Presence Of Cognitive Impairment Research Articles

French consensus procedure for neuropsychological assessment in multiple sclerosis

Cognitive impairment is one of the invisible symptoms of Multiple sclerosis (MS), which could be associated with depression, unemployment, reduced social interaction, inability to drive, and compromised quality of life. Moreover, the presence of cognitive impairment can be considered as a long-term prognostic factor and in the follow-up of disability. So, cognitive assessment is a crucial element in clinical follow-up of patients with MS (pwMS). International recommendations mention the use of the Brief International Cognitive Assessment in MS (BICAMS). The BICAMS, that has been recently validated in French is a brief non-exhaustive assessment, developed as a short screening battery, hence needing other supplemented tests. The present paper aims to propose a consensus, approved by expert French consensus from the Cognition group of the SF-SEP (http://sfsep.org [Société Francophone de la Sclérose en Plaques]), for cognitive assessment of pwMS suggesting the tools that should be used in order to apprehend the other cognitive impairments that could appear in MS.

Risk Factors for Emergency Room Visits in Patients with Digestive Bleeding Associated with Direct-Acting Anticoagulants

Gastrointestinal bleeding is the main cause of admission to the emergency services of patients taking direct-acting oral anticoagulants (DOACs). Little is known about the effects of treatment modification on the risk of readmission, especially in elderly patients. This retrospective observational study included elderly patients with atrial fibrillation who were on DOACs and who were admitted to the emergency department due to gastrointestinal bleeding from 2018 to 2023. To evaluate the risk factors for readmission 90 days after discharge, a multivariate analysis was conducted, which included patient comorbidities, concomitant treatment, changes in anticoagulant treatment, and the prescription of DOACs at discharge. One hundred and thirty-nine patients were included. At discharge, anticoagulant therapy was modified in 44 (31.6%) patients, 16 (36.3%) patients were switched from one DOAC to another, 23 (52.2%) to heparins, and 5 (11.3%) to vitamin K antagonists. A total of 21 (15.1%) patients returned to the emergency department within 90 days after discharge due to new bleeding events. No significant differences were observed depending on the modification of treatment at discharge. The presence of cognitive impairment was the only factor associated with readmission at 90 days. Patients who undergo treatment with DOACs and have gastrointestinal bleeding at discharge are at risk of readmission to the emergency room due to new bleeding events. No benefit was observed in modifying anticoagulant treatment at discharge.

In-Hospital Delirium and Disability and Cognitive Impairment After COVID-19 Hospitalization.

Older adults who are hospitalized for COVID-19 are at risk of delirium. Little is known about the association of in-hospital delirium with functional and cognitive outcomes among older adults who have survived a COVID-19 hospitalization. To evaluate the association of delirium with functional disability and cognitive impairment over the 6 months after discharge among older adults hospitalized with COVID-19. This prospective cohort study involved patients aged 60 years or older who were hospitalized with COVID-19 between June 18, 2020, and June 30, 2021, at 5 hospitals in a major tertiary care system in the US. Follow-up occurred through January 11, 2022. Data analysis was performed from December 2022 to February 2024. Delirium during the COVID-19 hospitalization was assessed using the Chart-based Delirium Identification Instrument (CHART-DEL) and CHART-DEL-ICU. Primary outcomes were disability in 15 functional activities and the presence of cognitive impairment (defined as Montreal Cognitive Assessment score <22) at 1, 3, and 6 months after hospital discharge. The associations of in-hospital delirium with functional disability and cognitive impairment were evaluated using zero-inflated negative binominal and logistic regression models, respectively, with adjustment for age, month of follow-up, and baseline (before COVID-19) measures of the respective outcome. The cohort included 311 older adults (mean [SD] age, 71.3 [8.5] years; 163 female [52.4%]) who survived COVID-19 hospitalization. In the functional disability sample of 311 participants, 49 participants (15.8%) experienced in-hospital delirium. In the cognition sample of 271 participants, 31 (11.4%) experienced in-hospital delirium. In-hospital delirium was associated with both increased functional disability (rate ratio, 1.32; 95% CI, 1.05-1.66) and increased cognitive impairment (odds ratio, 2.48; 95% CI, 1.38-4.82) over the 6 months after discharge from the COVID-19 hospitalization. In this cohort study of 311 hospitalized older adults with COVID-19, in-hospital delirium was associated with increased functional disability and cognitive impairment over the 6 months following discharge. Older survivors of a COVID-19 hospitalization who experience in-hospital delirium should be assessed for disability and cognitive impairment during postdischarge follow-up.

