessed with CAM-ICU was positive in only 13 (1.3%, 95% confidence interval: 0.8-2.2) patients. Ninety-five (9.5% 95% confidence interval: 7.9-11.5) patients had 6-CIT more than or equal to 14. We found a delirium prevalence of 1.3% using the CAM-ICU, which was much lower than the expected prevalence of around 10% as being frequently reported in the literature and what we found when using the 6-CIT. On the basis of these results, caution is warranted to use the CAM-ICU for early screening in the ED.

Identifying People with Dementia in Electronic Primary Care Records in the UK

Abstract Background Many epidemiological questions need to be answered regarding dementia, including the causes, prognosis, comorbidities, and treatment of the condition and complications. A routine electronic primary care dataset provides a way of investigating some of the complicated factors with rich information. However, there has been concern regarding whether dementia is recorded well enough. Methods This study has therefore explored this by conducting a systematic review to understand how dementia has been identified previously in primary care databases in the UK, and added to this by exploring additional terms and symptoms, and medications that might be helpful in identifying people with dementia. The study estimated the prevalence and incidence rates of dementia in The Health Improvement Network (THIN) database and compared with other longitudinal studies using the comprehensive list of diagnostic codes. Results The estimated incidence rates per 1,000 person-years for the 60+ age group who had any of the first diagnosis among the Quality Outcomes Framework (QOF) defined codes, Other diagnoses, Dementia symptoms and Prescribed medications were 2.5, 4.7, and 15.9 in 1995, 2004, and 2015 respectively. The estimated prevalence were 2.8, 3.2, and 10.2 in 1995, 2004, and 2015 respectively. Conclusions The codes related to dementia symptoms (represented by mini-mental state examination, the six item cognitive impairment test, referral to memory clinic and behaviour assessment) seem to cover a broad definition of dementia or pre-existing dementia population in the UK primary care records. At least, using of the Other diagnoses (represented by dementia annual review, senile/presenile dementia and dementia monitoring) in addition to the QOF defined codes, and Prescribed medications were evidenced that will not missing out a number of people with dementia. Key messages The codes related to dementia symptoms seem to cover a broad definition of dementia or pre-existing dementia population in electronic primary care records in the UK. Nevertheless, the codes about non-specific or temporary symptoms may need to be used carefully as it is possible for memory or cognitive function to be impaired temporarily due to other factors.

Associations between Frailty and Delirium among Older Patients Admitted to an Emergency Department

Background: Switzerland’s demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium. Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland. Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants’ cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant’s most significant informal caregiver. Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference. Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

The Relationship between Hypertension and Cognitive Function Impairment in the Elderly

BACKGROUND:Hypertension is still a health problem both in developed and developing countries. Hypertension can cause various complications; one of them is cognitive function impairment.AIM:This study aimed to look at the relationship of hypertension with cognitive function. This research can also be useful to help optimise the health of the elderly, maximise quality of life and avoid hypertension as a risk factor for cognitive impairment in the elderly at the Karya Kasih Nursing Homes, Medan from May to June 2018.METHODS:This research was carried out by analytic observational with cross-sectional research approach. In this study, 57 elderly from Karya Kasih Nursing Homes Medan who met the inclusion and exclusion criteria participated. Assessment of cognitive function used Mini-Mental State Examination (MMSE), Six Item Cognitive Impairment Test (6CIT) and Abbreviated Mental Test Score (AMT) instruments.RESULT:This study obtained a significant relationship between the history of hypertension with impaired cognitive function (p = 0.003). The results of the cognitive function examination with MMSE showed that among 57 elderly, 16 people (43.2%) were normal and 21 people (56.8%) had impaired cognitive function in the first degree hypertension group, besides that, 3 people were normal (15%) and 7 people (85%) had impaired cognitive function in the second degree hypertension group (p = 0.031). Based on the result of mild and severe cognitive function impairment, among 12 people (57.1%) and 9 people (42.9%) had a mild and severe cognitive function impairment, respectively, in first-degree hypertension. 3 people (17.6%) and 14 people (82.4%) had a mild and severe cognitive function impairment, respectively, in the second-degree hypertension (p = 0.013). The 6-CIT instrument also showed a significant relationship between the severity of hypertension and impaired cognitive function (p = 0.027), and there was no significant relationship with AMT instruments (p = 0.078).CONCLUSION:There was a relationship between the history or duration and degree of hypertension with cognitive dysfunction in the elderly at the Karya Kasih Nursing Home Medan.

