Presence Of Cognitive Impairment Research Articles

Risco de quedas e seus fatores associados na pessoa idosa hospitalizada

Abstract Objective To analyze the risk of falls and its association with demographic and clinical variables, cognitive status, risk of sarcopenia and frailty among older adults hospitalized in a medical clinic of a university hospital. Method A quantitative, observational, cross-sectional analytical study of 60 older adults hospitalized in the medical clinic of a university hospital in São Paulo city, São Paulo state, Brazil, was carried out. Questionnaires collecting demographic profile and clinical data, the Mini-Mental State Examination, Morse Scale, SARC-F Scale and Tilburg Frailty Indicator were applied. Descriptive analyses and the Kolmogorov-Smirnov normality test were performed. Spearman’s correlation test was used for quantitative variables and the Mann-Whitney U-test for categorical variables. Multiple linear regression was used to identify the associations and a significance level of 5% was adopted. Results The study sample comprised predominantly individuals that were female, aged 60-79 years and without a partner. Overall, 80% had cognitive impairment, 88.3% were diagnosed as frail, 60% were at risk for sarcopenia, and 75% had a high risk of falls during hospitalization. Cognitive impairment, frailty and sarcopenia risk were associated with risk of falls in the hospitalized older adults. Conclusion High risk of falls in the hospitalized older adults was directly associated with the presence of cognitive impairment, frailty syndrome and sarcopenia risk, confirming that these factors warrant attention from managers and nursing professionals.

Frailty and its associates in community-dwelling older adults.

While the literature contains several studies on the frailty assessed during hospitalization and/or outpatient settings and nursing homes, few studies have assessed frailty in community-dwelling older adults. We investigated the prevalence of frailty and associated factors among older adults in a sample of community-dwelling older adults. We included community-dwelling older adults >60 years living in the Fatih District of the Istanbul Province. We conducted the study between November 2014 and May 2015. We collected the data such as age, sex, number of diseases and drugs, functional status, frailty, the presence of geriatric syndromes, common diseases, and quality-of-life assessment. Frailty was evaluated by the FRAIL scale. A total of 204 adults (mean age: 75.4±7.3 years) were included, of whom 30.4% were robust, 42.6% were pre-frail, and 27% were frail. In multivariate analyses, associated factors of frailty were the number of drugs [odds ratio (OR)=1.240, p=0.036], the presence of cognitive impairment (OR=0.300, p=0.016), and falls (OR=1.984, p=0.048). The present study established the prevalence of frailty in a large district in the largest metropolis in the country through a valid screening method. Our results suggest that clinicians should consider frailty evaluation in patients with multiple drug usage, cognitive impairment, and falls.

Association Between Cognitive Performance and Nutritional Status: Analysis From LASI-DAD.

Malnutrition in low- and middle-income countries causes cognitive decline and other health problems. Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI DAD) is an extensive study on late-life cognition and dementia. This study examines the link between nutrition and cognitive abilities in older adults using data from the LASI DAD. We conducted descriptive statistics on nutritional parameters (body-mass index, waist-hip ratio, and Mini-Nutritional Assessment), cognitive functions, and socio-demographic variables in 2,892 adults aged ≥60 years. Cognitive domains assessed included delayed recall, orientation, language, executive function, abstract reasoning, and attention. Cognitive impairment was defined as impaired performance in two or more domains. Mean age was 69.3 ± 7.1 years, 52.9% were female, and 57.5% were illiterate. Low body-mass index (adjusted OR: 1.88, p < .001), at risk of malnutrition (adjusted OR: 1.89, p < .001) and malnourished (adjusted OR: 2.86, p < .001) on Mini-Nutritional Assessment were associated with the presence of cognitive impairment. Better cognitive performance was associated with increased body mass index (adjusted OR: 0.74, p-.03), hemoglobin (adjusted OR: 0.91, p-.006), and serum albumin (adjusted OR: 0.38, p < .001). This study shows that nutritional status assessed by anthropometric measures and blood markers is strongly linked to cognitive performance in older adults.

