Previous Diagnosis Of Dementia Research Articles

The Clinical Impact of Hospital-Acquired Adverse Drug Reactions in Older Adults: An Australian Cohort Study

IntroductionHospital-acquired adverse drug reactions (HA-ADRs) are common in older adults. However, there is limited knowledge regarding the association between HA-ADRs and adverse clinical outcomes. ObjectiveTo investigate the incidence and characteristics of HA-ADRs in older adults, and any association with mortality, length of stay, and readmissions. DesignProspective cohort study. Setting and ParticipantsFlinders Medical Centre, a large tertiary referral hospital in Adelaide, South Australia. Older adults admitted under the General Medicine and Acute Care of the Elderly units with no previous diagnosis of dementia. MethodsAll patients had a Multidimensional Prognostic Index (MPI) assessment performed within 3 days of the admission. Data collected included age, gender, estimated glomerular filtration rate (eGFR), length of stay, readmissions, and mortality. HA-ADRs were identified by review of individual discharge summaries. Univariate and multivariate analyses were performed to investigate associations with clinical outcomes including mortality, length of stay, and readmissions. Exploratory analyses were performed for HA-ADR groups based on Medical Dictionary for Regulatory Activities System Organ Class and World Health Organization Anatomical Therapeutic Chemical classifications that accounted for ≥10% of all HA-ADRs. ResultsThere were 737 patients in the cohort with 72 having experienced a HA-ADRs (incidence = 9.8%). Patients with an HA-ADR had increased length of stay and 30-day readmissions compared with those without an HA-ADR. In multivariate analysis, the number of HA-ADRs was associated with in-hospital mortality and length of stay but not post-discharge mortality or readmissions within 30 days. In exploratory analyses, patients with an HA-ADR to antibacterial drugs had significantly higher rates of in-hospital mortality compared with those without these reactions. Conclusions and ImplicationsThe number of HA-ADRs are associated with in-hospital mortality and length of stay in older Australian inpatients. The occurrence of HA-ADRs may be a trigger to offer advice to prescribers to prevent future ADRs to similar agents and proactively manage disease to improve health outcomes.

Phosphodiesterase Type 5 Inhibitors in Men With Erectile Dysfunction and the Risk of Alzheimer Disease: A Cohort Study.

Repurposing phosphodiesterase type 5 inhibitors (PDE5Is) as drugs for Alzheimer disease (AD) risk reduction has shown promise based on animal studies. However, evidence in humans remains inconclusive. Therefore, we conducted a cohort study to evaluate the association between PDE5I initiation compared with nonuse and the risk of developing AD in men with erectile dysfunction (ED). Using electronic health records from IQVIA Medical Research Data UK (formerly known as the THIN database), we identified men aged ≥40 years with a new diagnosis of ED between 2000 and 2017. Individuals with a previous diagnosis of dementia, cognitive impairment, confusion, or prescription for dementia symptoms were excluded. The occurrence of incident AD was identified using diagnostic read codes. To minimize immortal-time bias, PDE5I initiation was treated as a time-varying exposure variable. Potential confounders were adjusted using inverse probability of treatment weighting based on propensity scores. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) with 95% CIs. A secondary analysis explored the association between AD and the cumulative number of PDE5I prescriptions. Sensitivity analyses included lag (delay) periods of 1 and 3 years after cohort entry to address the prodromal stage of AD. The study included 269,725 men, with 1,119 newly diagnosed with AD during a median follow-up of 5.1 (interquartile range 2.9-8.9) years. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72-0.93). The associated risk of AD decreased in individuals issued >20 prescriptions: HR 0.56 (95% CI 0.43-0.73) for 21-50 prescriptions and HR 0.65 (95% CI 0.49-0.87) for >50 prescriptions. Sensitivity analysis with a 1-year lag period supported the primary findings (HR 0.82, 95% CI 0.72-0.94), but the results differed with the inclusion of a 3-year lag period (HR 0.93, 95% CI 0.80-1.08). PDE5I initiation in men with ED was associated with a lower risk of AD, particularly in those most frequently issued prescriptions. The differences between primary and sensitivity analyses highlight the need to explore the optimal lag period. To enhance the generalizability of our findings, a randomized controlled trial including both sexes and exploring various PDE5I doses would be beneficial to confirm the association between PDE5I and AD.

