Prevalence Of Severe Impairment Research Articles

Long-Term Neurocognitive Functioning and Social Attainment in Adult Survivors of Pediatric CNS Tumors: Results From the St Jude Lifetime Cohort Study.

To assess the prevalence and severity of neurocognitive impairment in adult survivors of pediatric CNS tumors and to examine associated treatment exposures. Participants included 224 survivors of CNS tumors who were treated at St Jude Children's Research Hospital (current median age [range], 26 years [19 to 53 years]; time from diagnosis, 18 years [11 to 42 years]) and completed neurocognitive testing. Information on cranial radiation therapy (CRT) doses and parameters of delivery were abstracted from medical records. The prevalence of severe impairment (ie, at least two standard deviations below normative mean) was compared across radiation treatment groups (no CRT, focal irradiation, craniospinal irradiation) using the χ(2) test. Log-binomial models were used to estimate risk ratios (RRs) and corresponding 95% CIs for severe impairment. In multivariable models, craniospinal irradiation was associated with a 1.5- to threefold increased risk of severe impairment compared with no CRT (eg, intelligence: RR = 2.70; 95% CI, 1.37 to 5.34; memory: RR = 2.93; 95% CI, 1.69 to 5.08; executive function: RR = 1.74; 95% CI, 1.24 to 2.45). Seizures were associated with impaired academic performance (RR = 1.48; 95% CI, 1.02 to 2.14), attention (RR = 1.54; 95% CI, 1.12 to 2.13), and memory (RR = 1.44; 95% CI, 1.04 to 1.99). Hydrocephalus with shunt placement was associated with impaired intelligence (RR = 1.78; 95% CI, 1.12 to 2.82) and memory (RR = 1.42; 95% CI, 1.03 to 1.95). Differential follow-up time contributed to variability in prevalence estimates between survivors treated with older nonconformal and those treated with more contemporary conformal radiation therapy methods. Neurocognitive impairment was significantly associated with lower educational attainment, unemployment, and nonindependent living. Survivors of pediatric CNS tumors are at risk of severe neurocognitive impairment in adulthood. The prevalence of severe impairment is greater than expected in the general population, even in the absence of CRT, and is associated with disrupted attainment of adult social milestones.

Clinical Value of Automatic Reporting of Estimated Glomerular Filtration Rate in Geriatrics

Background: Geriatric patients frequently have impaired renal function. Multimorbidity leads to polypharmacy with high risk of adverse drug reactions. Objective: The aim was to evaluate the prevalence of renal impairment and risk of overdosing renally excreted drugs in hospitalized geriatric patients. Methods: In 221 patients aged ≥65 years, GFR was estimated by the MDRD, Cockcroft-Gault (CG) and lean body mass (LBM)-adjusted CG equations. Results: A reduced renal function (<60 ml/min/1.73 m²) was found in 43% by MDRD, 61% by CG, and 71.9% by LBM-CG. The prevalence of severe impairment (<30 ml/min/1.73 m²) was 3.3% based on MDRD, 5.4% on CG, and 13.6% on LBM-CG. At mean 10 medications were applied simultaneously. In patients with reduced eGFR, 52% of medications required dosage adjustment. Unfractionated heparins, ACE inhibitors, antibiotics, diuretics, and potassium were frequently used. Conclusions: For all limitations of formulaic GFR estimation in the elderly, routine assessment of renal function by reporting of eGFR helps to identify patients with chronic kidney disease and supports drug dosing. Implementation of routine reporting of eGFR is mandatory in standardized geriatric assessment.

Cognitive impairment among the elderly in a Korean rural community

Cognitive function among the elderly aged 65 or older was studied in a rural community of Korea. The prevalence rates of cognitive impairment were significantly higher in females (64%) than in males (33%). Sex differences of prevalence of both mild impairment (25% in males vs 45% in females) and severe (8% in males vs 19% in females) reached statistically significant levels. The prevalence of severe impairment increased with age, and the age-related increase was steeper after 80 in males and after 75 in females. The prevalence of mild impairment, on the other hand, did not increase so prominently with aging. From this point of view, it could be assumed that severe cognitive impairment may be highly related to real dementia, and that the elderly with mild impairment may consist of heterogenous groups associated with cognitive dysfunction of mild degree.