Age aspect of neurophysiological diagnostics of post-concussion syndrome in patients with mild blast traumatic brain injury

Introduction. It is generally accepted that age influences neuropsychological and neurophysiological findings due to a decrease in memory and attention in older age groups as a result of diseases and damage to the central nervous system of various origins. This should be taken into account when dealing with patients who underwent mild blast traumatic brain injury (mbTBI), and focus on standard characteristics considering the age factor. Purpose: to investigate the influence of the age factor on the characteristics of cognitive evoked potentials in patients with post-concussion syndrome (PCS) in the long-term period of mbTBI. Materials and methods. The study involved 41 patients with PCS aged 18-45 years (study group) and 30 healthy subjects (control group). The patients were in the late period of trauma (from 6 months to 3 years). The age distribution of patients in the study group was the following: 6 patients under 30 years old, 18 patients aged 31-40 years, 17 patients over 40 years old. Neuropsychological testing was performed according to the Montreal Cognitive Assessment Scale. Quantitative electroencephalography was performed according to standard parameters (sensitivity ‒ 70 μV/cm, time constant ‒ 0.1 s, filter ‒ 40 Hz). The results. Neurophysiological testing using the CEP P300 method allows us to verify the dysfunction of brain activity in the form of attention and memory disorders in patients with PCS as a result of mbTBI in the chronic period of damage. Exceeding the upper limit of the age norm of P2 and P3 latency components of CEP P300 is statistically significantly associated with the presence of cognitive impairment in patients with PCS. Conclusions. The CEP P300 method can be recommended for the use in the complex diagnostics of cognitive disorders in patients with PCS in the subacute and chronic periods of the injury. In the clinical interpretation of latency characteristics of CEP P300 components, it is reasonable to focus on standard parameters, including age factor.

Reduction and Prevention of Agitation in Patients with Neurocognitive Disorders: An International Psychogeriatric Association Consensus Algorithm

AbstractBackgroundThe International Psychogeriatric Association (IPA) extends its commitment to serving those with psychiatric and behavioral manifestation in the presence of cognitive impairment and dementia with this introduction of an agitation reduction and prevention algorithm that builds on the definition of agitation developed by IPA.MethodThis presentation describes a review of literature, treatment guidelines, to recommend an algorithm for care and a reiterative integration of expert opinion within the context of an IPA Agitation Work group, a panel of international experts on agitation. The outcome is an integration of available information into a comprehensive algorithm.ResultThe IPA Agitation Work Group recommends the Investigate, Plan, and Assess (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and implementation with an emphasis on shared decision‐making; the success of the plan in assessed and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Nonpharmacologic interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal agitation, mild‐moderate agitation or agitation with prominent mood features, moderate‐severe agitation, and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a different venues is considered (home, nursing home, emergency depaThe IPA definition of agitation is operationalized into an agitation management algorithm emphasizing the integration of non‐pharmacologic and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision‐making. rtment, hospice), with adjustments to the therapeutic approach.ConclusionThe IPA definition of agitation is operationalized into an agitation management algorithm emphasizing the integration of non‐pharmacologic and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision‐making.

The Brain Health Platform: Combining Resilience, Vulnerability and Performance to assess brain health and risk of Alzheimer’s disease and related disorders

AbstractBackgroundOne of the great challenges in conducting ADRD research in community samples is the standardized measurement of medical, social, and environmental factors that may increase the risk of ADRD (vulnerability) or may provide some protective benefits from ADRD (resilience). While all physicians can diagnose mild cognitive impairment (MCI) and ADRD, it is much more difficult to assess the status of brain health and identify those at risk for future impairment. We developed and validated a novel clinical tool, the Brain Health Platform, to quantify brain health and identify risk factors for MCI and ADRD.MethodWe combined the Resilience Index (RI), a brief, quantifiable measure of 6 modifiable factors of brain health and risk of MCI and ADRD, the Vulnerability Index (VI), a weighted measure of cognitive impairment risk that assesses modifiable and non‐modifiable risk factors, and the Number Symbol Coding Task (NSCT), a brief, 90‐second executive task that incorporates attention, planning, and set‐shifting, to measure objective cognitive performance, into the Brain Health Platform to assess overall brain health and the presence of cognitive impairment. We tested this in a combined clinical and research sample (n = 400; 53 controls, 347 impaired) compared with a Gold Standard clinical‐cognitive‐behavioral evaluation.ResultThe Brain Health Platform was able to correctly segregate healthy controls from MCI and ADRD in time‐ and cost‐efficient fashion. We applied a linear discriminant analysis using the NSCT, RI and VI to predict control, MCI and ADRD groups performing 5‐fold cross validation with 1000 replications. The area under the curve for Controls vs MCI was 0.823±0.09, for Control vs ADRD was 0.974±0.03 and for MCI vs ADRD was 0.884±0.06. In an exploratory fashion, we also demonstrated the ability of the Brain Health Platform to assist in differential diagnosis.ConclusionThe Brain Health Platform can intake the inputs of three brief assessments (RI, VI, NSCT) and output a patient risk score to determine the cross‐sectional status of an individual’s brain health, from which effective, personalized, precision‐medicine‐like prevention interventions, including lifestyle changes, medications and clinical trial enrollment, can be implemented in at‐risk individuals to decrease the development or progression of cognitive decline.