Oral health and cognitive function: Insights from longitudinal ageing study in India (LASI) - A cross-sectional analysis

IntroductionThe oral cavity is related to nervous system diseases, and oral issues have a bidirectional correlation with cognitive dysfunction. Thus, this study aims to explore the association between oral health problems and cognitive dysfunction in community-dwelling Indian older adults. Materials and MethodsUtilizing data from LASI, a nationally representative cohort study, this study involved 30,726 participants aged ≥60 years. The oral health problems of study participants were self-reported. Cognitive impairment was assessed using composite score, and a score of less than -1.5 SD was defined as the presence of cognitive impairment. ResultsIn univariate analysis, significant associations were observed between oral health problems (loss of some natural teeth, OR: 1.33, 95 % CI: 1.15–1.52, p < 0.001; lost all natural teeth, OR: 2.33, 95 % CI: 1.97–2.76, p < 0.001) and ease of chewing solid food [Fairly well (OR: 1.51, 95 % CI: 1.33–1.71, p < 0.001) and not at all (OR: 2.37, 95 % CI: 2.11–2.67, p < 0.001)] with cognitive impairment. In multivariate analysis, adjusted for various factors, a significant association persisted between loss of all natural teeth (OR: 1.62, 95 % CI: 1.34–1.95, p < 0.001) and the ability to chew solid food. Specifically, individuals reporting chewing solid food “Fairly well” (OR: 1.34, 95 % CI: 1.16–1.52, p < 0.001) and those unable to chew at all (OR: 1.73, 95 % CI: 1.51–1.97, p < 0.001) with cognitive impairment. ConclusionThe findings of this study underscore a compelling connection between oral health issues and cognitive impairment. Consequently, it is imperative to proactively identify and address oral health problems in older adults.

Association between serum 25-hydroxyvitamin D3 level and cognitive impairment in older chronic kidney disease patients

This study aims to examine whether hypovitaminosis D was associated with cognitive impairment among chronic kidney patients with different level of albuminuria. This population-based cross-sectional study was conducted on elderly (over 60 years old) with urine albumin to creatinine ratio (UACR) ≥ 30 mg/g from 2011 to 2014 in the US National Health and Nutrition Examination Survey (NHANES). Cognitive function was assessed by the Consortium to Establish a Registry for Alzheimer’s Disease Word List Learning (CERAD). Subjects were divided into 2 groups according to the absence or presence of cognitive impairment and a propensity score matching (PSM) was further conducted. The association was assessed with Spearman correlation and logistic regression analysis. The positive association of 25-hydroxyvitamin D3 (25(OH)D3) and cognitive score was presented. PSM analysis revealed that a higher level of 25(OH)D3 correlated to a better cognitive function in CKD patients with albuminuria, especially in patients with 30 mg/g ≤ UACR < 300 mg/g. This study indicated that a low 25(OH)D3 level was associated with poor cognitive performance, especially in patients with microalbuminuria. Thus, early diagnosis of vitamin D insufficiency and an effective intervention might be a useful therapeutic strategy to prevent cognitive decline in patients with the progression of renal dysfunction.

#2492 The GLIM classification of malnutrition in an elderly population of patients on maintenance haemodialysis

Abstract Background and Aims The prevalence of malnutrition increases with age and is common in elderly patients on haemodialysis. Malnutrition increases complications, disability, mortality, length of hospital stay and healthcare costs. The Global Leadership Initiative on Malnutrition (GLIM) classification has been proposed to define malnutrition by the combined use of aetiological (weight loss, low body mass index and reduced muscle mass on initial bioimpedentiometry and on anthropometry if bioimpedentiometry is not feasible) and phenotypic (reduced food intake and inflammation) criteria; it is still poorly validated in CKD patients. Method Retrospective study of 121 patients on maintenance haemodialysis aged 65 years or older (mean age 77.3 ± 6.57 years, M/F 97/24, 43.1% with diabetes) who underwent routine assessment of nutritional status by anthropometric measurements and impedentiometry. Patients also received a geriatric prognostic calculator, the Multidimensional Prognostic Index (MPI, 1, low risk, 2, moderate risk, 3, high risk) and the MNA sf as an initial nutritional screening tool. According to the GLIM criteria, patients were defined as malnourished if they had at least one phenotypic criterion. By definition, haemodialysis patients fulfil the aetiological criteria of inflammation. Therefore, we added additional aetiological criteria, including loss of food intake and/or high burden of comorbidities (third tertile of CIRS): Extended HD GLIM. Results The MNAsf identified 56 (46%) patients as malnourished or at risk. However, a further 21 patients had reduced muscle mass on anthropometric measurements. Given the lack of specificity of the screening in identifying patients with malnutrition in our population, all patients were considered for GLIM characterisation. 40 out of 123 (32%) patients could not undergo impedentiometry, mainly because of cardiovascular exclusion criteria. 19 of 83 (23%) patients who underwent impedentiometry had a reduced lean tissue index (LTI). We identified 54 out of 121 (44.6%) patients who met the GLIM phenotypic criteria (4 with 3, 14 with 2 and 36 with 1 criteria). The addition of the two phenotypic GLIM criteria to the simple assessment of muscle mass allowed the identification of 17 additional patients at risk of malnutrition. Compared to patients without malnutrition, those fulfilling the GLIM criteria were more likely to have a higher KT/V (1.26 ± 1.39 vs. 1.39 ± 1.52, p = 0.008), lower PTH (286.7 ± 238.8 vs. 403.1 ± 215.0), lower triglycerides (125.8 vs. 48.91 vs. 159.51 ± 85.9, p+0.012), lower serum albumin (3.76 ± 0.32 vs. 3.92 ± 0.27 g/dl, p = 0.004). In addition, patients with GLIM criteria were more likely to have a higher MPI score (0.42 ± 0.51 vs 0.31 ± 0.37, p &amp;lt; 0.001) and to live alone or in a nursing home than with a family member or carer. Conversely, no association was found between GLIM and the presence of cognitive impairment or mobility. 38 (31.4%) patients had a loss of appetite, digestive problems, chewing or swallowing difficulties in the last 3 months. By adding this criterion and that of being in the third highest tertile of CIRS, we found that among patients fulfilling the GLIM criteria, 29/54 (37%) had enhanced aetiological criteria (Expanded HD GLIM). Conclusion A significant percentage of the elderly population on maintenance haemodialysis are malnourished or at high risk. The GLIM classification is a new classification with the potential to identify patients at risk earlier, before the development of sarcopenia. Malnutrition as defined by the GLIM criteria is related to the MPI outcome score.