Hearing Loss as a Risk Factor for Cognitive Decline in the Elderly: A Rapid Review

Purpose: The aim of this rapid review was to identify and evaluate evidence exploring hearing loss as a risk factor for cognitive decline in the elderly population. Methods: A literature search was performed in three databases: CINAHL, Cochrane Central, and PubMed. The PRISMA template was used to record the search and selection process. Search criteria included older adults aged 65 and up with diagnosed or self-reported hearing loss and no previous diagnosis of dementia or Alzheimer’s disease. Participants were excluded if they had been diagnosed with dementia or tested for it before the study began. Hearing loss was categorized using the pure tone average (PTA): normal (/= 25-40 dB), and moderate to severe impairment (> 40 dB). Selected research studies were critically appraised using the JBI checklist. A custom data extraction form was used to record inclusion/exclusion criteria, PICO data elements, risk of bias, and level of evidence. Results: Three longitudinal cohort studies met the inclusion criteria. The Joanna Briggs Institute evidence hierarchy was used to rate the level and quality of the studies. Results of the rapid review indicate the quality of studies a high or moderately high. A summary of the results for each study is provided. Clinical Implications: This review contributes to the growing body of literature suggesting that untreated hearing loss is a risk for cognitive decline. While there are various hypotheses on whether there is a definitive relationship between the two, many of the studies reviewed found that a hearing loss in older adults will result in a poorer change of cognitive ability or cognitive decline. Any patient aged 65 years or more indicating concern about hearing loss should be referred to an audiologist for a comprehensive hearing evaluation.

P152: Early detection and evolution of Mild Behavioral Impairment in a sample of people with subjective cognitive complaints

Objective:Mild behavioral impairment (MBI) is a validated diagnostic entity, that describes the emergence of later life neuropsychiatric symptoms (NPS) in pre-dementia states. The aim of this study was to estimate the prevalence of MBI in people with subjective cognitive complains (SCCs) in primary care centers and observe the evolution in a longitudinal study.Methods:Three hundred twenty-three participants belonging to the CompAS longitudinal study who attended primary care centers with SCCs and without previous diagnosis of dementia and other neurological or psychiatric disturbances underwent clinical, neurological, and neuropsychological examinations at baseline and at two follow-up times (around 24 and 60 moths). At each evaluation point participants were diagnosed as Cognitively Unimpaired (UC), Mild Cognitive Impairment (MCI) and SDC; at the follow-up assessments dementia was diagnosed as well. Diagnosis of MBI was made via a series of semistructured independent interviews with patients and relatives in accordance with the ISTAART-AA criteria and using the Spanish MBI-C cut-off point (Mallo et al, 2019). Frequencies of participants diagnosed in each category were obtained and evolution of the MBI along the follow-up evaluations was studied.Results:MBI diagnosis prevalence was 22.9% at baseline corresponding to 74 individuals of which at 24 months follow-up were MBI stable 31.1%, 14.9% evolved to MCI, 1.3% to dementia and 40% to CU, (attrition 12.2%). At 60 months follow-up, from the 23 individuals with MBI, 6 remained stable (26.1%), 6 (21.1%) evolved to MCI, 2 (8.7%) to dementia, 3 (13%) to CU, (attrition 26.1%) (Figure 1).Conclusions:Results indicated that almost a quarter of individuals attending primary care centers with SCCs without previous diagnosis of dementia or psychiatric disorders are MBI. An important part of them evolve to UC or MCI, and only a minority progress to dementia. More studies are needed to analyze the cognitive, personal, and biological factors that determine this evolution.

Brazilian Subjective Cognitive Decline (BRASCODE) Cohort: protocol and preliminary results