Persistence with Botulinum Toxin Treatment for Spasticity Symptoms in Multiple Sclerosis.

Botulinum toxin (BT) is an effective treatment for spasticity symptoms in multiple sclerosis (MS). Despite its wide use in clinical practices, only few studies have explored long-term persistence. We aim to evaluate the rate of discontinuation of BT treatment and the correlation with MS, spasticity, and injection variables. This retrospective study on 3-year prospectively collected data included 122 MS patients receiving BT injections for spasticity. We collected MS clinical variables (disease durations, Expanded Disability Status Scales [EDSSs], disease-modifying treatments [DMT], and Symbol Digit Modalities Tests [SDMTs]), modified Ashworth scales [MASs], concomitant treatments, and injection variables (formulation, dose, number of injections, and intervals between injections). A total of 14 out of the 122 patients discontinued BT after a mean time of 3.0 ± 1.5 years. In the Cox regression model including the MS clinical variables, the probability of BT discontinuations increased in patients with DMT changes during follow-ups (HR = 6.34; 95%Cl = 2.47, 18.08; p &lt; 0.01) and with impaired SDMTs (HR = 1.20; 95%Cl = 1.04, 1.96; p &lt; 0.01). In the model including the spasticity variables, there were no associations between BT discontinuation and MAS or other spasticity treatments. In the model including the injection variables, the probability of discontinuation decreased by 80% for each cumulative injection (HR = 0.16; 95%Cl = 0.05, 0.45; p &lt; 0.01), but increased by 1% for each additional day over the 3-month interval between injections (HR = 1.27; 95%Cl = 1.07, 1.83; p &lt; 0.01). BT discontinuation was associated with concomitant MS-related issues (e.g., treatment failure and DMT change) and the presence of cognitive impairment, which should be accounted for when planning injections. The interval between injections should be kept as short as possible from regulatory and clinical perspectives to maximize the response across all of the spasticity symptoms and to reduce discontinuation in the long term.

Cognitive Disorders in Patients with Parkinson's Disease

The aim of the study was to identify cognitive disorders in patients with Parkinson's disease&#x0D; Material and methods. The study was conducted on the basis of the neurological department of the Regional Clinical Hospital (Odesa) during 2011-2021. 364 patients were diagnosed with Parkinson disease (PD) on the basis of diagnostic criteria of the British Brain Bank. Clinical and demographic data were studied: age, sex, severity according to the UPDRS scale, stage of the disease according to the Hoen-Yahr scale, the presence of cognitive impairment and their nature. MMSE (Mini-Mental State Examination;) and PD-CRS (Parkinson’s Disease-Cognitive Rating Scale) were used to study cognitive functions. Statistical processing was performed by analysis of variance, correlation and factor analysis using Statistica 13.0 software (TIBCO, USA).&#x0D; Results.&#x0D; At the onset of the disease, left lesions were noted in 126 of 364 patients, ie 34.6%, right - 127 (34.9%), the remaining 111 (30.5%) - bilateral lesions. The structure of the disease was dominated by mixed forms. Akinetic-rigid form was observed in 92 (25.3%) cases, trembling - in 27 (7.4%), mixed rigid-trembling in 157 (43.1%) cases, trembling-rigid in 92 (7.4%). Patients with stage 2 and 3 CP were most often registered in 28.6% and 28.0% of cases, respectively. 31 (8.5%) patients had more severe motor disorders (stages 3.5 and 4). Cognitive impairment was detected in a significant number of patients (238 or 45.2%), the mean score on the MMSE scale was 25.3 ± 0.3. Accordingly, on the PD-CRS scale, the average score was 91.2 ± 3.4 points. Subdemental changes were present in 82 (15.6%) patients. Accordingly, mild dementia was found in 15 (2.8%) patients, moderate dementia - in 18 (3.4%).&#x0D; Conclusions:&#x0D; &#x0D; The frequency of detection of cognitive impairment in patients with CP was 45.2% with a mean score on the MMSE scale of 25.3 ± 0.3, and on the PD-CRS scale - 91.2 ± 3.4 points&#x0D; Dementia changes were in 82 (15.6%) patients, mild dementia was found in 15 (2.8%) patients, moderate dementia - in 18 (3.4%)&#x0D; There is a direct correlation between the age and severity of intellectual disabilities (r = 0.50).&#x0D; Self-care disorders are determined by the severity of both motor and cognitive disorders by 72% (R = 0.851; R2 = 0.723; Adjusted R2 = 0.721; F (2.2) = 309; p &lt;10-4; SE = 4.6 ).&#x0D; &#x0D; Key words: Parkinson's disease, cognitive impairment, quality of life