Clinical markers of cognitive impairment in patients with chronic heart failure of ischemic origin during out-patient regular follow-up: a cross-sectional study

Background: Cognitive impairment (CI) is present in 25–50% of chronic heart failure (CHF) patients. Doctors who monitor patients with cardiovascular disorders do not have clearly set criteria for their referral to a neurologist in case of suspected CI. Therefore, CHF patients do not receive treatment for CI on time.&#x0D; Aim: To identify significant clinical markers of CI in patients with CHF of ischemic origin.&#x0D; Materials and methods: This cross-sectional cohort study included 134 patients with CHF of ischemic origin (mean age 63.36 ± 10.63 years; men, 76.12%), who were regularly monitored in a municipal polyclinic. All patients were tested for CI with the Montreal Cognitive Assessment Scale (MoCA); basic hemodynamic parameters, lipid profile, brain natriuretic peptide (NT-proBNP) were assessed, and triglyceride-glucose index (TyG) and body mass index (BMI) were calculated. Cardio-ankle vascular index (CAVI) was measured, echocardiography and a 6-minute walk test (SMWТ) were performed and past history of CHF, arterial hypertension (AH) and diabetes mellitus (DM) was collected.&#x0D; Results: CI (MoCA score ≤ 25) was detected in 85 (63.43%) outpatients with CHF of ischemic origin; the group without CI (MoCA score 26) included 49 (36.67%) patients. There were significant correlations between MoCA and CAVI scores (partial correlation coefficient, r = -0.802, p 0.001; adjusted squared multiple correlation coefficient (adj. R2) = 0.881, p 0.001), MoCA and TyG (r = -0.357, p = 0.029; adj. R2 = 0.363, p 0.001), MoCA and SMWТ (r = -0.211, p = 0.037; adj. R2 = 0.696, p 0.001). The multivariate test for significance of planned comparisons between CAVI and MoCA scores (Wilks' lambda) was 0.005 (F = 4.74; p 0.001).&#x0D; Conclusion: CAVI, TyG and SMWТ values are the clinical markers of CI in patients with CHF of ischemic origin. There is a direct association between increased CAVI and the presence of CI, regardless of age, lipid metabolism parameters, structural and functional heart parameters, CHF duration, AH and DM. Identification of these markers could be an indication for an in-depth assessment of CHF patients by a neurologist.

Outcome After Modern Proton Beam Therapy in Childhood Craniopharyngioma: Results of the Prospective Registry Study KiProReg

BackgroundCraniopharyngiomas (CPs) are rare tumours of the sellar region often leading to significant comorbidities due to their close proximity to critical structures. Aim of this study was to analyse survival outcome and late toxicities after surgery and proton beam therapy (PBT) in childhood CPs. Patients and methodsWithin the prospective XXXX study (XXXX), data of 74 childhood patients with CP, receiving PBT between 08/2013-06/2022 were eligible. Late toxicities were analysed according to the grading system of CTCAE 4.0. Results: Median follow-up (FU) since first diagnosis was 4.3 years (range, 0.8-14.7). 75.7% of patients received PBT at time of disease progression or recurrence, whereas 24.3% as part of their primary therapy (definitive or adjuvant). Predominantly (85.1%), pencil beam scanning technique was used. Median total dose and initial tumour volume were 5400 cGyRBE (relative biological effectiveness) and 17.64 cm³ (range, 3.07-300.59), respectively. The estimated (±SE) 3-year overall survival, progression-free and cystic failure-free survival rate after PBT were 98.2% (±1.7), 94.7% (±3.0), and 76.8% (±5.4), respectively. All local failures (n=3) were in-field relapses necessitating intervention and occurred exclusively in patients receiving PBT at progression or recurrence. Early cystic enlargements after PBT were typically asymptomatic and self-limiting. Fatigue, headaches, vision disorders, obesity and endocrinopathies were the predominant late toxicities. No high grade (≥3) new-onset visual impairment or cognitive deterioration occurred compared to baseline. The presence of cognitive impairments at the end of FU correlated with size of the planning target volume (p=0.034), Dmean dose to the temporal lobes (p=0.032,p=0.045) and the number of surgical interventions prior to PBT (p=0.029). Conclusions: Our findings demonstrate favourable local control rates using modern PBT with acceptable late toxicities. Cyst growth within 12 month after radiotherapy is typically not associated with tumour progression. Longer FU has to be awaited to confirm results.