The relationship between functional status, physical fitness and cognitive performance in physically active older adults: A pilot study.

ObjectiveAgeing is associated with a progressive decline in physical function and cognitive performance which could result in a shift from an independent to a more dependent lifestyle. The aim of this research study was to assess the fitness, functional performance and cognitive ability in independently living older South Africans and to determine which fitness parameters and functional performance tests best explain the variance in cognitive function.DesignDescriptive observational study.ParticipantsOlder adults with a mean age 71±4.7 years (n = 70; 28 men and 42 women) were recruited. Sixty percent of the sample completed at least secondary schooling and more than two-thirds were taking medication for a chronic medical condition.MeasurementsSelf-reported physical activity was assessed using the Yale Physical Activity Survey. Fitness tests included the 6-minute walk test and Bicep Curls. The functional performance tests were; Static and Dynamic balance, Timed Up and Go, Sit to Stand, Grip strength and Functional Reach. The Stroop Task and 6-Item cognitive impairment test were used to measure cognitive performance. Bivariate and multivariate analyses were conducted between performance on the novel cognitive Stroop Task and functional and cognitive tests.ResultsWe found significant relationships between the number of correct responses on the Stroop Task and scores on the 6-Item Cognitive Impairment test (-0.520, p < 0.01) and grip strength (r = 0.42, p< 0.01). The number of incorrect responses was inversely associated with functional reach (r = -0.445, p< 0.01). The final regression model included: age, dynamic balance, right arm grip strength and the score on the 6-item cognitive impairment test, and explained 44% of the variance in performance of the Stroop Task.ConclusionsThe results of this study showed that measures of physical function were associated with cognitive performance even in highly functioning older South African adults. Further research is needed to determine the extent to which exercise training can improve functional capacity and the effect on cognitive performance.

P299 Relation of body mass index and health outcomes in elderly patients with inflammatory bowel disease (IBD)

Since the global population is aging and inflammatory bowel disease (IBD) has a minimal effect on mortality, the IBD population is aging .Thereby, obesity is a substantial health care problem in the general population, as it is associated with multiple comorbidities. Underweight is a known health risk in IBD patients, but elderly IBD patients may also follow the trend of becoming obese. This study evaluates 1. the prevalence of underweight and obesity, 2. in which way clinical outcome measures are associated with BMI in elderly IBD patients. Finally, dietician consultations are assessed in order to find out whether underweight and obesity are noticed and acted upon by the physician Consecutive patients aged 65 years and older with IBD were included at the IBD outpatient clinic at the Leiden University Medical Centre. Patients were classified as underweight (BMI< 20 kg/m2), normal weight (20–25 kg/m2), overweight (25–30 kg/m2) or obese ( >30 kg/m2). Additionally, the following parameters were assessed: physical frailty (4-meter walking speed test), cognitive frailty (six item cognitive impairment test (6-CIT)), depression risk (geriatric depression scale (GDS)) and quality of life (QoL) according to the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Moreover, dietician outpatient visits were assessed in the last 5 years. BMI and health outcomes 145 patients were included, of whom 55% had Crohn’s disease. The mean age was 71 years. An overview of the results are shown in Table1. Underweight was prevalent in 7% and obesity was found in 14.1%. Underweight was more frequently found in Crohn’s disease and obesity in ulcerative colitis. Walking speed was lower in underweight patients compared with the other groups, and QoL was lowest in underweight patients. The 6-CIT did not differ between groups. Risk of depression was highest in the obese-group. More underweight patients visited a dietician than those with a higher BMI. Although a substantial part of the elderly IBD patients is underweight, obesity is twice as frequently encountered, of whom most are ulcerative colitis patients. Both underweight and obesity are associated with unfavourable health-outcomes, since underweight is associated with lower quality of life and physical frailty and obesity is associated with a higher depression risk. However, obesity is not recognised by the physician. In conclusion, weight monitoring in IBD outpatients should focus both on underweight and obesity.