Neuroimaging in the Acute Psychiatric Setting: Associations With Neuropsychiatric Risk Factors.

The appropriateness and clinical utility of neuroimaging in psychiatric populations has been long debated, and the ambiguity of guideline recommendations is well established. Most of the literature is focused on first-episode psychosis. The investigators aimed to review ordering practices and identify risk factors associated with neuroradiological MRI abnormalities and their clinical utility in a general psychiatric population. A retrospective file review was undertaken for 100 consecutive brain MRI scans for adult psychiatric inpatients who received scanning as part of their clinical care in an Australian hospital. Brain MRI was abnormal in 79.0% of scans; in these cases, 72.2% of patients required further investigation or follow-up, with 17.7% requiring urgent referral within days to weeks, despite only 3.7% of admitted patients undergoing MRI during the study period. Psychiatrically relevant abnormalities were found in 32.0% of scans. Abnormalities were more likely to be found in the presence of cognitive impairment, older age, and longer duration of psychiatric disorder. Psychiatrically relevant abnormalities had further associations with older age at onset of the psychiatric disorder and a weak association with abnormal neurological examination. Multiple indications for imaging were present in 57.0% of patients; the most common indications were physical, neurological, and cognitive abnormalities. Brain MRI is a useful part of psychiatric management in the presence of certain neuropsychiatric risk factors. The present findings suggest that treating teams can judiciously tailor radiological investigations while limiting excessive imaging. Future research in larger cohorts across multiple centers may contribute to shaping more consistent neuroimaging guidelines in psychiatry.

A personalised approach to the choice of oral anticoagulants in elderly and senile patients with atrial fibrillation

Introduction. In recent years, data have been accumulated regarding possible associations between cognitive impairment and atrial fibrillation. The results of retrospective and prospective studies confirm that anticoagulant therapy in patients with AF can reduce the risk of cognitive impairment and dementia.Objective. To study the individual characteristics of elderly and senile patients with atrial fibrillation, influencing the choice of anticoagulant therapy, with a view to its subsequent optimization.Materials and methods. The study included 159 patients with atrial fibrillation of non-valvular genesis aged over 60 years. 4 groups of patients were formed. The largest number of patients received rivaroxaban and warfarin (36.4% and 34.6%, respectively). 26 (16.3%) patients were treated with dabigatran, 20 (12.6%) patients with apixaban. The risk of thromboembolic complications was assessed on the CHA2DS2-VASc scale. The HAS-BLED scale was used to assess the risk of bleeding. A pharmacogenetic study (carriage of polymorphic alleles of the CYP2C9 and VCORC1 genes) was conducted in 138 patients. Cognitive impairment was assessed by a Mini-Cog test and a battery of frontal tests.Results. Taking oral anticoagulants reduces the risk of stroke and dementia in patients; the presence of cognitive impairment, in turn, significantly reduces the patient’s adherence to therapy and reduces the effectiveness of therapy. Patients’ adherence to therapy was significantly lower by 10–20% in patients with cognitive impairment according to the Mini-Cog test and a battery of frontal tests. In the absence of pronounced cognitive impairment (higher adherence to treatment) and availability and willingness to control INR, warfarin remains the drug of choice in patients with renal insufficiency.Conclusions. A number of problems with the use of oral anticoagulants in elderly patients with atrial fibrillation have been identified. The ease of use of new oral anticoagulants, the absence of the need to select doses and monitor therapy is an important factor when choosing a drug.