Polyvascular atherosclerosis and renal dysfunction increase the odds of cognitive impairment in vascular disease: findings of the LipidCardio study

IntroductionGrowing evidence suggests a causal role for atherosclerotic vascular disease in cognitive impairment and dementia. Atherosclerosis may present as monovascular disease (monoVD) or as widespread polyvascular atherosclerotic disease (polyVD). Evidence on the relationship between monoVD or polyVD and cognitive impairment is limited.MethodsWe conducted a cross-sectional analysis of baseline data from the LipidCardio Study. The main outcome measure was the presence of cognitive impairment, defined as a Mini-Mental State Examination (MMSE) score < 26.ResultsThe mean age was 71.5 years, 30.3% were female, 17.3% had no evidence of large-vessel atherosclerosis, 71.1% had monoVD, and 11.7% had polyVD, defined as the presence of atherosclerosis in ≥ 2 vascular territories (coronary, cerebral, aortic, or lower extremity). A total of 21.6% had cognitive impairment according to the prespecified cutoff (MMSE < 26). Overall, the odds of cognitive impairment increased for each additional vascular territory affected by atherosclerosis [adjusted odds ratio 1.76, 95% confidence interval (CI) 1.21–2.57, p = 0.003]. Furthermore, there was evidence for an interaction between vascular disease and chronic kidney disease (CKD). The odds of cognitive impairment were not greater in the monoVD subgroup compared to those without any atherosclerosis, if CKD was absent (OR 0.98, 95% CI 0.48–2.10; p = 0.095), while the odds ratio (OR) of cognitive impairment with polyVD compared to no atherosclerosis was 2.71 (95% CI 1.10–6.92; p = 0.031). In contrast, in patients with CKD, both monoVD and polyVD were associated with significantly higher odds of cognitive impairment than no atherosclerosis.ConclusionsPolyVD is associated with increased odds of cognitive impairment. MonoVD is associated with cognitive impairment only in the presence of CKD.

Machine Learning Models of Polygenic Risk for Enhanced Prediction of Alzheimer Disease Endophenotypes.

Alzheimer disease (AD) has a polygenic architecture, for which genome-wide association studies (GWAS) have helped elucidate sequence variants (SVs) influencing susceptibility. Polygenic risk score (PRS) approaches show promise for generating summary measures of inherited risk for clinical AD based on the effects of APOE and other GWAS hits. However, existing PRS approaches, based on traditional regression models, explain only modest variation in AD dementia risk and AD-related endophenotypes. We hypothesized that machine learning (ML) models of polygenic risk (ML-PRS) could outperform standard regression-based PRS methods and therefore have the potential for greater clinical utility. We analyzed combined data from the Mayo Clinic Study of Aging (n = 1,791) and the Alzheimer's Disease Neuroimaging Initiative (n = 864). An AD PRS was computed for each participant using the top common SVs obtained from a large AD dementia GWAS. In parallel, ML models were trained using those SV genotypes, with amyloid PET burden as the primary outcome. Secondary outcomes included amyloid PET positivity and clinical diagnosis (cognitively unimpaired vs impaired). We compared performance between ML-PRS and standard PRS across 100 training sessions with different data splits. In each session, data were split into 80% training and 20% testing, and then five-fold cross-validation was used within the training set to ensure the best model was produced for testing. We also applied permutation importance techniques to assess which genetic factors contributed most to outcome prediction. ML-PRS models outperformed the AD PRS (r2 = 0.28 vs r2 = 0.24 in test set) in explaining variation in amyloid PET burden. Among ML approaches, methods accounting for nonlinear genetic influences were superior to linear methods. ML-PRS models were also more accurate when predicting amyloid PET positivity (area under the curve [AUC] = 0.80 vs AUC = 0.63) and the presence of cognitive impairment (AUC = 0.75 vs AUC = 0.54) compared with the standard PRS. We found that ML-PRS approaches improved upon standard PRS for prediction of AD endophenotypes, partly related to improved accounting for nonlinear effects of genetic susceptibility alleles. Further adaptations of the ML-PRS framework could help to close the gap of remaining unexplained heritability for AD and therefore facilitate more accurate presymptomatic and early-stage risk stratification for clinical decision-making.