AbstractBackgroundSubjective Cognitive Decline (SCD) is a condition characterized by consistent cognitive complaints in cognitively unimpaired (CU) individuals and is associated with progressive cognitive impairment, especially in the context of Alzheimer’s disease (AD). We aimed to show the study protocol and the preliminary results of the Brazilian Subjective Cognitive Decline (BRASCODE) Cohort.MethodCU individuals with > 65 years old and cognitive complaints were recruited. Exclusion criteria were previous diagnosis of dementia, uncontrolled neuropsychiatric/clinical illness, or cerebrovascular disease. The assessment was performed exclusively by phone calls. It consisted of a brief cognitive (Modified Telephone Interview for Cognitive Status ‐ TICS‐M) and anxiety/depression screenings, in addition to the SCD‐scale (Figure 1).ResultBetween March and November 2022, 52 SCD patients were included, 73.1% (n = 38) women. Their median interquartile range (IQR) age was 70 (68‐73) years old, with 16 (9.25‐19) years of formal education and median score of 28.5 (IQR 26,30) on Mini Mental State Examination (MMSE) (Table 1). Percentage of agreement on the presence of cognitive complaints between informants and patients was 38.5%. The main SCD‐plus criteria were the age at onset of SCD ≥ 60 years old (84.6%, n = 44) and concerns associated with SCD (78.8%, n = 41). The key findings of the neuropsychological assessment are reported in Table 2. Deficits were observed mainly in memory and executive functioning domains. Explorative analysis showed that Cognitive Reserve Scale scores correlated positively with MMSE (rho = 0.311; p = 0.02) and with formal education (rho = 0.541; p<0.001) and negatively with CDR‐sum of boxes (rho = ‐0.307; p = 0.03). The prevalence of APOE ε4 carriers was 29.8% (n = 14) and a dementia family history was more frequent in APOE ε4 carriers ‐ 12 (85.7%) ‐ than non‐carries, 12 (36.4%).ConclusionThe increase in the sample size, especially with individuals with low education, associated with AD biomarkers analysis and long‐term follow‐up may bring valuable information about the progression of SCD to cognitive decline in Brazil. We estimate that a total of 150 individuals will be included by the end of 2023.

SARS-CoV-2 infection and cognition in community-dwelling and nursing home residents in southern Switzerland

BackgroundCOVID-19 patients can report ‘brain fog’ and may exhibit cognitive symptoms for months after recovery (Cognitive COVID). However, evidence on whether and the extent to which SARS-CoV-2 infection impacts cognition irrespective of COVID-19 course and severity is limited to clinical samples and mainly comes from prognostic studies. We aimed to explore the association between serologically confirmed SARS-CoV-2 infection and cognitive functioning in community-based and institutionalized older adults, irrespective of COVID-19 symptoms. MethodsWe conducted a case-control study nested into two cohorts in Southern Switzerland. Eligible subjects were Italian speaking older adults, without a previous diagnosis of dementia, who underwent serological testing for anti-SARS-CoV-2 antibodies between November 2020 and July 2021. We manually selected age-, sex- and education-matched cases (i.e., individuals with a serologically confirmed SARS-CoV-2 infection), with seronegative controls, and we conducted in-person neuropsychological assessments using validated, highly sensitive cognitive tests. ResultsWe completed 38 neuropsychological assessments in a mostly female sample of older adults (Mean age: 83.13 ± 8.95; 86.8% women). 17 were community dwelling individuals while 21 lived in a nursing home. As expected, socio-demographic characteristics of age, gender and educational level were similarly distributed between cases (n = 14) and controls (n = 24). In linear regression models, cases had significantly lower scores in cognitive tasks of memory (β = −0.367, p = 0.023), attention (β = 0.428, p = 0.008) and executive functions (β = 0.326, p = 0.046). We found no significant difference in tests of language and spatial-temporal orientation (all p values > 0.05). ConclusionsSARS-CoV-2 infection was associated with cognitive impairment in memory, attention, and executive functions in older adults. Our findings are consistent with mechanistic evidence of the neurotropism of the virus and provide empirical support for the “Cognitive COVID” construct also in non-clinical samples. With nearly 800 million COVID-19 cases (in April 2023), and many more infections worldwide, the clinical and public health implications of Cognitive COVID due to SARS-CoV-2 infection may be massive and warrant further epidemiological investigations.

The Effect of Cataract Surgery on the Risk of Dementia: A Nationwide Cohort Study.

An advanced age and the female sex are widely recognized risk factors for both cataract and dementia. We investigated the effect of cataract surgery on the incidence of dementia in a Korean population aged ≥ 45 years with a previous diagnosis of cataract. This nationwide cohort study was performed using Korean National Health Insurance Service data collected from 2006 to 2017. A total of 300,327 subjects aged ≥ 45 years with a history of cataract diagnosis but no previous diagnosis of dementia were analyzed. The relationship between cataract surgery and dementia was evaluated, applying a time-varying analysis to evaluate the hazard ratio (HR) and 95% confidence interval (CI) values according to dementia. It was calculated via a multivariable Cox regression model, with adjustments for age, sex, visual acuity (VA), ocular and systemic comorbidities, and social factors (including body mass index, income, smoking, and drinking). In the multivariate analysis, the cataract surgery group showed a marginal difference in dementia development (HR 1.10 [95% CI 1.02-1.19]) because both cataract and dementia share common risk factors. However, in the subgroup analysis, men (HR 0.49 [95% CI 0.26-0.90]) and patients under 65 years of age (HR 0.88 [95% CI 0.79-0.99]) in the group with cataract surgery and good VA showed a significantly lower incidence of dementia. Through visual improvement, together with timely surgical intervention, the procedure can alleviate the risk of dementia in visually impaired patients, especially in younger and male patients.