Stability of the Gross Motor Function Classification System over time in children with cerebral palsy.

To assess the stability of the Gross Motor Functional Classification System (GMFCS) in children with cerebral palsy (CP) from time of preliminary diagnosis (~2 years of age) to time of diagnosis (~5 years of age), and to examine factors associated with reclassification. We conducted a longitudinal study using a sample from the Canadian CP Registry. Stability was analysed by using the percentage of agreement between timepoints and a weighted prevalence and bias adjusted kappa statistic. Univariate and multivariate logistic regressions were performed to identify variables associated with reclassification. The study included 1670 children (857 males, 713 females) with a mean age of 11 years 4 months (SD 4 years, range 3 years 5 months-20 years 1 month) at time of data extraction (3rd September 2019), of which 1435 (85.9%) maintained a stable GMFCS, with a weighted kappa of 0.91 (95% confidence interval 0.89-0.92). Univariate logistic regression showed that initial GMFCS level, CP subtype, and the presence of cognitive impairment were associated with the likelihood of change in the GMFCS level (p < 0.1). In the multivariate analysis, however, the likelihood was associated with initial GMFCS level only (odds ratio 7.10-8.88, p < 0.00). The GMFCS has good stability in early childhood. For the majority of children, it is predictive of their long-term motor function. The Gross Motor Function Classification System (GMFCS) rating in early childhood is stable over time. There is no directionality in the reclassification of the GMFCS. The initial GMFCS level was related to the likelihood of change in follow-up GMFCS level.

Brain volume loss and physical and cognitive impairment in naive multiple sclerosis patients treated with fingolimod: prospective cohort study in Buenos Aires, Argentina.

The percentage of brain volume loss (PBVL) has been classically considered as a biomarker in multiple sclerosis (MS). The objective of the present study was to analyze if the PBVL during the 1st year after the onset of the disease predicts physical and cognitive impairment (CI). Prospective study that included naïve patients without cognitive impairment who initiated MS treatment with fingolimod. Patients were followed for 3 years and relapses, expanded disability status scale (EDSS) progression (defined as worsening of 1 point on the EDSS), the annual PBVL (evaluated by structural image evaluation using normalization of atrophy [SIENA]), and the presence of CI were evaluated. Cognitive impairment was defined in patients who scored at least 2 standard deviations (SDs) below controls on at least 2 domains. The PBVL after 1 year of treatment with fingolimod was used as an independent variable, while CI and EDSS progression at the 3rd year of follow-up as dependent variables. A total of 71 patients were included, with a mean age of 35.4 ± 3 years old. At the 3rd year, 14% of the patients were classified as CI and 6.2% had EDSS progression. In the CI group, the PBVL during the 1st year was - 0.52 (±0.07) versus -0.42 (±0.04) in the no CI group (p < 0.01; odds ratio [OR] = 2.24; 95% confidence interval [CI]: 1.72-2.44). In the group that showed EDSS progression, the PBVL during the 1st year was - 0.59 (±0.05) versus - 0.42 (±0.03) (p < 0.01; OR = 2.33; 95%CI: 1.60-2.55). A higher PBVL during the 1st year in naïve MS patients was independently associated with a significant risk of CI and EDSS progression.

Relations of impaired blood flow and cerebrospinal fluid flow with damage of strategic for cognitive impairment brain regiones in cerebral small vessel disease