Diagnostic uncertainty and decision-making in home-based primary care: A qualitative study of antibiotic prescribing.

Evaluating infection in home-based primary care is challenging, and these challenges may impact antibiotic prescribing. A refined understanding of antibiotic decision-making in this setting can inform strategies to promote antibiotic stewardship. This study investigated antibiotic decision-making by exploring the perspectives of clinicians in home-based primary care. Clinicians from the Department of Veterans Affairs Home-Based Primary Care Program were recruited. Semi-structured interviews were conducted from June 2022 through September 2022 using a discussion guide. Transcripts were analyzed using grounded theory. The constant comparative method was used to develop a coding structure and to identify themes. Theoretical saturation was reached after 22 clinicians (physicians, n = 7; physician assistants, n = 2, advanced practice registered nurses, n = 13) from 19 programs were interviewed. Mean age was 48.5 ± 9.3 years, 91% were female, and 59% had ≥6 years of experience in home-based primary care. Participants reported uncertainty about the diagnosis of infection due to the characteristics of homebound patients (atypical presentations of disease, presence of multiple chronic conditions, presence of cognitive impairment) and the challenges of delivering medical care in the home (limited access to diagnostic testing, suboptimal quality of microbiological specimens, barriers to establishing remote access to the electronic health record). When faced with diagnostic uncertainty about infection, participants described many factors that influenced the decision to prescribe antibiotics, including those that promoted prescribing (desire to avoid hospitalization, pressure from caregivers, unreliable plans for follow-up) and those that inhibited prescribing (perceptions of antibiotic-associated harms, willingness to trial non-pharmacological interventions first, presence of caregivers who were trusted by clinicians to monitor symptoms). Clinicians face the difficult task of balancing diagnostic uncertainty with many competing considerations during the treatment of infection in home-based primary care. Recognizing these issues provides insight into strategies to promote antibiotic stewardship in home care settings.

Gender-and age-specific associations of sleep duration and quality with cognitive impairment in community-dwelling older adults in Anhui Province, China.

To examine associations of sleep duration and quality with cognitive impairment in older adults and the moderating role of gender and age in these associations. This community-based cross-sectional study included 4,837 participants aged 60 years and above. Cognitive function was assessed using the Chinese version of the Mini-Mental State Examination (MMSE), and the participants were grouped based on the presence of cognitive impairment. The duration and quality of sleep were assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression models were used to analyze associations of sleep duration and quality with cognitive impairment. The role of age and gender in these associations have also been explored. The age (mean ± SD) of the participants was 71.13 ± 5.50 years. Of all older adults, 1,811 (37.44%) were detected as cognitive impairment, and 1755 (36.8%) had poor sleep quality. Among those with cognitive impairment, 51.09% were female. The proportion of the participants with cognitive impairment is significantly higher in those with symptoms of depression (49.73%, 273/549) (χ2 = 41.275, p < 0.001) than in those without depressive symptoms. After adjustment for multiple confounding factors and the crucial covariate (depressive symptoms), the odds ratios (OR) (95% confidence interval [CI]) of cognitive impairment (with 7-7.9 h regarded as the reference group) for individuals with a sleep duration of <6, 6-6.9, 8-8.9, and ≥ 9 h were 1.280 (1.053-1.557), 1.425 (1.175-1.728), 1.294 (1.068-1.566), and 1.360 (1.109-1.668), respectively. Subgroup analysis showed a V-shaped association between night sleep duration and cognitive impairment in males (p ≤ 0.05), and the association was stronger for individuals aged 60-80 years. With regard to sleep quality, the fully adjusted OR (95%CI) of cognitive impairment were 1.263 (1.108-1.440). According to scores of subscales in the PSQI, daytime dysfunction was associated with an increased risk of cognitive impairment (OR: 1.128, 95%CI: 1.055-1.207). Subgroup analysis also revealed a statistically significant correlation between poor sleep quality (including daytime dysfunction) and cognitive impairment in different gender and age groups, with the association being stronger in females (OR: 1.287, 95%CI: 1.080-1.534) and those aged 81-97 years (OR: 2.128, 95%CI: 1.152-3.934). For cognitive impairment, the group aged 81-97 years with daytime dysfunction was associated with a higher odds ratio than other age groups. The present study showed that inadequate or excessive sleep was associated with cognitive impairment, especially in males, who exhibited a V-shaped association. Cognitive impairment was also associated with poor sleep quality as well as daytime dysfunction, with females and individuals aged 81-97 years exhibiting the strongest association.

Prioritized health outcomes of acutely hospitalized older patients.