219 Delirium snapshot—inpatient rates and demographics of delirium in an Irish university teaching hospital

Abstract Background Delirium has been repeatedly demonstrated to increase morbidity and mortality both in the inpatient setting and post-discharge. This study sets out to examine the rates and demographics of delirium in the inpatient setting and identify significant risk factors for its development. Methods Data was collected on inpatients on a single day (13/12/22) using an internet application developed by the Hospital’s Quality and Improvement Department. Biographical data, length of stay (LOS), source of admission, admission diagnosis, clinical diagnosis of delirium and/or dementia and preadmission and current continence data were gathered from medical or nursing notes. Data was analysed and statistical significance determined via Pearson’s Chi-Squared Test. Results Data was available for 309 inpatients. The point prevalence of delirium was 25.2% (78/309). About half of delirious patients were female (41/78) and (38/78) had a previous diagnosis of dementia (p = <0.01). Almost a quarter of the cohort had pre-existing cognitive impairment (73/309, 23.6%). Nursing home residents had the highest percentage of delirium 17/42 (40.5%) by admission source (p = 0.01). Delirium prevalence increased with age reaching 37.5% in those over 90 years, (p = 0.03). Delirium was more prevalent in those with a longer LOS (19.8% LOS <7 days compared to 44.6% LOS >7 days). Delirium rates were higher in those incontinent or catheterized both at baseline and during admission (p = <0.01), as well as in those requiring assistance with mobility (p = <0.01). Conclusion Approximately a quarter of all inpatients experienced delirium during their admission. However, these figures were significantly higher in at risk categories such as those aged ≥70, Nursing Home residents and those with cognitive impairment. Despite extensive awareness and education of the risks of delirium, its prevalence remains too high. Further interventions are urgently needed.

#6696 COGNITIVE IMPAIRMENT IN PATIENTS ON HEMODIALYSIS EXPERIENCE FROM A CENTER IN SANTA ROSA GUATEMALA

Abstract Background and Aims Cognitive impairment in patients with chronic kidney disease (CKD) involves multiple factors such as inflammation, uremic toxins and endothelial dysfunction, having rates of up to 10.7 cases per 1000/patient year and that can increase in renal replacement therapy (RRT). The cognitive impairment can progress to dementia and this has adverse long-term outcomes such as mortality. The prevalence of cognitive impairment is 19% to 77% in patients with hemodialysis therapy. The aims of this study was determine the prevalence of cognitive impairment in hemodialysis patients and possible associated factors. Method A cohort study was conducted in a hemodialysis unit of Santa Rosa, Guatemala. Patients over 18 years of age were included with more than two months of having started hemodialysis and with 3 sessions per week. Patients with a previous diagnosis of dementia, with visual-hearing deficits, illiterate, a history of cerebrovascular events or psychiatric disorders and who did not agree to participate in the study were excluded. For cognitive assessment, the Montreal Cognitive Assessment tool (MoCA test) was used, taking a score of less or equal than 26 points as cognitive impairment. A value of p<0.05 was taked significant. Results 78 patients were screened, however 30 patients were discarded due to exclusion criteria. A total of 48 patients were analyzed. A mean age was of 51 years, the majority of whom were male, 40% had only a basic level of education and 38% did not know the cause of CKD. Arterial hypertension was the most frequent comorbidity and the most used antihypertensive were beta-blockers. As for medications for complications of CKD, vitamin D and erythropoietin are the most used. The patients had an average time on hemodialysis of 41.3 months, the last calculated Kt/V was of 1.73 (mean), the mean hemoglobin level was 9.9 g /dl and the mean MoCA test score performed for the study was 23.3 points. Regarding the primary objective, it was determined that the prevalence of cognitive impairment was 67% and when analyzing the variables it was found that age and level of education are associated with greater cognitive impairment, older patients (p: 0.002) and with lower level of education (p: 0.02). In analysis the cognitive domains, it is founded that those patients who present alterations in the attention and delayed recall domain are those that are statistically more associated with cognitive impairment and their counterpart those who have conserved the naming and language domain are those that are associated with having a normal global cognitive practice (Table 1). A correlation analysis was performed where it was found that there is a negative correlation which is moderate and statistically significant between age and the MoCA test score (Table 2). Conclusion The prevalence of cognitive impairment was 67%, age and educational level seem to be influencing factors, with older patients and those with lower educational level being the most affected. Within the cognitive domains, attention and delayed recall are the most affected and most associated with cognitive impairment. It is important to conduct further studies evaluating other variables that have been shown to influence cognitive status such as vitamin B12, vitamin D and homocysteine. It is important to perform cognitive evaluation of patients on hemodialysis and other RRT to have an early diagnosis and intervene early considering that cognitive impairment can progress to dementia and this is a cause of abandonment in treatment and mortality.