Introduction. Cerebral small vessel disease (CSVD), associated with age and vascular risk factors, as well as the main cause of vascular and degenerative mixed cognitive impairment (CI). Previously established microstructural predictors of CI (axial diffusion in normal-appearing periventricular white matter of the posterior left frontal lobe, the right midcingulate cortex, and the middle posterior part of the corpus callosum) can be used to calculate an integrative factor, exceeding the threshold value for which indicates the presence of CI. The use of this factor in the diagnosis of CI in CSVD is supported by the fact that leading mechanisms of CSVD are involved in the damage to areas of the brain that are strategic for CI. The aim of this study was to clarify the link between the known microstructural predictors of CI in CSVD and MRI findings that correspond to the main mechanisms of CSVD. Materials and methods. Patients (n = 74; including 48 women; average age 60.6 6.9 years) with CSVD and CI of varying severity underwent phase-contrast MRI and voxel-based morphometry (3T) to assess arterial, venous and CSF flow, as well as atrophy. Results. The established microstructural predictors of CI correlated with measures of arterial and venous blood flow, as well as atrophy. Linear regression models allow us to estimate cognitive impairment (CI) predictors in cerebral small vessel disease (CSVD), based on increased arterial velocity pulse index, CSF flow at the level of the cerebral aqueduct, cerebral aqueduct area and lateral ventricles volume, when there is reduced blood flow in the superior sagittal sinus and the overall arterial blood flow. Conclusion. The ability to calculate microstructural predictors of CI due to CSVD, based on MRI findings, indicates the validity of using an integrative measure of microstructural predictors of CI as a diagnostic tool of CI in CSVD.

Pilot study of the implementation of G8 screening tool, cognitive screening assessment and chemotherapy toxicity assessment in older adults with cancer in a tertiary University Hospital in Ireland.

e24019 Background: 11% of Ireland’s population is above the age of 65. This is projected to double to 1.4 million by 2040 corresponding to doubling of cancer cases. Clinical trials often exclude patients (pts) ≥70; therefore, it can be challenging to apply evidence based treatment (tx) to this population. Data from the National Cancer Registry of Ireland suggests under tx of older patients (pts). Comprehensive Geriatric assessment (CGA) is recommended by the National Comprehensive Cancer Network (NCCN) and the International Society of Geriatric Oncology (SIOG). In practice, CGA is limited by time constraints, lack of resources and expert interpretation. Geriatric screening tools can help identify frail pts who are most likely to benefit from CGA. The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), presence of cognitive impairment (assessed by Mini-Cog), and risk of chemo-toxicity (assessed by Chemo-Toxicity Calculator) among pts ≥ 65 years (yrs) starting systemic anti-cancer tx. Methods: Pts ≥65yrs starting new systemic anticancer tx were identified between 1st of December 2020 to 31ST of September 2021 in St. Vincent’s University Hospital. Verbal consent was obtained. Printed versions of the G8 screening tool and Mini-Cog were used. CARG chemo-toxicity score was conducted online ( www.mycarg.org/tools ). .The assessment was conducted by consultants, specialist registrars and registrars. Data including pts’ age, type of malignancy, stage of cancer, and planned treatment were recorded. Analysis was conducted by SPSS statistical software, V.25(SPSS Institute, IBM Corp., 2017). Results: We identified 56 pts ≥65 years.27 (48.1%) were females and 29 (50.8%) were males. The majority of treated pts, N = 33 (58.1%) had metastatic cancer. The median G8 score was 12 (IQR 9.6-14). 83.9% of pts had a G8 score ≤14. Mini-Cog was found to be positive in 11 pts (19.6%). The median CARG score was 7 (IQR 6-11) and the median risk of toxicity 51% (IQR 44-78%). Of these, 44 (78.2%) received chemotherapy and 12 pts (21.4%) received non-chemotherapy systemic tx. In multi-variate analyses, age, type of cancer, planned treatment, and stage of disease did not impact G8, Min-cog, and CARG scores. Conclusions: In this single center study of elderly pts, more than 80% of pts had a positive G8 score representing a need for formal CGA assessment. The risk of toxicity was substantial with almost 50% risk of grade ≥ 3 toxicity in this cohort. Chronological age was not found to negatively impact patient’s frailty, cognition, or risk of toxicity. Interpretation of this pilot study is limited by small sample size, possible inter-operator variability, and lack of self-reported assessment.