Background: The population is ageing, leading to an increase in older patients visiting the Emergency Department (ED) and acute hospitalizations. Ageing is often accompanied by the presence of multiple chronic diseases, known as multimorbidity. This presence of multimorbidity challenges the application of treatment guidelines, that are generally focused on treating a single disease. Consequently, choosing the most fitting treatment option for the patient with multimorbidity often entails making a trade-off. A trade-off is a situational decision in which prioritization leads to a decrease of benefits for an outcome in return for gains in another. Insight in the health priorities of patients can aid in making this trade-off. Little is known about older patients’ health priorities while being hospitalized, especially for acute hospitalizations. Therefore, we aimed to explore the health priorities of acutely hospitalized older patients.&#x0D; Method: In this study we performed a post-hoc analysis of prospectively collected data by the Acutelines Bio- and Databank. Older hospitalized patients (aged ≥ 70 years) were included between September 2020 and October 2022 at the University Medical Centre Groningen, the Netherlands. Demographic, medical and survey data were collected. The primary outcome was the prioritized health outcome of the patient, assessed using the Outcome Prioritization Tool (OPT). Health outcomes of the OPT were life extension, maintain independence, reducing pain and reducing other complaints. Data were analyzed descriptively, whereafter two separate multivariate logistic regression analyses were performed to assess which factors are associated with prioritized health outcomes. For analysis, reducing pain and reducing other complaints were taken together and life extension was used as reference category.&#x0D; Preliminary Results: Three-hundred-ninety-nine older patients (mean age 76.7 ± 5.3) were included, with a median Charlson comorbidity score of five. Patients mainly experienced problems with their mobility (75%), somatic complaints (73%) and problems with activities in daily living (69%). Their self-rated health (0-100), based on two weeks before hospitalization, was scored with a mean of 55.5 ± 21.9. The main prioritized health outcome by patients was maintaining independence (42%), whereafter reducing pain (22%), life extension (20%) and reducing other complaints (16%) were ranked. When patients prioritized maintaining independence highest, life extension was most often the lowest priority. If patients did not prioritize maintaining independence highest, it was often prioritized as the second most important health outcome. The education level of the patient and the presence of cognitive impairment were associated more with maintaining independence compared to life extension. Experiencing fear and a lower self-rated health were associated more with reducing complaints compared to life extension. &#x0D; &#x0D; Conclusion: Our study showed that, despite being hospitalized for an acute problem, most patients prioritized maintaining independence. This is an interesting finding, as treatment guidelines focus on life extension and treating complaints. Our findings in acutely hospitalized older patients, emphasizes the importance of goal elicitation by healthcare professionals and alignment of a treatment plan to the patients’ goal. An increased awareness of this importance amongst healthcare professionals can lead to providing more optimally integrated care.

Effect of Resilience, Well-Being, Happiness, and Social Support on the Levels of Perceived Negative Emotions of Colombian People During the COVID-19 Pandemic

The research established the relationships between resilient coping, subjective well-being, subjective happiness, and social support on anxiety levels, depression, and perceived stress among Colombians during the COVID-19 pandemic in the department of Córdoba, Colombia. Participants were 997 elderly people of both genders with literacy skills and without the presence of cognitive impairment. The Brief Resilient Coping Scale (BRCS), the Happiness Scale (SHS), the Subjective Wellness Scale (SWLS), the Duke-UNC 12 social support scale, the PHQ-4 scale (anxiety-depression), and the Perceived Stress Scale (PSS-14) were used as measuring instruments. We worked with a nonexperimental cross-sectional design and a correlative scope.

Utility of accessible neuroimaging markers of cerebrovascular disease in identifying cerebral amyloidosis across the Alzheimer’s disease spectrum