Prevalence of dementia and cognitive impairment no dementia in a large nationally representative sample: The ELSI‐Brazil study

AbstractBackgroundApproximately 77% of older adults in Brazil with dementia have not been diagnosed, indicating a major public health issue. Previous dementia epidemiologic studies from Brazil were based on data from one geopolitical region. We aimed to estimate the general and subgroup‐specific (age, education, and sex) prevalence of dementia diagnosis and cognitive impairment no dementia (CIND) using data from 5,249 participants aged 60 years and older from the Brazilian Longitudinal Study of Aging (ELSI‐Brazil), a large nationally representative sample of older adults.MethodParticipants were classified as either: having normal cognitive function, CIND, or dementia based on a combination of the individuals’ cognitive and functional status. A normative subsample provided adjusted regression‐based norms for the cognitive assessment, and a z‐score of ‐1.5 or lower for global cognition was considered to indicate cognitive impairment. We considered functional impairment if the participant reported one or more difficulties in four gender‐independent daily living activities. Participants were classified as having normal cognitive function if there was no cognitive and functional impairment, as CIND if there was only cognitive impairment, and as dementia if there were both cognitive and functional deficits or if the informant scored above 3.4 points in the Informant Questionnaire on Cognitive Decline in the Elderly.ResultWe found a general prevalence of 6.1% (95% CI = 5.1‐7.3) for dementia and 8.6% (95% CI = 7.1‐10.3) for CIND (Table 1). Dementia prevalence ranged from 3.3% (60‐64 years) to 43.0% (≥ 90 years) by age, and from 2.0% (College level or higher) to 17.5% (illiterates) by educational level. Females had a higher prevalence (7.4%) than males (4.4%). CIND prevalence was similar across the age, sex, and education groups.ConclusionThe estimated dementia prevalence is in line with previous epidemiologic studies. Only 0.8% of the ELSI participants self‐reported having a previous diagnosis of dementia, revealing that underdiagnosis is rampant and a common reality. Based on our results, we expect that nearly 1.7 million of the 2015 population, and 2 million of the 2019 population, might have dementia in Brazil.

Effects of Multidisciplinary Rehabilitation Enhanced with Neuropsychological Treatment on Post-Acute SARS-CoV-2 Cognitive Impairment (Brain Fog): An Observational Study.

Concentration and memory impairment (named "brain fog") represents a frequent and disabling neuropsychological sequela in post-acute COVID-19 syndrome (PACS) patients. The aim of this study was to assess whether neurocognitive function could improve after a multidisciplinary rehabilitation program enhanced with individualized neuropsychological treatment. A prospective monocentric registry of PACS patients consecutively admitted to our Rehabilitation Unit was created. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive impairment at admission and discharge. A total of sixty-four (64) PACS patients, fifty-six (56) of them with brain fog, were treated with a day-by-day individualized psychological intervention of cognitive stimulation (45 min) on top of a standard in-hospital rehabilitation program. The mean duration of the acute-phase hospitalization was 55.8 ± 25.8 days and the mean in-hospital rehabilitation duration was 30 ± 10 days. The mean age of the patients was 67.3 ± 10.4 years, 66% of them were male, none had a previous diagnosis of dementia, and 66% of the entire sample had experienced severe COVID-19. At admission, only 12% of the patients had normal cognitive function, while 57% showed mild, 28% moderate, and 3% severe cognitive impairment. After psychological treatment, a significant improvement in the MoCA score was found (20.4 ± 5 vs. 24.7 ± 3.7; p < 0.0001) as a result of significant amelioration in the following domains: attention task (p = 0.014), abstract reasoning (p = 0.003), language repetition (p = 0.002), memory recall (p < 0.0001), orientation (p < 0.0001), and visuospatial abilities (p < 0.0001). Moreover, the improvement remained significant after multivariate analysis adjusted for several confounding factors. Finally, at discharge, 43% of the patients with cognitive impairment normalized their cognitive function, while 4.7% were discharged with residual moderate cognitive impairment. In conclusion, our study provides evidence of the effects of multidisciplinary rehabilitation enhanced with neuropsychological treatment on improvement in the cognitive function of post-acute COVID-19 patients.

Predictors of delirium in patients with acute decompensated heart failure at a cardiac intensive care unit

Abstract Funding Acknowledgements Type of funding sources: None. Background Delirium is commonly observed in critically ill patients and is associated with a worse overall prognosis in patients hospitalized with acute decompensated heart failure. However, in patients with acute decompensated heart failure (ADHF), the impact of delirium on prognosis and the factors that influence it have not been thoroughly examined. Objective To study the predictors of delirium in patients hospitalized in the cardiac intensive care unit (CICU) due to acute decompensated heart failure. Methods We retrospectively analyzed 105 patients admitted to a CICU due to ADHF. Delirium was diagnosed based on the Confusion Assessment Method for ICU (CAM­-ICU) during CICU stay. Echocardiography and laboratory measurements were performed during hospitalization. A logistic regression analysis was performed, looking for independent predictors of delirium development. Results Delirium was observed in 25 patients (23.8%) during CICU hospitalization. Multivariable analysis revealed that older age (odds ratio [OR]: 7.6; 95% confidence interval [CI]: 3.2-21.2; p&amp;lt;0.001), previous diagnosis of dementia (OR: 7.31, 95% CI: 3.65­-14.91, p&amp;lt;0.001), high plasma level of C reactive protein &amp;gt; 79 mg/L (OR: 1.26, 95% CI: 1.09-­1.61, p=0.031), and prior alcohol misuse (OR: 5.4; 95% CI: 2.76-13.40; p=0.003) as significant independent determinants of delirium. Furthermore, we determined that delirium was an independent predictor of in-hospital mortality (OR: 1.93, 95% CI 1.1-3.4.1, p=0.033). There was no relationship to the previous medical history of arterial hypertension, diabetes mellitus, or left ventricular ejection fraction. Conclusions In patients with ADHF, the development of delirium during CICU stay is associated with a higher risk of in-hospital mortality. Older age, dementia, high levels of C reactive protein, and alcohol misuse were identified as predictors of delirium. Therefore, this clinical entity's early diagnosis and proper management are essential.

Prevalence of Dementia and Cognitive Impairment No Dementia in a Large and Diverse Nationally Representative Sample: The ELSI-BrazilStudy.

Approximately 77% of older adults with dementia in Brazil have not been diagnosed, indicating a major public health issue. Previous epidemiological dementia studies in Brazil were based on data from 1 geopolitical region. We aimed to estimate the general and subgroup-specific (age, education, and sex) prevalence of dementia and cognitive impairment no dementia (CIND) classification using data from 5249 participants aged 60years and older from the ELSI-Brazil, a large nationally representative sample. Participants were classified as having normal cognitive function, CIND, or dementia based on a combination of the individual's cognitive and functional status. We found a general prevalence of 5.8% (95% CI=4.7-7.2) for dementia and 8.1% (95% CI=6.8-9.5) for CIND. Dementia prevalence ranged from 3.2% (60-64years old) to 42.8% (≥90years old) by age, and from 2.1% (college level or higher) to 16.5% (illiterates) by education. Females had a higher dementia prevalence (6.8%) than males (4.6%). CIND prevalence was similar across age, sex, and education. The estimated dementia prevalence is lower than that in previous Brazilian epidemiological studies, but is in line with other Latin American studies. Only 1.2% of the ELSI-Brazil participants reported having a previous diagnosis of dementia, revealing that underdiagnosis is rampant and a common reality. Based on our results and national statistics projections, we estimate that in 2019, there were 1757480 people aged 60years and older living with dementia in Brazil and, at least, another 2271314 having to deal with some form of cognitive impairment.

Clock drawing errors in the Mini-Cog test predict postoperative delirium following transurethral resection of bladder tumors while awake

BackgroundIn urology, where the proportion of elderly patients is high, a simple, practical, and reliable screening tool to predict the development of postoperative delirium would be useful. This study aimed to evaluate the efficacy of the mini-cognitive assessment instrument (Mini-Cog) test and the clock drawing test (CDT) for predicting postoperative delirium after transurethral resection of bladder tumors (TURBT). MethodsWe conducted a retrospective cohort study of patients who underwent TURBT under awake spinal anesthesia, and who had preoperative cognitive screening based on the Mini-Cog test consisting of the CDT and a 3-word recall task, in our department between 2020 and 2021. We aimed to identify clinical risk factors for post-TURBT delirium and compared the ability of the CDT alone and the Mini-Cog test to predict post-TURBT delirium. ResultsOf the 229 eligible patients, eighty patients (35%) had abnormal CDT outcomes. Postoperative delirium occurred in 26 patients (11%), of whom 21 (81%) had an abnormal CDT. Multivariate analysis demonstrated that a decline in instrumental activities of daily living (odds ratio (OR), 3.1, p = 0.03), previous diagnosis of dementia (OR = 8.7, p = 0.01), and abnormal CDT (OR = 7.8, p < 0.001) were independent risk factors for post-TURBT delirium. The area under the receiver operating characteristic curve in predicting post-TURBT delirium was 0.759 for the CDT alone and 0.705 for the Mini-Cog test, which was not significantly different (p = 0.30). ConclusionsThe CDT from the Mini-Cog test served as a formal, simple, and brief screening tool for assessing cognitive function as its predictive power adequately identified the risk of postoperative delirium in patients undergoing TURBT under spinal anesthesia while awake.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

IntroductionDelirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.MethodsThe analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.ResultsA sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].Discussion and conclusionLow muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Associations of hypertension burden on subsequent dementia: a population-based cohort study

In this nationwide cohort study, we assessed the effects of hypertension burden and blood pressure (BP) control on dementia in different age subgroups. From the Korean National Health Insurance Service-Health Screening cohort from January 1, 2005 to December 31, 2013, we enrolled 428,976 subjects aged 40–79 years without previous diagnosis of dementia or stroke. During a mean follow-up of 7.3 ± 1.5 years, 9435 (2.2%) were diagnosed with dementia. Per 10 mmHg increase in systolic BP (SBP), risk of dementia was increased by 22% (95% confidence interval [CI] 1.15–1.30) in subjects aged 40–59 years and 8% (95% CI 1.04–1.11) in subjects aged 60–69 years. No significant associations were observed in subjects aged ≥ 70 years. Among subjects aged 40–59 years, both vascular and Alzheimer’s dementia risks were increased with increasing SBP. Increasing hypertension burden (proportion of days with increased BP) was associated with higher dementia risk (hazard ratio [HR] 1.09 per 10% increase, 95% CI 1.08–1.10). Among patients with baseline SBP ≥ 140 mmHg, optimal follow-up SBP (120–139 mmHg) was associated with decreased dementia risk (HR 0.69, 95% CI 0.50–0.95). Hypertension burden was associated with higher risks of dementia. Adequate BP control was associated with lower risk of dementia in individuals aged < 70 years.

Memory complaints at primary care in a middle-income country: clinical and neuropsychological characterization

ABSTRACT.There are different causes of memory complaints in the elderly, such as subjective cognitive decline (SCD), mild cognitive impairment (MCI) or dementia.Objective:1) To characterize individuals with memory complaints in a mid-sized city in Brazil, through clinical, cognitive and functional assessment; 2) to compare SCD individuals with MCI and dementia patients in terms of clinical and cognitive variables.Methods:We consecutively included individuals aged ≥50 years, with memory complaints (spontaneous or inquired). Subjects who scored ≥25 on the Memory Complaint Questionnaire or who had spontaneous memory complaints were selected. Participants underwent a semi-structured interview, the Mini-Mental State Examination, Figure Memory Test for visual episodic memory, Clock Drawing Test, Category Fluency (Animals), Neuropsychiatric Inventory, and functional assessment. Individuals were classified as SCD, MCI or dementia. We did not include individuals with previous diagnosis of dementia.Results:The final sample consisted of 91 subjects (73.6% women; mean age 67.6±9.8 years): 14.3% had spontaneous complaints and 85.7% had inquired complaints. The most common comorbidities were hypertension (69.2%), diabetes (36.3%), and dyslipidemia (24.2%). Low levels of vitamin B12 and hypothyroidism were found in 26.4 and 16.5%, respectively. Regarding cognitive diagnosis, 16.5% of the sample were classified as SCD, 49.4% as MCI and 34.1% as dementia. MCI and dementia were identified in five (38.5%) and seven (53.4%) patients with spontaneous complaint, respectively.Conclusions:MCI and dementia are frequently underdiagnosed. Potential reversible causes of cognitive decline are common. The diagnosis of dementia is highly frequent among individuals with spontaneous memory complaints.

Impact of delirium on short-term outcomes in hip fracture patients under a program of approach to delirium.

We aimed to investigate the impact of delirium on short-term outcomes in hip fracture patients. Special attention was given to patients with delirium and dementia. A prospective observational cohort study was carried out in hip fracture patients aged ≥70 years who were admitted to a hospital unit where a multicomponents approach to delirium is established for all patients. Our population was split into delirium (n = 212) and non-delirium cohort (n = 171) according to the Confusion Assessment Method. Patients with a previous diagnosis of dementia in an outpatient appointment were also assessed within the delirium cohort. The utility of the rehabilitation was measured with the Absolute Functional Gain index. A total of 383 patients were entered into the study. The median age was 86 years, and most patients were women (78.8%). Delirium patients were older, presented a lower previous Barthel Index (BI), had higher rates of dementia and came more frequently from nursing homes. Comparative analysis did not show differences in mortality, complications, length of stay or walking ability between the cohorts. However, lower BI on discharge, lower Absolute Functional Gain and the presence of nosocomial infections were found more frequently in the delirium cohort. In multivariate analysis, only the BI on discharge (P = 0.010) was lower in delirium patients. Within the delirium cohort, those suffering from dementia had worse BI on discharge (P = 0.017) and lower Absolute Functional Gain (P = 0.019). Delirium was not associated with mortality, walking ability, length of stay and clinical complications in hip fracture patients. BI on discharge was the only short-term outcome affected. In the delirium cohort, those suffering from dementia showed worse rehabilitation results. Geriatr Gerontol Int 2020; 20: 130-137.

Adaptation of the Modified Mini-Mental State Examination (3MS) and Determination of Its Normative Values in Turkey

Background/Aims: This study aimed to adapt the Modified Mini-Mental State Examination (3MS) and determine its normative values in Turkey. Methods: After translation and cultural adaptation processes, a population-based study was conducted between February and June 2016 in Ankara with individuals over the age of 55 years. Subjects with a previous diagnosis of dementia along with neuropsychiatric disorders that might affect cognition were excluded. Data analyses were performed to assess the association of sociodemographic variables with 3MS scores. Results: Two versions of the Turkish 3MS (for educated and minimally educated individuals) were developed. A total of 2,235 participants were included in the field study. After exclusion, the data on the final sample of 1,909 individuals were analyzed, where age, gender, and education accounted for variance in 3MS scores. Younger age and higher educational attainment were associated with better 3MS performance. Conclusions: A widely applicable dementia screening test was adapted to Turkish and its normative values were determined. The test will make it possible to evaluate the cognitive performance of both educated and minimally educated elderly individuals based on their age, gender, and educational level.

The relationship between peripheral hearing loss and higher order listening function on cognition in older Australians

Objective: Peripheral hearing, central auditory processing (CAP) and cognition are all important for comprehension of speech and deteriorate with increased age. This study aimed to examine the relation between hearing impairment and cognitive impairment by assessing both peripheral hearing impairment and CAP ability.Design: Cognition was measured using the CogState Brief Battery (CSBB). Peripheral hearing was measured across eight frequencies (250 Hz–8000 Hz) using pure tone audiometry, and CAP was measured using the Listening in Spatialised Noise-Sentences test (LiSN-S) and the Dichotic Digits Test. Data were analysed using correlation and regression analyses.Study sample: Around 85 adults aged 60.33–83.08 years who attended the Melbourne Audiology clinic and had no previous diagnosis of dementia were included in the study.Results: A significant association was found between degree of peripheral hearing impairment and the cognitive skills of attention and executive function as measured by the CSBB. Additionally, CAP abilities as assessed using the LiSN-S test were significantly correlated with at least one cognitive measure.Conclusions: This study adds to the knowledge that peripheral hearing and CAP ability both share an association with cognition, specifically identifying cognitive skills and measures of “hearing” that mediate this relationship.