Association of Well-Being Index and Cognitive Impairment with Primary Open Angle Glaucoma Patients of Malaysia: A Case-Control Study.

The purpose of this study was to determine the association of well-being and cognitive impairment with primary open angle glaucoma (POAG) patients attending a tertiary care hospital in Malaysia. Fifty-four individuals were recruited for study as cases were matched with 60 individuals as the control subjects, and data were collected using the WHO well-being index and the validated 6-item cognitive impairment test dementia test. The results showed that there was no significant association between gender, ethnicity, socioeconomic status and POAG. Patients with POAG had significantly lower well-being index scores (mean 67.93) than the control group (mean 81.60) with P-value < 0.001. Similarly, patients with POAG had a significantly higher score of cognitive impairment (CIT test) (mean 6.15) compared to the control group (mean 0.40) with P-value < 0.001. Consequently, POAG is likely to be associated with higher cognitive impairment and lower well-being index.

Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees.

Backgroundscreening for cognitive impairment in Emergency Department (ED) requires short, reliable tools.Objectiveto validate the 4AT and 6-Item Cognitive Impairment Test (6-CIT) for ED dementia and delirium screening.Designdiagnostic accuracy study.Setting/subjectsattendees aged ≥70 years in a tertiary care hospital’s ED.Methodstrained researchers assessed participants using the Standardised Mini Mental State Examination, Delirium Rating Scale-Revised 98 and Informant Questionnaire on Cognitive Decline in the Elderly, informing ultimate expert diagnosis using Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for dementia and delirium (reference standards). Another researcher blindly screened each participant, within 3 h, using index tests 4AT and 6-CIT.Resultof 419 participants (median age 77 years), 15.2% had delirium and 21.5% had dementia. For delirium detection, 4AT had positive predictive value (PPV) 0.68 (95% confidence intervals: 0.58–0.79) and negative predictive value (NPV) 0.99 (0.97–1.00). At a pre-specified 9/10 cut-off (9 is normal), 6-CIT had PPV 0.35 (0.27–0.44) and NPV 0.98 (0.95–0.99).Importantly, 52% of participants had no family present. A novel algorithm for scoring 4AT item 4 where collateral history is unavailable (score 4 if items 2–3 score ≥1; score 0 if items 1–3 score is 0) proved reliable; PPV 0.65 (0.54–0.76) and NPV 0.99 (0.97–1.00). For dementia detection, 4AT had PPV 0.39 (0.32–0.46) and NPV 0.94 (0.89–0.96); 6-CIT had PPV 0.46 (0.37–0.55) and NPV 0.94 (0.90–0.97).Conclusion6-CIT and 4AT accurately exclude delirium and dementia in older ED attendees. 6-CIT does not require collateral history but has lower PPV for delirium.

Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care.

We estimated the cost effectiveness of different cognitive screening tests for use by General Practitioners (GPs) to detect cognitive impairment in England. A patient-level cost-effectiveness model was developed using a simulated cohort that represents the elderly population in England (65 years and older). Each patient was followed over a lifetime period. Data from published sources were used to populate the model. The costs include government funded health and social care, private social care and informal care. Patient health benefit was measured and valued in Quality Adjusted Life Years (QALYs). Base-case analyses found that adopting any of the three cognitive tests (Mini-Mental State Examination, 6-Item Cognitive Impairment Test or GPCOG (General Practitioner Assessment of Cognition)) delivered more QALYs for patients over their lifetime and made savings across sectors including healthcare, social care and informal care compared with GP unassisted judgement. The benefits were due to early access to medications. Among the three cognitive tests, adopting the GPCOG was considered the most cost-effective option with the highest Incremental Net Benefit (INB) at the threshold of £30 000 per QALY from both the National Health Service and Personal Social Service (NHS PSS) perspective (£195 034 per 1000 patients) and the broader perspective that includes private social care and informal care (£196 251 per 1000 patients). Uncertainty was assessed in both deterministic and probabilistic sensitivity analyses. Our analyses indicate that the use of any of the three cognitive tests could be considered a cost-effective strategy compared with GP unassisted judgement. The most cost-effective option in the base-case was the GPCOG. Copyright © 2016 John Wiley & Sons, Ltd.