Previous Diagnosis Of Dementia Research Articles

Sex differences in 1-year mortality risks in older patients experiencing a first acute heart failure hospitalization.

To assess whether 1-year mortality in older patients experiencing a first admission for acute heart failure was related to sex, and to explore differential characteristics according to sex. We reviewed the medical records of 1132 patients aged >70 years of age admitted within a 3-year period because of a first episode of acute heart failure. We analyzed sex differences. Mortality was assessed using multivariate Cox analysis. There were 648 (57.2%) women (mean age 82.1 years) and 484 men (mean age 80.1 years). There were some differences in risk factors: women more often had hypertension, and less frequently had coronary heart disease and comorbidities (women more often had dementia, and men more often had chronic obstructive pulmonary disease, chronic kidney disease and stroke). Women were treated more frequently with spironolactone. The 1-year all-cause mortality rate was 30.2% (30.7% women and 29.5% men). Multivariate Cox analysis identified an association between reduced heart failure (hazard ratio [HR] 0.35, 95% confidence interval [95% CI] 0.21-0.59), hemoglobin <10 g/dL (HR 1.99, 95% CI 1.16-3.40), systolic blood pressure (HR 0.98, 95% CI 0.97-0.99), previous diagnosis of dementia (HR 2.07, 95% CI 1.12-3.85), number of chronic therapies (HR 1.12, 95% CI 1.05-1.19) and 1-year mortality in women. In men, an association with mortality was found for low systolic blood pressure (HR 0.97, 95% CI 0.97-0.98) and higher potassium values (HR 1.42, 95% CI 1.01-2.00). Among older patients hospitalized for the first acute heart failure episode, there is a slightly higher predominance of women. There are sex differences in risk factors and comorbidities. Although the mortality rate is similar, the factors associated with it according to sex are different. Geriatr Gerontol Int 2019; 19: 184-188.

Underdiagnosis of delirium in the elderly in acute care hospital settings: lessons not learned

Delirium is a common and poorly diagnosed cause of behavioral change in elderly. This study aimed to estimate the prevalence, diagnostic accuracy and factors associated with the onset of delirium in the elderly admitted to an urgency unit. Cross-sectional study including clinically stable subjects aged ≥60 years between April and June of 2014. Diagnosis of delirium based on the Confusion Assessment Method (CAM, gold standard) was compared to the subjective assessment made by physicians on duty as recorded in the medical chart. Association of sociodemographic, psychological/behavioural, and clinical variables with delirium was assessed using multivariate analysis. A sample of 110 participants with a mean age of 72.7 ± 8.3 years was studied. Of these, 56.4% were men and 28.2% had a diagnosis of delirium on CAM. Significant associations were observed between delirium and male gender (P-value = 0.019), poor or very poor self-perception of health (P-value = 0.033), previous diagnosis of dementia (P-value = 0.001), previous history of stroke (P-value = 0.014), and acute bacterial infection (P-value = 0.008). Physician diagnosis had a sensitivity of 35.5%, specificity of 100%, and accuracy of 81.8% to detect delirium. Rate of misdiagnosis was 64.5%. Delirium was underdiagnosed in this urgent care hospital setting.

Factores asociados al estado nutricional en pacientes adultos mayores hospitalizados

Introducción: La desnutrición es una condición frecuente en las personas mayores de 65 años. El mal estado nutricional se ha relacionado con mayores estancias hospitalarias, complicaciones, aumento en comorbilidades y mortalidad. Este estudio busca describir la relación entre el estado nutricional de adultos mayores hospitalizados y factores como red de apoyo, funcionalidad y presencia de demencia.&#x0D; Materiales y Métodos: Se llevó a cabo un estudio descriptivo de corte transversal analítico basado en la revisión de historias de los pacientes hospitalizados por el servicio de Geriatría del Hospital Universitario San Ignacio de Bogotá D.C. La variable dependiente fue el estado nutricional medido con el instrumento Mini-Nutritional Assessment y se usaron como variables independientes factores sociodemográficos, el estado funcional, el diagnóstico previo de demencia, la red de apoyo, delirium, tiempo de estancia hospitalaria, comorbilidades.&#x0D; Resultados: Se incluyeron 887 pacientes con edad promedio de 85,43 (DE=7,02) años, de los cuales 382 (43,07%) eran hombres. En el modelo de regresión logística se encontró un aumento del riesgo de malnutrición de 2,48 veces con demencia (OR= 2,48 (1,63-3,77), p=0,00) y una disminución del mismo de 0,02 veces con un mayor Barthel al ingreso (OR=0,98 (0,97-0,987), p=0,00).&#x0D; Conclusión: Se encontró una asociación significativa entre mal estado nutricional con menor funcionalidad, mayor estancia hospitalaria, tener diagnóstico de demencia, presentar delirium, tener un mayor número de comorbilidad y mayor mortalidad. Se requieren más estudios que aborden este tema.

A Predictive Model of the Prevalence of Delirium in Elderly Subjects Admitted to Nursing Homes.

Delirium is common in geriatric patients admitted to nursing homes, with an incidence of 22-79% among long-term residents. To establish a predictive model of the risk of delirium episodes in a sample of elderly people living in nursing homes. A retrospective, cross-sectional case-control study covering a period of 12 consecutive months (April 2014 - March 2015) was carried out. The included cases had suffered at least one episode of delirium during the study period. Sociodemographic and clinical variables as well as risk factors predisposing to or triggering episodes of delirium were recorded. A total of 193 cases and 123 controls were recruited. The mean age of the cases was 89.6 years (SD 6.9), and 75.1% were women. The mean age of the controls was 84.7 years (SD 7.42), and 75.6% were women. The prevalence of delirium was 60.7%. The presence of infections (with the exception of urinary tract infections) was the variable offering the best predictive capacity (OR=7.08; 95% CI: 3.30-15.02; p<0.001). Other predictors of delirium were also identified, such as a previous diagnosis of dementia (OR=3.14; 95% CI: 1.81-5.45; p<0.001), the use of anticholinergic drugs (OR=2.98; 95% CI: 1.34-6.60; p=0.007), a diagnosis of depression (OR=1.92; 95% CI: 1.03-3.56; p=0.039), and urinary incontinence (OR=1.73; 95% CI: 0.97-3.08; p=0.065). The area under the curve (AUC) was 0.794 (95% CI: 0.74-0.84; p<0.001). The prevalence of delirium among elderly subjects admitted to nursing homes was 60.7%. Infections (with the exception of urinary tract infections), dementia, anticholinergic drug use, depression and urinary incontinence were predictive of the presence of delirium.

Frailty and cognitive status evaluation can better predict mortality in older adults?

Objectivesto evaluate the improvement in one-year mortality prediction after adding a 2-min cognitive screening to a simple 1-min frailty detection instrument. Secondary outcomes were new activities of daily living (ADL) disability and falls. DesignProspective cohort study. SettingA geriatric day-hospital for intermediate care. ParticipantsA total of 701 older adults with an acute or decompensated disease (79.5 (8.3) years, 64% female). MeasurementsA rapid and simple frailty evaluation was performed using the FRAIL questionnaire. The presence of cognitive impairment was defined by previous diagnosis of dementia or a score of five or less on an education-corrected 10-point cognitive screening tool. ResultsFrail participants with normal (hazard risk [HR] 4.0, 95% confidence interval [CI], 1.73–9.25) and impaired cognition had a higher risk of death (HR 4.38, 95% CI, 1.95–9.87) than robust participants. The presence of cognitive impairment increased the risk of death in prefrail (HR 3.60, 95% CI, 1.55–8.34) and robust participants (HR 3.49, 95% CI, 1.22–9.96). Cognitive impairment was associated with an increased risk of incident ADL disability in all frailty categories. The presence of cognitive impairment was associated with a significantly higher risk of fall in robust seniors. The predictive accuracy of the FRAIL scale was lower than expected (between 0.58 and 0.69), and a small improvement was observed after adding the cognitive screening (between 0.61 and 0.72). ConclusionDespite of significant results in predicting relevant clinical events, the present combination of the FRAIL and 10-CS scales may not be ideal in clinical practice.

Abstract TP155: Cognitive Impairment in Mild Stroke

Background: Cognitive symptoms are easily overlooked despite its effect on quality of life after stroke. In patients with minimal physical residual symptoms, the true burden of cognitive impairment is unknown. Objective: To evaluate the risk factors and burden associated with cognitive impairment after mild stroke. Methods: A retrospective observational cohort study of 56 patients (51 ischemic, 5 hemorrhagic) evaluated at the stroke clinic between July 2016 and June 2017 was performed. Patients completed a questionnaire including demographics and history including previously known cognitive impairment. Cognition was evaluated with the Montreal Cognitive Assessment Score (MOCA). Results: The median age of the group studied was 61.5 years. Sixty-six percent (66.1%) patients were men and 76.8% Caucasian. The median discharge NIH score was 1. This study group did not have a previous diagnosis of dementia. About 4% (n=2) of patients presented to clinic &lt;6 weeks, 71.4% (n=40) 6-12 weeks, 17.9% (n=10) 12-24weeks and 7.1% (n=4) &gt;24 weeks from discharge. Cognitive assessment at the stroke clinic after discharge identified 19.6% patients with mild impairment, 16.1% with moderate impairment and 14.3% with dementia. MOCA scores were lower in those greater than 65 years of age ( p =0.022), living in facilities post-stroke ( p =0.007), have history of stroke and diabetes mellitus ( p =0.011, 0.019). Education level did not show significant difference in MOCA scores ( p =0.283). Those who were employed prior to their stroke have a higher MOCA score compared to those who were unemployed ( p =0.001). Of those previously working, 50% were able to return to work and this group had higher MOCA scores ( p =0.011). Of those who stopped driving, 19.6% was due to cognitive concerns. Conclusion: In our study, about 50% of the mild stroke patients were found to have some degree of cognitive impairment. Factors that may suggest a higher risk for cognitive impairment after stroke include those age greater than 65, history of stroke and diabetes, unemployment and living in a facility. Post-stroke cognitive impairment was found to be associated with inability to return to work and drive. Since cognitive impairment can impact life quality, screening even in mild stroke could be beneficial.

Less dementia with oral anticoagulation in atrial fibrillation

The association between atrial fibrillation (AF) and dementia is well documented, but it is not clear if oral anticoagulant treatment offers protection. The aim of the study is therefore to compare the incidence of new dementia in patients with AF with and without oral anticoagulants, and to explore if there is a difference between novel anticoagulants and warfarin in this respect. Retrospective registry study of all patients with hospital diagnosis of AF and no previous diagnosis of dementia in Sweden between 2006 and 2014. Propensity score matching, falsification endpoints, and analyses according to intention to treat as well as on-treatment principles were used. The study included 444 106 patients and over 1.5 million years at risk. Patients on anticoagulant treatment at baseline was associated with 29% lower risk of dementia than patients without anticoagulant treatment [hazard ratio (HR) 0.71, 95% confidence intervals (95% CI) 0.68-0.74] and 48% lower risk analysed on treatment (HR 0.52, 95% CI 0.50-055). Direct comparison between new oral anticoagulants and warfarin showed no difference (HR 0.97, 95% CI 0.67-1.40). The risk of dementia is higher without oral anticoagulant treatment in patients with AF. This suggests that early initiation of anticoagulant treatment in patients with AF could be of value in order to preserve cognitive function.

ADAPTATION OF THE MODIFIED MINI-MENTAL STATE (3MS) EXAM, DEVELOPMENT OF A VERSION FOR THE UNDEREDUCATED, AND DETERMINATION OF NORMATIVE VALUES IN THE TURKISH POPULATION

No dementia screening tests with a completed standardization is available in Turkey at present. Most tests in use only have certain threshold values derived from clinical settings, not from population-based studies, which restricts their administration among different patient groups. This study aimed to standardize a potentially widely-applicable screening test to be used in the Turkish population. Currently, over 20% of the Turkish elderly have less than 5 years education, therefore development of a separate version for undereducated elderly population was also planned. Since Mini-Mental-State-Examination (MMSE) is widely used in primary care and a version for the undereducated exists, we decided to standardize Modified-Mini-Mental-Test (3MS) which is an expanded and modified version of MMSE. Translation and cultural adaptation process included a preliminary study, which led to the final version of the Turkish-3MS. A population-based study including individuals over the age of 55 was run to determine the normative values in a representative sample in Ankara, Turkey. A sociodemographic form including health status, lifestyle and environmental factors, daily activities of living and 3MS were used for data collection. Previous diagnosis of dementia along with neuropsychiatric disorders that might affect cognition were determined as exclusion criteria. The association of sociodemographic variables with 3MS scores were evaluated. This study was funded by the Scientific and Technological Research Council of Turkey (Grant no: 214S048). A total of 2235 participants were included. After the exclusion, data of 1948 individuals were analyzed for normative study. Of the study sample, 51.3% were female and 41.1% had less than five years of education (grouped as undereducated). Among the sociodemographic variables examined, age, gender, and education accounted for variance in 3MS scores. Younger age, male gender and higher educational attainment were associated with better 3MS performance. Normative values for both undereducated and educated versions of 3MS-Turkish form were determined. A dementia screening test with normative values was developed for the Turkish population. The test will provide the opportunity for health professionals, including primary care workers to evaluate the cognitive performance based on age, gender and education level, in both educated and undereducated elderly. Studies for further psychometric features are ongoing.

CLINICAL TRIAL RECRUITMENT FRAMEWORK FOR EARLY ALZHEIMER’S DISEASE

Recruitment and retention of early Alzheimer's patients in clinical trials provide both challenges and opportunities for improvement (Watson, 2012). To expedite recruitment of 24 participants at a single clinical site for NCT02221622 we sought to move past traditional recruitment approaches. We discuss innovative methods to recruit, retain, and budget for an early phase trial in a university setting. Recruitment materials included paper and web-based flyers, social media, health fairs, and radio advertisements (3 local radio stations). All recruitment materials were approved by IRB. Qualified staff with current protected health information compliance certificates conducted phone pre-screens and entered caller information into a secure REDCap database. The Clinical Study Coordinator called potential volunteers for follow-up phone interviews and scheduled first screening visit. Many participants (55%) opted to use taxi transportation (Uber) that allowed real-time smartphone tracking for both the caregivers and clinicians, improving appointment efficiency. Other than reimbursements for transportation and parking costs, no other compensation benefits were afforded. The trial was conducted at USC and funded by NIH-NIA and ADDF. Of the recruitment materials used, radio advertisements were most effective. Radio Station: KUSC (11.8%), KNX (86.3%), KOST (0.0%), Other (2.0%). Self-referral: Yes (45.7%), No (54.3%). Age range: 56–91, mean 71.47 +/-10.19. Previous diagnosis of dementia: Yes (48.8%), No (51.2%). Study Partner available: Yes (92.3%), No (7.7%). Previous MRI: Yes (42.1%), No (42.1%), Maybe (15.8%). Pre-screen results: Pass (31.6%), Fail (17.1%), Declined to participate (17.1%), Called for information only (34.2%). Of those that passed pre-screen inclusion/exclusion criteria, 47% of those screened at clinic were enrolled with acceptable MRI results and MMSE >20. To date, of those enrolled, there has been only one dropout. We developed an effective recruitment framework to enroll 24 volunteers with early Alzheimer's disease into a double-blind placebo controlled phase-Ib study to test the safety of once-per-week intravenous Allopregnanolone, a candidate regenerative therapeutic. Recruitment was most effective through brief radio advertisements followed by prescreening interviews and medical record review to recruit willing volunteers. Our recruitment strategy utilized local radio announcements and convenient ride-share transportation and serves as an innovative model for efficient clinical trial recruitment.

Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design.

Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design. Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership. Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement. This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.

Deterioro cognitivo como factor independiente de riesgo hospitalario: estudio DECOFIRH

Cognitive impairment is underdiagnosed in the elderly. We aimed to study the rate of positive responses to an informant-based questionnaires and functional disability after hospital discharge.Observational prospective case series of patients aged 70-85 years-old admitted for hospitalization in an Internal Medicine ward. All medical records were reviewed and those patients with no previous diagnosis of dementia or related neurological conditions, no previous recent hospitalization or not having a caregiver were evaluated after signing an informed consent. A medical interview including the Alzheimer's Disease 8 (AD8), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and Barthel Index was completed. Barthel Index was obtained three months after discharge.During a 3-month period a total of 809 admissions were screened and 79 (9.7%) fulfilled the study criteria. Patient's mean age was 80 years-old. Common comorbidities were arterial hypertension (83.5%), major surgery (54.4%) and heart disorders (50.6%). The most frequent cause of admission was infectious disease (37.9%). Test positivity for cognitive impairment was 30.3% for IQCODE and 34.1% for AD8. At admission 37.9% of the patients were functionally independent. At three months this percentage dropped to 24%.In this small sample size, almost a third of older patients, without major comorbidities or neurological disorders, admitted to a general hospital showed an informant-based suggestion of cognitive impairment previously undiagnosed. Functional impairment affects almost a quarter of these patients three months after admission.Deterioro cognitivo como factor independiente de riesgo hospitalario: estudio DECOFIRH.Objetivo. El deterioro cognitivo esta infradiagnosticado. El estudio DECOFIRH pretende detectar la tasa de deterioro cognitivo no conocido y su impacto en la situacion funcional de estos pacientes tras un ingreso hospitalario mediante cuestionarios realizados a un informador. Pacientes y metodos. Estudio observacional prospectivo realizado sobre una serie de casos, de pacientes comprendidos entre 70 y 85 años, que ingresan en el Servicio de Medicina Interna de un hospital terciario. Se excluyo a los pacientes con diagnostico de demencia o enfermedades neurologicas graves, asi como a los que habian sido hospitalizados recientemente. Los tests empleados en la deteccion de deterioro cognitivo fueron Alzheimer's Disease 8 (AD8) e Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Asimismo, se evaluo la situacion funcional mediante el indice de Barthel en el momento del ingreso y tres meses despues. Resultados. Durante los tres meses de seguimiento ingresaron 809 pacientes y cumplieron los criterios de inclusion 79 (9,7%) de ellos. Su edad media era de 80 años. Mediante el IQCODE se detecto una tasa de deterioro cognitivo del 30,3%, y con el AD8, del 34,1%. En el ingreso, el 37,9% de los pacientes era funcionalmente independiente. A los tres meses, este porcentaje cayo al 24%. Conclusiones. En nuestra muestra, casi un tercio de los ancianos sin comorbilidades sistemicas o neurologicas graves dio positivo para la deteccion de deterioro cognitivo segun nuestros tests basados en el informador, sin ser este conocido previamente. El deterioro funcional afecta casi a una cuarta parte de estos pacientes a los tres meses del ingreso.

Association Between Androgen Deprivation Therapy and Risk of Dementia

ImportanceA growing body of evidence supports a link between androgen deprivation therapy (ADT) and cognitive dysfunction, including Alzheimer disease. However, it is currently unknown whether ADT may contribute to the risk of dementia more broadly.ObjectiveTo use an informatics approach to examine the association of ADT as a treatment for prostate cancer with the subsequent development of dementia (eg, senile dementia, vascular dementia, frontotemporal dementia, and Alzheimer dementia).Design, Setting, and ParticipantsIn this cohort study, a text-processing method was used to analyze electronic medical record data from an academic medical center from 1994 to 2013, with a median follow-up of 3.4 years (interquartile range, 1.0-7.2 years). We identified 9455 individuals with prostate cancer who were 18 years or older at diagnosis with data recorded in the electronic health record and follow-up after diagnosis. We excluded 183 patients with a previous diagnosis of dementia. Our final cohort comprised 9272 individuals with prostate cancer, including 1826 men (19.7%) who received ADT.Main Outcomes and MeasuresWe tested the effect of ADT on the risk of dementia using propensity score–matched Cox proportional hazards regression models and Kaplan-Meier survival analysis.ResultsAmong 9272 men with prostate cancer (mean [SD] age, 66.9 [10.9] years; 5450 [58.8%] white), there was a statistically significant association between use of ADT and risk of dementia (hazard ratio, 2.17; 95% CI, 1.58-2.99; P < .001). In sensitivity analyses, results were similar when excluding patients with Alzheimer disease (hazard ratio, 2.32; 95% CI, 1.73-3.12; P < .001). The absolute increased risk of developing dementia among those who received ADT was 4.4% at 5 years (7.9% among those who received ADT vs 3.5% in those who did not receive ADT). Analyses stratified by duration of ADT found that individuals with at least 12 months of ADT use had the greatest absolute increased risk of dementia (hazard ratio, 2.36; 95% CI, 1.64-3.38; P < .001). Kaplan-Meier analysis demonstrated that ADT users 70 years or older had the lowest cumulative probability of remaining dementia free (log-rank P < .001).Conclusions and RelevanceAndrogen deprivation therapy in the treatment of prostate cancer may be associated with an increased risk of dementia. This finding should be further evaluated in prospective studies.

Prevalence and correlates of mild cognitive impairment in adults aged over 50 years with subjective cognitive complaints in primary care centers

To examine the prevalence and correlates of mild cognitive impairment in adults aged over 50 years attending primary care centers with complaints of cognitive failure. A sample of 689 individuals aged ≥ 50 years with no previous diagnosis of dementia was assessed by use of the Mini-Mental State Examination, the Cambridge Cognitive Examination-Revised and the California Verbal Learning Test--to evaluate the mild cognitive impairment as dependent variables--and administration of a questionnaire on cognitive complaints and other instruments--to measure correlates. The prevalence of mild cognitive impairment was 31.40%, and positive associations were found for age, occupation, subjective memory complaints, reading habits and level of vocabulary. In the logistic regression, modeled mild cognitive impairment was associated with age (70 years or older), subjective cognitive complaints and level of vocabulary. Almost one-third of the adults aged ≥ 50 years attending primary care centers with subjective cognitive complaints were affected by mild cognitive impairment. Early evaluation of cognitive functioning is essential to establish adequate preventive and intervention strategies.

Prevalence and characteristics of liver disease in alcoholic patients with Wernicke encephalopathy

CO RR EC TE D PR OO F physician is required in disregarding another pathology and to adjust treatment.We collected epidemiological data, associated comorbidities, days of delay to surgery, presence of another complications, length of stay, evolution (discharge or death) and readmissions within 30 days after discharge. Results: The study included 131 patients with hip fracture in this period; the mean age was 81.15 +/− 10.19 years and 107 (81.7%) were women. A total of 24 (18.3%) patients developed delirium. There was no differences in gender (p= 0.12), but thosewith deliriumwere older (84.9 vs 80.2, p = 0.04) and had a higher length of stay (25.2 vs 17.3, p = 0.03). The mean Barthel index was lower in those with delirium (65 vs 78, p = 0.14). Previous diagnosis of dementia is associated with the presence of this complication (41.7% vs 22.4%, p = 0.04). There were no differences between those who were operated before or after 72 h (p= .87). The presence of another complications (heart failure, arrhythmia, renal failure, pneumonia, diabetic ketoacidosis, urinary tract infections, pressure ulcers, and hypertension) was similar in both groups. In evolution, the development of delirium did not provide a higher mortality (4.2% vs 8.4%, p = 0.42) but was associated with a higher rate of readmissions within 30 days (20.8% vs. 7.5%, p = 0.04), especially for medical reasons and higher mortality rate in the readmission (80% vs 12.5%, p = 0.03). The healthcare cost of a patient with delirium is 19% greater than in a patient without delirium (1.121.15€). Conclusion: In our series, the presence of acute deliriumhas been associatedwith increased age, prior history of dementia and a lower score on the Barthel Index. Surgical delay does not affect the development of this syndrome. There is no increased mortality during hospitalization, however, these patients have a higher length of stay, readmission rate and mortality within 30 days, with a consequent increase in healthcare costs. Measures to reduce the incidence of this syndrome, would lead to significant economic savings.

Prevalence and Correlates of Cognitive Impairment in Adults with Subjective Memory Complaints in Primary Care Centres

Aims: To examine the prevalence and correlates of cognitive impairment (CI) in adults over 50 years old attending primary care centres with complaints of memory failure. Methods: A sample of 580 individuals aged 50+ years with no previous diagnosis of dementia was assessed by use of the Mini Mental State Examination, the Cambridge Cognitive Assessment-Revised and the California Verbal Learning Test – to evaluate CI-dependent variables – and administration of a questionnaire on memory complaints and other instruments – to measure correlates. Results: The prevalence of CI was 46.20% and positive associations were found for age, gender, level of education, subjective memory complaints, instrumental activities of daily living, reading habits and frequency of leisure activities. In the logistic regression, modelled CI was associated with older age, gender (49.12% women, 39.66% men), instrumental activities of daily living, and reading habits. Conclusion: Almost half of the adults aged 50+ years attending primary care centres with subjective memory complaints were affected by CI. Early evaluation of cognitive functioning is essential to establish adequate preventive and intervention strategies.

&lt;b&gt;Screening for Undiagnosed Cognitive Impairment in Homebound Older Adults&lt;/b&gt;

To screen for undetected cognitive impairment in homebound elders receiving home health care services. A cross-sectional study of adults 60 years of age and older receiving visiting nurse services. A pharmacist administered the Mini-Cog, a rapid screening test for cognitive impairment, during the enrollment home visit. Participants' homes. A consecutive sample of 100 homebound adults, 60 years of age or older with no previous diagnosis of dementia, Alzheimer's disease, or other cognitive impairment. Percentage of participants scoring in the likely impaired range (screen failure) on the Mini-Cog. Seventeen percent of persons with no prior diagnosis of dementia or cognitive decline failed the Mini-Cog. Rates of undetected cognitive impairment are substantial in homebound elders receiving care from a visiting nurse service. The home health setting represents an important point in the continuum of geriatric care for detection of cognitive impairment. Future work should define the types and trajectories of cognitive impairment detected in home care patients by simple screens such as the Mini-Cog and test ways to integrate this knowledge into longitudinal treatment plans across settings of care.

Undiagnosed dementia and value of serial cognitive impairment screening in developing countries: A population‐based study

We conducted a population-based prospective study in 420 older persons to examine the prevalence of undiagnosed dementia and validity of the Chula Mental Test (CMT) as well as value of serial administration of the CMT and its score evolution over 2 years. The CMT score was obtained in 1997 and 1999 surveys. In 1999, all participants were evaluated by a geriatrician to make diagnoses of dementia according to the 4th edn of the Diagnostic and Statistical Manual criteria. Information on previous diagnosis of dementia by physicians was collected. Validity of the CMT was determined by the receiver-operator curve. The pattern of cognitive evolution over 2 years was analyzed. Of 420 subjects, 23 had dementia, of which 22 (95.6%) were undiagnosed. The prevalence (95% confidence interval) of dementia and undiagnosed dementia were 5.5% (3.3-7.7%) and 5.3% (4.1-6.3%), respectively. With original cut-off (15/14) of the CMT, the sensitivity and specificity were 0.74 and 0.86, respectively. The best cut-off found in this study was 16/15 which provided better sensitivity (0.91) but worse specificity (0.76) than those of the original cut-off. Pattern of cognitive evolution was heterogeneous. The heterogeneous change was substantial in subjects with mild low CMT score. Cognitive evolution pattern showed that serial administration of the CMT could reduce workload of primary care physicians and might be useful in a screening protocol. The prevalence of undiagnosed dementia in community-dwelling Thai older persons was high. The CMT was valid for use in a community. Heterogeneous evolution of cognitive function and value of serial cognitive impairment screening was found.

Characteristics of fall-related hip fractures in community-dwelling elderly patients according to cognitive status

Falls are a major cause of morbidity and mortality in older people who have cognitive impairment. The present study compared the characteristics of community-dwelling patients, with and without previous diagnosis of dementia, hospitalized because of a hip fracture. 1024 consecutive patients >65 years (77.2% women, mean age 82.9 yrs) admitted for fall-related hip fracture to six Spanish hospitals during a 20-month period were included. Sociodemographic data, geriatric assessment and characteristics (location, time and possible cause: intrinsic, extrinsic or combined risk factor) of falls leading to hip fracture were evaluated. A total of 154 (15%) patients had a previous diagnosis of dementia. Analysis showed a greater number of previous falls before admission for hip fracture in demented patients. Moreover, in non-demented patients, we found both a predominance of falls during the day and of extrinsic factors. Some differences were observed, according to the cognitive status of elderly patients suffering a hip fracture due to a fall. A high percentage of dementia patients had suffered repeated falls prior to the fall-related hip fracture.

Prevalencia de delirium en pacientes ingresados por procesos médicos

Delirium is a common problem among people during hospitalization. The aim of the study was to analyze the prevalence and characteristics of delirium among patients admitted by medical conditions. We performed a transversal cohort study in 165 patients admitted to 6 tertiary teaching hospitals. We scored the Barthel index (BI) previously to their admission, and also comorbidity using the Charlson index. Diagnosis of delirium was assessed using the Confusional Assessment Method in this transversal study. There were 101 women (61.2%) and 64 men. The mean (SD) age was 80.3 (12) years. The average of Charlson Index was 2.6 (1.7). Previous and evaluation BI were 71.5 (27) and 40.3 (30) respectively. Forty-two patients (25.4%) had delirium. Poor BI at the evaluation and previous diagnosis of dementia were significant independent variables associated with delirium in the logistic regression analysis. Delirium is frequent in medical hospitalized patients. Previous dementia and low BI at the evaluation among medical patients are associated with delirium.

Factors Affecting Cardiac Catheterization Rates in Elders with Acute Coronary Syndromes

Elder patients with acute coronary syndromes (ACS) are less likely to receive cardiac catheterization. The reasons for this are unclear. To assess whether elder patients who had a documented history of dementia, lived in extended care facilities, or had do not intubate-do not resuscitate (DNR-DNI) advance directives were less likely to receive cardiac catheterization, despite having ACS with high-risk features. This was a medical record review conducted at an urban teaching hospital. DNR-DNI status before hospitalization, extended care facility (nursing home or assisted living) residence, and a previous diagnosis of dementia were obtained from the medical record. Patients 65 years and older who presented to the emergency department with acute myocardial infarction or with unstable angina with ST segment deviation were included. Univariate and multivariate logistic regression were performed, and odds ratios (ORs) were reported with their 95% confidence intervals (CIs). Of the 201 eligible patients, 66 (32.8%) patients did not undergo cardiac catheterization. In the univariate analysis, patients who had dementia, resided in extended care facilities, or were DNR-DNI were less likely to receive cardiac catheterization. Only extended care facility residence (OR, 0.18; 95% CI = 0.04 to 0.83) and DNR-DNI status (OR, 0.19; 95% CI = 0.04 to 0.92) remained significantly associated with decreased cardiac catheterization in the multivariate analysis. Elder patients with ACS residing in extended care facilities or who are DNR-DNI are less likely to receive cardiac catheterization. Future studies concerning the quality of ACS care for elders should take these variables into account.