Neurophysiological status of patients with non-valvular atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. The reduction of the risk of stroke in patients with AF is achieved with the help of continuous administration of oral anticoagulants (OAC). The presence of cognitive impairment in a patient may be a significant risk factor for low adherence to antithrombotic therapy, therefore, the medico-social significance of impaired cognitive functions in patients with AF is high. At the same time, it is still unclear which neurophysiological mechanisms and areas of the brain are responsible for the development of cognitive disorders in this pathology. Thus, further studies are needed to assess the state of higher cortical functions in patients with AF. Materials and methods The study included 50 patients with nonvalvular AF and a high risk of hemorrhagic and ischemic events, with a risk of thromboembolic complications on the CHA2DS2-VASc scale of at least 2 points and a risk of bleeding on the HAS-BLED scale of at least 3 points. The control group consisted of 17 relatively healthy individuals. Research results The analysis of indicators of extended neuropsychological testing made it possible to establish that, compared with healthy individuals of the same age, patients with AF perform worse on tests of neurodynamics, attention and short-term memory, Table. Patients with AF have a lower rate of complex sensorimotor reactions, a greater number of errors, especially in tests with biofeedback (brain performance test). Also, patients with AF have worse performance indicators and higher focused attention depletion (characterized by the number of characters processed in the 1st and 4th minutes of the proofreading test, respectively). As for the indicators of short-term memory, healthy subjects were superior to patients with AF in memorizing meaningless syllables and words, but not numbers. The power indicators of the theta EEG rhythms at rest with eyes closed were taken. The factors were identified - GROUP (2 levels: patients with AF; healthy individuals), AREA (5 levels: (frontal, central, temporal, parietal, occipital) and LATERALITY (2 levels: left, right hemisphere). In patients with cardiac arrhythmias, the increase in the power of the theta-2 rhythm biopotentials in the direction from the anterior to the posterior cortex is significantly pronounced (p = 0.000001), while in healthy individuals the gradient curve is flatter (p = 0.009). Conclusions It was found that about half of the examined AF patients have syndrome mild cognitive impairment (MCI). The most significant cognitive decline in these patients compared with relatively healthy individuals was noted for the speed of sensorimotor response, performance control indicators, and short-term memory, while decreased cognitive test scores were associated with a greater representation of slow waves in the resting EEG, mainly in the posterior regions of the cerebral cortex.

Health Literacy, Cognitive Impairment, and Diabetes Knowledge Among Incarcerated Persons Transitioning to the Community: Considerations for Intervention Development.

The purpose of this study was to evaluate the relationships of health literacy (HL; Short Test of Functional Health Literacy), cognitive impairment (CI), and diabetes knowledge (DK) among incarcerated persons transitioning to the community. Using preintervention data from a quasi-experimental nonequivalent control group study evaluating the feasibility of a six-session literacy-tailored Diabetes Survival Skills intervention for incarcerated men transitioning to the community, we conducted correlational analyses among the Short Test of Functional Health Literacy, Montreal Cognitive Assessment, and Spoken Knowledge in Low Literacy in Diabetes Scale using the SPSS PROCESS macro and bias-corrected bootstrapping to test the meditational hypothesis: HL mediates the relationship between CI and DK. Participants ( N = 73) were incarcerated for 1-30 years with a mean age of 47 (9.9) years, 40% Black, 19% White, and 30% Hispanic, with 78% having high school/GED or less education. Most (70%) screened positive for CI and had low DK, and 20% had marginal or inadequate HL. HL, CI, and DK were positively associated with each other. Controlling for race, age, and group (control/experimental), cognitive function had a significant direct effect on HL ( b = 0.866, p = 0.0003) but not on DK ( b = 0.119, p = 0.076). Results indicated a significant indirect effect of cognitive functioning on DK via HL, 95% confidence interval [0.300, 0.1882]. Intervention approaches aimed at increasing HL or tailored to low HL in the presence of CI may be effective in increasing DK in this population. Given the low risk to high benefit of implementing literacy-tailored approaches to persons in prison and the population demographics from studies supporting a high degree of CI, nurses should consider implementing literacy-tailored approaches and screening for CI before participation in all educational programs.