AbstractBackgroundAlzheimer’s disease (AD) is defined by the presence of cognitive impairment and cerebral amyloidosis and is associated with several cerebrovascular disease (CVD) risk factors including age, apolipoprotein‐E ε4 (APOE‐ε4) genotype, hypertension, diabetes and hyperlipidemia. Despite this association, the clinical utility of individual CVD biomarkers in screening for AD pathology is understudied. Therefore, we sought to examine the relationship between cerebral amyloidosis and magnetic resonance imaging (MRI)‐based CVD measures, including cerebral microbleeds, ischemic infarction, and white matter hyperintensities (WMH). We hypothesized that CVD biomarker burden would be positively associated with amyloidosis. Given recent studies have shown plasma phospho‐tau181 (P‐tau181) is a promising early biomarker of amyloidosis, we further hypothesized that combining P‐tau181 with CVD biomarkers would predict amyloid status in cognitively unimpaired and impaired persons.MethodParticipant data were extracted from the Alzheimer’s Disease Neuroimaging Initiative database (N = 1,430). Volumetric data (WMH volume [WMHv], medial temporal lobe volume [MTLv]) were normalized and log‐transformed. Adjusted odds ratio (OR) was calculated using logistic regression with dichotomized amyloid‐PET status as the outcome. Area under the curve (AUC) was compared by the likelihood ratio test.ResultAfter adjustment for age, sex, APOE‐ε4 status, MTLv, cognition (MoCA), and other CVD biomarkers of interest, we found that WMHv alone was significantly associated with amyloidosis in both cognitively impaired (OR = 1.21) and unimpaired (OR = 1.25) persons. We then developed an accessible diagnostic model incorporating WMHv, significant covariates and plasma P‐tau181. Addition of P‐tau181 to the model improved diagnostic accuracy in cognitively impaired persons (AUC = 0.85 to 0.87, p &lt; 0.001), and did not attenuate the relationship between WMHv and amyloidosis.ConclusionWe newly identify WMH, but not other CVD lesions, as predictive of amyloidosis in both preclinical and symptomatic AD. The current study adds to the literature regarding which CVD biomarkers are most predictive of AD pathology. Measurement of WMH alongside P‐tau181 and other biomarkers may produce an accessible screening algorithm for AD. Study generalizability is limited by ascertainment bias and lack of diversity. Future research will compare the performance of WMH to standard AD biomarkers in a more diverse, community‐based sample.

Prevalence and factors associated with inappropriate dosing of apixaban and rivaroxaban in hospitalized older adults with atrial fibrillation: a cross-sectional study.

Atrial fibrillation (AF) is a common condition among older adults, requiring anticoagulation therapy to prevent thromboembolic events. Direct oral anticoagulants (DOACs) are now recommended as first-line therapy for this purpose. Apixaban and rivaroxaban are two direct-factor Xa inhibitors whose dosing is based on various factors (age, weight, creatinine, and creatinine clearance) that can affect the pharmacokinetics of the medication. This study aimed to evaluate factors associated with inappropriate dosing of apixaban or rivaroxaban based on the summary of product characteristics. A retrospective, single-center study included 777 hospitalizations of patients treated with apixaban or rivaroxaban for AF between 1 January 2018 and 31 December 2022. Primary endpoint assessed whether the dose of apixaban or rivaroxaban was within the summary of product characteristics used by European Medicine Agency (EMA). Inappropriate dosing of apixaban or rivaroxaban is noted for approximately 30% of hospitalizations mostly underdosing. Factors associated with the risk of inappropriate dosing were the presence of cognitive impairment [adjusted odds ratio (OR*) 1.65, 95% confidence interval (CI) 1.19-2.29, p value (p) = 0.002], weight per kilogram increase (OR* 1.03, 95% CI 1.01-1.04, p < 0.0001), and history of bleeding under apixaban or rivaroxaban (OR* 1.94, 95% CI 1.24-3.03, p = 0.003). This study highlighted the high prevalence of inappropriate apixaban or rivaroxaban doses in older adults, particularly underdosing, which increases the risk of thromboembolism.

Neural correlates of face processing among preschoolers with fragile X syndrome, autism spectrum disorder, autism siblings, and typical development.

The current study examined patterns of event-related potential (ERP) responses during a face processing task in groups of preschoolers uniquely impacted by autism spectrum disorder (ASD), including (1) children with ASD; (2) children with fragile X syndrome (FXS); (3) children with familial risk for ASD, but without a diagnosis (i.e., ASIBs); and (4) a low-risk control (LRC) group. Children with FXS have a high incidence of ASD diagnoses, but there have been no studies of the ERP response to faces in children with FXS and little work focused on children with ASD who have cognitive impairment. The current study examined children's ERP responses to faces and houses in four groups: LRC (N = 28, age = 5.2 years), ASIB (N = 23, age = 5.5 years), FXS (N = 19, age = 5.82 years), and ASD (N = 23, age = 5.5 years). The FXS and ASD groups were characterized by the presence of cognitive impairment. Pictures of upright and inverted faces and houses were presented while recording EEG with a 128-channel system. The N170 occurred at about 200 ms post stimulus onset, was largest on the posterior-lateral electrodes, and was larger for faces than houses. The P1 and N170 ERP components were larger for the FXS group than for the other three groups. The N170 ERP amplitude for the ASD and ASIB groups was smaller than both the LRC and FXS groups, and the LRC and FXS groups had the largest N170 responses on the right side. No difference was found in N170 latency between groups. The similarity of the ASD and ASIB responses suggest a common genetic or environmental origin of the reduced response. Although children with FXS have a high incidence of ASD outcomes, they differed from ASD and ASIB children in this study. Specifically, the children with FXS were hyperresponsive to all stimulus types while the ASD and ASIB groups showed attenuated responses for specific stimuli.

Analysis of Clinical Features and Influencing Factors of Depression and Cognitive Dysfunction in Parkinson’s Patients

Objective: To explore the clinical characteristics and analyze the influencing factors of depression and cognitiveimpairment in Parkinson’s patients. Methods: 127 patients with Parkinson’s disease who were treated in two hospitals from March 2021 to March 2023 were selected for this study. The assessment of depression was conducted using the Geriatric Depression Self-Rating Scale (GDS). In addition, cognitive function was evaluated through the Montreal Cognitive Assessment (MOCA), and the clinical attributes of patients with cognitive impairment were examined. The study also aimed to analyze the factors that influence cognitive impairment in this patient population. Results: The progression of the disease, presence of cognitive impairment, and the Hoehn-Yahr stage were identified as significant influencing factors for depression among the 127 patients with Parkinson’s disease (P &lt; 0.05). The factors that influence cognitive impairment included the level of education, Hoehn-Yahr stage, and depression (P &lt; 0.05). Conclusion: Depression and cognitive dysfunction is relatively common in patients with Parkinson’s disease. The occurrence of depression and cognitive dysfunction varies significantly based on factors such as the duration of the disease, varying drug dosages, and the severity of the condition. Therefore, it is necessary to treat patients with Parkinson’s disease.

Cortical thickness and cognition in older people with multiple sclerosis.

The structural changes associated with cognitive performance in older people with multiple sclerosis (PwMS; age ≥ 50years old) remain unknown. To determine the relationship between whole-brain (WBV), thalamus as the largest deep gray matter nuclei, and cortex-specific volume measurements with both cognitive impairment and numerical performance in older PwMS. The main hypothesis is that cognitive impairment (CI) in older PwMS is explained by cortical thinning in addition to global and thalamic neurodegenerative changes. A total of 101 older PwMS underwent cognitive and neuroimaging assessment. Cognitive assessment included tests established as sensitive in MS samples (Minimal Assessment of Cognitive Function in MS; MACFIMS), as well as those tests often utilized in Alzheimer's dementia studies (Wechsler's Memory Scale, Boston Naming Test, Visual Motor Integration and language). Cognitive impairment (CI) was based on -1.5 standard deviations in at least 2 cognitive domains (executive function, learning and memory, spatial processing, processing speed and working memory and language) when compared to healthy controls. WBV and thalamic volume were calculated using SIENAX/FIRST and cortical thickness using FreeSurfer. Differences in cortical thickness between CI and cognitively preserved (CP) were determined using age, sex, education, depression and WBV-adjusted analysis of covariance (ANCOVA). The relationship between domain-specific cognitive performance and cortical thickness was analyzed by linear regression models adjusted for age, sex, education, depression, WBV and thalamic volume. Benjamini-Hochberg-adjusted p-values lower than 0.05 were considered significant. The average age of the study population was 62.6 (5.9) years old. After adjustment, CI PwMS had significantly thinner left fusiform (p = 0.0003), left inferior (p = 0.0032), left transverse (p = 0.0013), and bilateral superior temporal gyri (p = 0.002 and p = 0.0011) when compared to CP PwMS. After adjusting for age, sex, education, depression WBV, and thalamic volume, CI status was additionally predicted by the thickness of the left fusiform (p = 0.001) and left cuneus gyri (p = 0.004). After the adjustment, SDMT scores were additionally associated with left fusiform gyrus (p < 0.001) whereas letter-based verbal fluency performance with left pars opercularis gyrus (p < 0.001). In addition to global and thalamic neurodegenerative changes, the presence of CI in older PwMS is additionally explained by the thickness of multiple cortical regions.

Pediatric Palliative Care: Insights into Assessment Tools andReview Instruments.

The proper assessment of needs and outcomes in pediatric palliative care (PPC) is imperativeto ensure the best possible service to patients and families. However, given the multidimensionalnature of PPC, the low number of patients in this setting, the heterogeneity of diseases, the presenceof cognitive impairment in many patients, and the physiological development of children, outcomescan be complex and difficult to measure. Consequently, in this context, the use of standardizedand validated tools to assess the needs of children and families, to assess symptom severity, andto estimate the quality of PPC service represent a current need. Even if efforts have been made tostandardize approaches and tools for palliative care in adults, to our knowledge, a similar comprehensiveassessment of PPC has not yet been conducted to date. This narrative review provides anoverview and discusses the evaluation of tools currently applied in PPC, with an educational intentfor healthcare providers. We found that several instruments are available to assess different dimensionsof PPC. We proposed a classification into eligibility tools, patient and family needs assessmenttools, and care assessment tools. At present, two main eligibility tools exist, the PaPaS Scale and theACCAPED Scale questionnaire. Most of the tools for patient and family needs assessment have notbeen specifically validated in the PPC setting, and many may be more readily applied in researchsettings rather than in daily practice. Similar considerations can be made for tools assessing QoL,while tools assessing PPC service quality seem to be easily applied. Efforts to develop new specifictools and validate existing ones are undoubtedly advocated. However, in the patient's best interest,PPC healthcare providers should start using available tools, regardless of their validation status.