Aging metrics incorporating cognitive and physical function capture mortality risk: results from two prospective cohort studies

BackgroundAging metrics incorporating cognitive and physical function are not fully understood, hampering their utility in research and clinical practice. This study aimed to determine the proportions of vulnerable persons identified by three existing aging metrics that incorporate cognitive and physical function and the associations of the three metrics with mortality.MethodsWe considered three existing aging metrics including the combined presence of cognitive impairment and physical frailty (CI-PF), the frailty index (FI), and the motoric cognitive risk syndrome (MCR). We operationalized them using data from the China Health and Retirement Longitudinal Study (CHARLS) and the US National Health and Nutrition Examination Survey (NHANES). Logistic regression models or Cox proportional hazards regression models, and receiver operating characteristic curves were used to examine the associations of the three metrics with mortality.ResultsIn CHARLS, the proportions of vulnerable persons identified by CI-PF, FI, and MCR were 2.2, 16.6, and 19.6%, respectively. Each metric predicted mortality after adjustment for age and sex, with some variations in the strength of the associations (CI-PF, odds ratio (OR) (95% confidence interval (CI)) 2.87 (1.74–4.74); FI, OR (95% CI) 1.94 (1.50–2.50); MCR, OR (95% CI) 1.27 (1.00–1.62)). CI-PF and FI had additional predictive utility beyond age and sex, as demonstrated by integrated discrimination improvement and continuous net reclassification improvement (all P < 0.001). These results were replicated in NHANES.ConclusionsDespite the inherent differences in the aging metrics incorporating cognitive and physical function, they consistently capture mortality risk. The findings support the incorporation of cognitive and physical function for risk stratification in both Chinese and US persons, but call for caution when applying them in specific study settings.

Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco)

ObjectivesCompare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DesignRetrospective comparative study. SettingThree university hospitals in Biscay province (Basque Country, Spain). Patients77 patients over 65 years-old with PFF (AO 31-A and 31-B). InterventionStudy conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements30-Day mortality rate and risk factors for mortality. ResultsOf a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. ConclusionsSARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. Level of evidenceLevel III study.

Analysis of the Relationship among Cognitive Impairment, Nutritional Indexes and the Clinical Course among COVID-19 Patients Discharged from Hospital-Preliminary Report.

Numerous data indicate the presence of cognitive impairment in people who have undergone COVID-19, often called COVID Fog (CF). This phenomenon persists even 6 months after infection, and its etiology and pathogenesis are not fully known. The aim of this article was to analyze the relationship among cognitive functioning, clinical data and nutrition indexes in patients discharged from the COVID-19 hospital of the Military Institute of Medicine, Warsaw, Poland. The sample comprised 17 individuals—10 women and 7 men, with ages of 65 ± 14 years. Cognitive impairment was measured with the use of the Montreal Cognitive Assessment (MoCA). The nutrition parameters included: hemoglobin, red blood cells, total cholesterol and its fractions, triglycerides, total protein, albumin, urea, creatinine, phosphates, calcium and sodium. The analysis showed that albumin concentration significantly correlated with the total MoCA score and especially with the short-term memory test score. Conversely, total cholesterol, and especially LDL concentrations, were highly and negatively associated with the MoCA score. In conclusion: markers of nutritional status are correlated with the severity of CF. Individuals with malnutrition or risk of malnutrition should be screened for CF. Further studies need to be performed in this area.

The prevalence of cognitive impairment in older Indian persons with cancer and brain metastases.

BackgroundOlder patients with cancer are more vulnerable to the effects of cognitive impairment affecting their functional status, quality of life, compliance to treatment and ultimately survival. Cancer-related cognitive impairment may be due to the cancer itself or due to the treatment of cancer. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis.MethodsThis retrospective analysis was conducted on a prospectively collected data set of patients who attended the geriatric oncology clinic at a tertiary care comprehensive cancer centre in India from June 2018 to July 2021. Patients aged 60 years and above with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of ≤23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastasis was tested using the chi-square test.ResultsA total of 597 patients were included, of which 462 (77.4%) were male. The median age was 69 years (range: 60–100 years). All patients had solid tumours; 244 (40.9%) had lung, 189 (31.7%) had gastrointestinal and 75 (12.6%) had head and neck malignancies. Forty-one (6.9%) patients had brain metastases, of which 10 (24.4%) had solitary, 30 (73.2%) had multiple lesions and 1 (2.4%) had leptomeningeal metastases. Cognitive impairment was noted in 11 (26.8%) of the 41 patients with brain metastases and 91 (16.4%) of the 556 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment, p = 0.086.ConclusionOlder persons with cancer and brain metastases were not found to have a higher occurrence of cognitive impairment than those without brain metastases in this study. The next step is to understand whether older persons with brain metastases are at a higher risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy.