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He Q, Sun M, Wang Y, Li G, Zhao H, Ma Z, Feng Z, Li T, Han Q, Sun N, Li L, Shen Y. Association between residential greenness and incident delirium: A prospective cohort study in the UK Biobank. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 937:173341. [PMID: 38797415 DOI: 10.1016/j.scitotenv.2024.173341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Contemporary environmental health investigations have identified green space as an emerging factor with promising prospects for bolstering human well-being. The incidence of delirium increases significantly with age and is fatal. To date, there is no research elucidating the enduring implications of green spaces on the occurrence of delirium. Therefore, we explored the relationship between residential greenness and the incidence of delirium in a large community sample from the UK Biobank. METHODS Enrollment of participants spanned from 2006 to 2010. Assessment of residential greenness involved the land coverage percentage of green space within a buffer range of 300 m and 1000 m. The relationship between residential greenness and delirium was assessed using the Cox proportional hazards model. Further, we investigated the potential mediating effects of physical activity, particulate matter (PM) with diameters ≤2.5 (PM2.5), and nitrogen oxides (NOx). RESULTS Of 232,678 participants, 3722 participants were diagnosed with delirium during a 13.4-year follow-up period. Compared with participants with green space coverage at a 300 m buffer in the lowest quartile (Q1), those in the highest quartile (Q4) had 15 % (Hazard ratio [HR] = 0.85, 95 % confidence interval [CI]: 0.77, 0.94) lower risk of incident delirium. As for the 1000 m buffer, those in Q4 had a 16 % (HR = 0.84, 95 % CI: 0.76, 0.93) lower risk of incident delirium. The relationship between green space in the 300 m buffer and delirium was mediated partially by physical activity (2.07 %) and PM2.5(49.90 %). Comparable findings were noted for the green space percentage within the 1000 m buffer. CONCLUSIONS Our results revealed that long-term exposure to residential greenness was related to a lower risk of delirium. Air pollution and physical activity exerted a significant mediating influence in shaping this association.
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Affiliation(s)
- Qida He
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Mengtong Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Yu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Guoxian Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Hanqing Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Ze Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Zhaolong Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Tongxing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Qiang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Na Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China
| | - Linyan Li
- School of Data Science, City University of Hong Kong, 999077, Hong Kong; Department of Infectious Diseases and Public Health, City University of Hong Kong, 999077, Hong Kong.
| | - Yueping Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou City, Jiangsu Province, PR China.
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Arnold E, Finucane AM, Taylor S, Spiller JA, O'Rourke S, Spenceley J, Carduff E, Tieges Z, MacLullich AM. The 4AT, a rapid delirium detection tool for use in hospice inpatient units: Findings from a validation study. Palliat Med 2024; 38:535-545. [PMID: 38767241 DOI: 10.1177/02692163241242648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Delirium is a serious neuropsychiatric syndrome with adverse outcomes, which is common but often undiagnosed in terminally ill people. The 4 'A's test or 4AT (www.the4AT.com), a brief delirium detection tool, is widely used in general settings, but validation studies in terminally ill people are lacking. AIM To determine the diagnostic accuracy of the 4AT in detecting delirium in terminally ill people, who are hospice inpatients. DESIGN A diagnostic test accuracy study in which participants underwent the 4AT and a reference standard based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The reference standard was informed by Delirium Rating Scale Revised-98 and tests assessing arousal and attention. Assessments were conducted in random order by pairs of independent raters, blinded to the results of the other assessment. SETTING/PARTICIPANTS Two hospice inpatient units in Scotland, UK. Participants were 148 hospice inpatients aged ⩾18 years. RESULTS A total of 137 participants completed both assessments. Three participants had an indeterminate reference standard diagnosis and were excluded, yielding a final sample of 134. Mean age was 70.3 (SD = 10.6) years. About 33% (44/134) had reference standard delirium. The 4AT had a sensitivity of 89% (95% CI 79%-98%) and a specificity of 94% (95% CI 90%-99%). The area under the receiver operating characteristic curve was 0.97 (95% CI 0.94-1). CONCLUSION The results of this validation study support use of the 4AT as a delirium detection tool in hospice inpatients, and add to the literature evaluating methods of delirium detection in palliative care settings. TRIAL REGISTRY ISCRTN 97417474.
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Affiliation(s)
| | - Anne M Finucane
- Marie Curie Hospice Edinburgh, Edinburgh, UK
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Zoë Tieges
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Computing, School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Scotland, UK
| | - Alasdair Mj MacLullich
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Yang Y, Hou DL. Association of depressive symptoms and dementia among middle-aged and elderly community-dwelling adults: Results from the China Health and Retirement Longitudinal Study (CHARLS). Acta Psychol (Amst) 2024; 243:104158. [PMID: 38277731 DOI: 10.1016/j.actpsy.2024.104158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND There has been a long-standing debate on whether depressive symptoms are associated with dementia. The aim of this study was to examine whether depressive symptoms were associated with a high risk for dementia in Chinese adults. METHODS A total of 13,426 Chinese adults (≥45 years old) from the China Health and Retirement Longitudinal Study (CHARLS) baseline were selected for analysis. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale (CESD-10). Dementia was assessed by the Community Screening Instrument for Dementia (CSI-D). When using linear regression for sensitivity analysis, there is still a correlation between depressive symptoms and dementia. RESULTS Of the 13,426 respondents, the mean (SD) age was 60 (10) years old. The prevalence of depressive symptoms and dementia among participants was 38 % (n = 945) and 18.3 % (n = 2457), respectively. After fully adjusted for demographic factors, health behavior and psychological factors, living and working conditions factors, social network factors, and social policy factors, the cross-sectional analyses showed that depressive symptoms had an increased risk of dementia (OR = 1.390, 95%CI: 1.253-1.543), compared with those without depressive symptoms. In addition, sensitivity analyses of the association between depressive symptoms and dementia were unchanged when reanalyzing using linear regression. CONCLUSIONS In this study, depression symptoms may be associated with dementia. Regardless of whether depressive symptoms acts as a dementia risk factor or an early symptom, monitoring depressive symptoms is crucial to watch for potential dementia onset.
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Affiliation(s)
- Yang Yang
- Jinan Third People's Hospital, Jinan, China
| | - Da Long Hou
- Shandong Provincial Third Hospital, Shandong University, Jinan, China.
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Lee SH, Hur HJ, Kim SN, Ahn JH, Ro DH, Hong A, Park HY, Choe PG, Kim B, Park HY. Predicting delirium and the effects of medications in hospitalized COVID-19 patients using machine learning: A retrospective study within the Korean Multidisciplinary Cohort for Delirium Prevention (KoMCoDe). Digit Health 2024; 10:20552076231223811. [PMID: 38188862 PMCID: PMC10771056 DOI: 10.1177/20552076231223811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Delirium is commonly reported from the inpatients with Coronavirus disease 2019 (COVID-19) infection. As delirium is closely associated with adverse clinical outcomes, prediction and prevention of delirium is critical. We developed a machine learning (ML) model to predict delirium in hospitalized patients with COVID-19 and to identify modifiable factors to prevent delirium. Methods The data set (n = 878) from four medical centers was constructed. Total of 78 predictors were included such as demographic characteristics, vital signs, laboratory results and medication, and the primary outcome was delirium occurrence during hospitalization. For analysis, the extreme gradient boosting (XGBoost) algorithm was applied, and the most influential factors were selected by recursive feature elimination. Among the indicators of performance for ML model, the area under the curve of the receiver operating characteristic (AUROC) curve was selected as the evaluation metric. Results Regarding the performance of developed delirium prediction model, the accuracy, precision, recall, F1 score, and the AUROC were calculated (0.944, 0.581, 0.421, 0.485, 0.873, respectively). The influential factors of delirium in this model included were mechanical ventilation, medication (antipsychotics, sedatives, ambroxol, piperacillin/tazobactam, acetaminophen, ceftriaxone, and propacetamol), and sodium ion concentration (all p < 0.05). Conclusions We developed and internally validated an ML model to predict delirium in COVID-19 inpatients. The model identified modifiable factors associated with the development of delirium and could be clinically useful for the prediction and prevention of delirium in COVID-19 inpatients.
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Affiliation(s)
- So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul,
South Korea
| | - Hyun Jung Hur
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung Nyun Kim
- Department of Psychiatry, Seoul Medical Center, Seoul, South Korea
| | - Jang Ho Ahn
- Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Arum Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam,
South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Back Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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Chu C, Pan W, Ren Y, Mao P, Yang C, Liu C, Tang YL. Executive function deficits and medial temporal lobe atrophy in late-life depression and Alzheimer's disease: a comparative study. Front Psychiatry 2023; 14:1243894. [PMID: 37720905 PMCID: PMC10501151 DOI: 10.3389/fpsyt.2023.1243894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives Alzheimer's disease (AD) and late-life depression (LLD) frequently exhibit executive function deficits (EFD) and medial temporal lobe atrophy (MTA) as shared characteristics. The objective of this research was to examine the utility of the Trail Making Test (TMT) and the MTA scale in distinguishing between LLD and AD. Methods A study of 100 patients, 50 with AD and 50 with LLD, was conducted using a cross-sectional design. The individuals were subjected to clinical evaluations to assess their level of depression and overall cognitive abilities, which included the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA). We evaluated executive function deficits (EFD) through the use of the TMT, which includes both TMT-A and TMT-B. MTA was measured using magnetic resonance imaging. To evaluate the ability of TMT and MTA scale to distinguish between the two groups, a receiver operating characteristic (ROC) curve was utilized. To investigate the connections between MTA and neuropsychological measures, a correlation analysis was performed. Results AD patients exhibited notably reduced MMSE, MoCA, and GDS scores, as well as an increased MTA total scores, time spent on TMT-A, and TMT-B compared to LLD patients (p < 0.05). TMT-A and TMT-B both exhibited excellent discriminatory power between AD and LLD, achieving area under curve (AUC) values of 92.2 and 94.2%, respectively. In AD patients, there was a negative correlation between MMSE and MoCA scores and MTA scores, while in LLD patients, there was a positive correlation between time spent on TMT-A and GDS scores and MTA scores. Conclusion AD patients experience more severe EFD and MTA than LLD patients. The differential diagnosis of AD and LLD can be aided by the useful tool known as TMT. It is important to acknowledge that TMT is capable of capturing only a fraction of the executive function, thus necessitating a cautious interpretation of research findings.
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Affiliation(s)
- Changbiao Chu
- Innovation Center for Neurological Disorders and Department of Neurology, Xuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Weigang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanping Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Peixian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chunlin Yang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Chaomeng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders and National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States
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Jahangir S, Allala M, Khan AS, Muyolema Arce VE, Patel A, Soni K, Sharafshah A. A Review of Biomarkers in Delirium Superimposed on Dementia (DSD) and Their Clinical Application to Personalized Treatment and Management. Cureus 2023; 15:e38627. [PMID: 37159618 PMCID: PMC10163832 DOI: 10.7759/cureus.38627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/11/2023] Open
Abstract
Delirium superimposed on dementia (DSD) occurs when patients with pre-existing dementia develop delirium. This complication causes patients to become impaired, posing safety concerns for both hospital staff and patients. Furthermore, there is an increased risk of worsening functional disability and death. Despite medical advances, DSD provides both diagnostic and therapeutic challenges to providers. Identifying at-risk patients and providing personalized medicine and patient care can decrease disease burden in a time-efficient manner. This review delves into bioinformatics-based studies of DSD in order to design and implement a personalized medicine-based approach. Our findings suggest alternative medical treatment methods based on gene-gene interactions, gene-microRNA (miRNA) interactions, gene-drug interactions, and pharmacogenetic variants involved in dementia and psychiatric disorders. We identify 17 genes commonly associated with both dementia and delirium including apolipoprotein E (ApoE), brain-derived neurotrophic factor (BDNF), catechol-O-methyltransferase (COMT), butyrylcholinesterase (BChE), acetylcholinesterase (AChE), DNA methyltransferase 1 (DNMT1), prion protein (PrP), tumor necrosis factor (TNF), serine palmitoyltransferase long chain base subunit 1 (SPTLC1), microtubule-associated protein tau (MAPT), alpha-synuclein (αS), superoxide dismutase 1 (SOD1), amyloid beta precursor protein (APP), neurofilament light (NFL), neurofilament heavy, 5-hydroxytryptamine receptor 2A (HTR2A), and serpin family A member 3 (ERAP3). In addition, we identify six main genes that form an inner concentric model, as well as their associated miRNA. The FDA-approved medications that were found to be effective against the six main genes were identified. Furthermore, the PharmGKB database was used to identify variants of these six genes in order to suggest future treatment options. We also looked at previous research and evidence on biomarkers that could be used to detect DSD. According to research, there are three types of biomarkers that can be used depending on the stage of delirium. The pathological mechanisms underlying delirium are also discussed. This review will identify treatment and diagnostic options for personalized DSD management.
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Affiliation(s)
- Saira Jahangir
- Neurology, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | - Manoj Allala
- Internal Medicine, Mediciti Institute of Medical Sciences, Medchal, IND
| | - Armughan S Khan
- Internal Medicine, Midwest Sleep and Wellness, Gurnee, USA
- Internal Medicine, JC Medical Center, Florida, USA
| | | | - Anandkumar Patel
- Medicine, Maharshi Hospital Private Limited, Surendranagar, IND
- Neurology, Shalby Hospitals Naroda, Ahmedabad, IND
| | - Karsh Soni
- Neurology, Grodno State Medical University, Ahmedabad, IND
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Cano-Escalera G, Graña M, Irazusta J, Labayen I, Gonzalez-Pinto A, Besga A. Mortality Risks after Two Years in Frail and Pre-Frail Older Adults Admitted to Hospital. J Clin Med 2023; 12:jcm12093103. [PMID: 37176544 PMCID: PMC10179017 DOI: 10.3390/jcm12093103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/11/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Frailty is characterized by a progressive decline in the physiological functions of multiple body systems that lead to a more vulnerable condition, which is prone to the development of various adverse events, such as falls, hospitalization, and mortality. This study aims to determine whether frailty increases mortality compared to pre-frailty and to identify variables associated with a higher risk of mortality. MATERIALS Two cohorts, frail and pre-frail subjects, are evaluated according to the Fried phenotype. A complete examination of frailty, cognitive status, comorbidities and pharmacology was carried out at hospital admission and was extracted through electronic health record (EHR). Mortality was evaluated from the EHR. METHODS Kaplan-Meier estimates of survival probability functions were calculated at two years censoring time for frail and pre-frail cohorts. The log-rank test assessed significant differences between survival probability functions. Significant variables for frailty (p < 0-05) were extracted by independent sample t-test. Further selection was based on variable significance found in multivariate logistic regression discrimination between frail and pre-frail subjects. Cox regression over univariate t-test-selected variables was calculated to identify variables associated with higher proportional hazard risks (HR) at two years. RESULTS Frailty is associated with greater mortality at two years censoring time than pre-frailty (log-rank test, p < 0.0001). Variables with significant (p < 0.05) association with mortality identified in both cohorts (HR 95% (CI in the frail cohort) are male sex (0.44 (0.29-0.66)), age (1.05 (1.01-1.09)), weight (0.98 (0.96-1.00)), and use of proton-pump inhibitors (PPIs) (0.60 (0.41-0.87)). Specific high-risk factors in the frail cohort are readmission at 30 days (0.50 (0.33-0.74)), SPPB sit and stand (0.62 (0.45-0.85)), heart failure (0.67 (0.46-0.98)), use of antiplatelets (1.80 (1.19-2.71)), and quetiapine (0.31 (0.12-0.81)). Specific high-risk factors in the pre-frail cohort are Barthel's score (120 (7.7-1700)), Pfeiffer test (8.4; (2.3-31)), Mini Nutritional Assessment (MNA) (1200 (18-88,000)), constipation (0.025 (0.0027-0.24)), falls (18,000 (150-2,200,000)), deep venous thrombosis (8400 (19-3,700,000)), cerebrovascular disease (0.01 (0.00064-0.16)), diabetes (360 (3.4-39,000)), thyroid disease (0.00099 (0.000012-0.085)), and the use of PPIs (0.062 (0.0072-0.54)), Zolpidem (0.000014 (0.0000000021-0.092)), antidiabetics (0.00015 (0.00000042-0.051)), diuretics (0.0003 (0.000004-0.022)), and opiates (0.000069 (0.00000035-0.013)). CONCLUSIONS Frailty is associated with higher mortality at two years than pre-frailty. Frailty is recognized as a systemic syndrome with many links to older-age comorbidities, which are also found in our study. Polypharmacy is strongly associated with frailty, and several commonly prescribed drugs are strongly associated with increased mortality. It must be considered that frail patients need coordinated attention where the diverse specialist taking care of them jointly examines the interactions between the diversity of treatments prescribed.
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Affiliation(s)
- Guillermo Cano-Escalera
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Manuel Graña
- Department of Computer Science and Artificial Intelligence, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
- Computational Intelligence Group, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Bilbao, Spain
- BioCruces Health Research Institute, 48903 Barakaldo, Spain
| | - Idoia Labayen
- Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006 Pamplona, Spain
| | - Ana Gonzalez-Pinto
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
| | - Ariadna Besga
- BioAraba, Health Research Institute, Department of Medicine, Hospital Universitario de Araba, 01004 Vitoria, Spain
- Biomedical Research Centre in Mental Health Network (CIBERSAM), 28029 Madrid, Spain
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Fick DM, Shrestha P. Delirium in Persons With Dementia: Integrating the 4Ms of Age-Friendly Care as a Set Into the Care of Older People. J Gerontol Nurs 2022; 48:3-6. [PMID: 36169297 DOI: 10.3928/00989134-20220909-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Donna M Fick
- Journal of Gerontological Nursing, Elouise Ross Eberly Endowed Professor, Ross and Carol Nese College of Nursing Pennsylvania State University Director, Tressa Nese and Helen Diskevich Center of Geriatric Nursing Excellence State College, Pennsylvania
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9
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Delirium in Nursing Home Residents: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10081544. [PMID: 36011202 PMCID: PMC9407867 DOI: 10.3390/healthcare10081544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Delirium is an important component of the geriatric syndromes and has been recognized to negatively influence the prognosis of older people in hospital and in a post-acute setting. About 2–5% of older people world-wide live in nursing homes and are characterized by functional impairment, cognitive decline, dementia, comorbidities, and polypharmacotherapy, all factors which influence the development of delirium. However, in this setting, delirium remains often understudied. Therefore, in this narrative review, we aimed to describe the latest evidence regarding delirium screening tools, epidemiology characteristics, outcomes, risk factors, and preventions strategies in nursing homes.
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10
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Delgado-Parada E, Alonso-Sánchez M, Ayuso-Mateos JL, Robles-Camacho M, Izquierdo A. Liaison psychiatry before and after the COVID-19 pandemic. Psychiatry Res 2022; 314:114651. [PMID: 35640325 PMCID: PMC9124364 DOI: 10.1016/j.psychres.2022.114651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.
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Affiliation(s)
- E Delgado-Parada
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain
| | - M Alonso-Sánchez
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain.
| | - J L Ayuso-Mateos
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
| | - M Robles-Camacho
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain
| | - A Izquierdo
- Department of Psychiatry, Hospital Universitario de La Princesa, c/ Diego de León, 62, (28006) Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario de la Princesa (IIS-Princesa), c/ Diego de León, 62, (28006) Madrid, Spain; Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Av/ Monforte de Lemos, 3-5. Pabellón 11. Planta 0 (28029) Madrid, Spain; Departament of Psychiatry, Universidad Autónoma de Madrid, c/ Arzobispo Morcillo, 4, (28029) Madrid, Spain
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11
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O’Sullivan JL, Schweighart R, Lech S, Kessler EM, Tegeler C, Teti A, Nordheim J, Gellert P. Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings. BMC Psychiatry 2022; 22:241. [PMID: 35382790 PMCID: PMC8981933 DOI: 10.1186/s12888-022-03876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (β = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (β = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (β = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (β = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (β = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (β = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (β = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (β = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).
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Affiliation(s)
- Julie L. O’Sullivan
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Roxana Schweighart
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany ,grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitätzu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Eva-Marie Kessler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Christina Tegeler
- grid.466457.20000 0004 1794 7698Department of Psychology, MSB Medical School Berlin, Rüdesheimer Str. 50, 14197 Berlin, Germany
| | - Andrea Teti
- grid.449789.f0000 0001 0742 8825Institute for Gerontology, University Vechta, Driverstraße 2, 49377 Vechta, Germany
| | - Johanna Nordheim
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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12
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Emsell L, Vanhaute H, Vansteelandt K, De Winter FL, Christiaens D, Van den Stock J, Vandenberghe R, Van Laere K, Sunaert S, Bouckaert F, Vandenbulcke M. An optimized MRI and PET based clinical protocol for improving the differential diagnosis of geriatric depression and Alzheimer's disease. Psychiatry Res Neuroimaging 2022; 320:111443. [PMID: 35091333 DOI: 10.1016/j.pscychresns.2022.111443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/28/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
Amyloid positron emission tomography (PET) and hippocampal volume derived from magnetic resonance imaging may be useful clinical biomarkers for differentiating between geriatric depression and Alzheimer's disease (AD). Here we investigated the incremental value of using hippocampal volume and 18F-flutemetmol amyloid PET measures in tandem and sequentially to improve discrimination in unclassified participants. Two approaches were compared in 41 participants with geriatric depression and 27 participants with probable AD: (1) amyloid and hippocampal volume combined in one model and (2) classification based on hippocampal volume first and then subsequent stratification using standardized uptake value ratio (SUVR)-determined amyloid positivity. Hippocampal volume and amyloid SUVR were significant diagnostic predictors of depression (sensitivity: 95%, specificity: 89%). 51% of participants were correctly classified according to clinical diagnosis based on hippocampal volume alone, increasing to 87% when adding amyloid data (sensitivity: 94%, specificity: 78%). Our results suggest that hippocampal volume may be a useful gatekeeper for identifying depressed individuals at risk for AD who would benefit from additional amyloid biomarkers when available.
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Affiliation(s)
- Louise Emsell
- Geriatric Psychiatry, UPC KU Leuven, Leuven, Belgium; Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium; Department of Imaging & Pathology, Translational MRI, Medical Imaging Research Center, KU Leuven, UZ Leuven (Gasthuisberg), Leuven 3000, Belgium.
| | - Heleen Vanhaute
- Geriatric Psychiatry, UPC KU Leuven, Leuven, Belgium; Department of Imaging & Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Kristof Vansteelandt
- Geriatric Psychiatry, UPC KU Leuven, Leuven, Belgium; Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium.
| | - François-Laurent De Winter
- Geriatric Psychiatry, UPC KU Leuven, Leuven, Belgium; Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium.
| | - Danny Christiaens
- Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- Geriatric Psychiatry, UPC KU Leuven, Leuven, Belgium; Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium.
| | - Rik Vandenberghe
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, Leuven, Belgium.
| | - Koen Van Laere
- Department of Imaging & Pathology, Nuclear Medicine and Molecular Imaging, KU Leuven, Leuven, Belgium; Nuclear Medicine, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
| | - Stefan Sunaert
- Department of Imaging & Pathology, Translational MRI, Medical Imaging Research Center, KU Leuven, UZ Leuven (Gasthuisberg), Leuven 3000, Belgium; Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium.
| | - Filip Bouckaert
- Geriatric Psychiatry, UPC KU Leuven, Leuven, Belgium; Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium.
| | - Mathieu Vandenbulcke
- Geriatric Psychiatry, UPC KU Leuven, Leuven, Belgium; Department of Neurosciences, Neuropsychiatry, KU Leuven, Leuven, Belgium.
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13
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Brunette AM, Rycroft SS, Colvin L, Schwartz AW, Driver JA, Nothern A, Harrington MB, Jackson CE. Integrating Neuropsychology into Interprofessional Geriatrics Clinics. Arch Clin Neuropsychol 2022; 37:545-552. [PMID: 34718368 PMCID: PMC9630824 DOI: 10.1093/arclin/acab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
Interprofessional healthcare teams are increasingly viewed as a clinical approach to meet the complex medical, psychological, and psychosocial needs of older adult patients. Despite the fact that older adults are at risk for cognitive difficulties, neuropsychologists are not routinely included on Geriatrics consult teams. The primary aim of this paper is to highlight the utility of neuropsychology within an interprofessional Geriatrics consult clinic. To address this aim, we describe specific benefits to patient care that may be associated with the inclusion of neuropsychologists on Geriatrics consult teams, including differential diagnosis, enhanced patient care, and reduced barriers to care. We provide a description of the integration of neuropsychology within a Veterans Health Administration (VA) interprofessional Geriatrics consult clinic team in order to illustrate the implementation of this model.
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Affiliation(s)
- Amanda M. Brunette
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA,Corresponding author at: The University of Kansas Health System, 4330 Shawnee Mission Pkwy Suite 2180, Fairway, KS 66205, USA. Tel.: 913-588-6973; Fax: 913-588-6964. (A.M. Brunette)
| | | | - Leigh Colvin
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA
| | - Andrea Wershof Schwartz
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA,Harvard Medical School, Department of Medicine, Boston, MA, USA,Brigham & Women’s Hospital, Division of Aging, Boston, MA, USA
| | - Jane A. Driver
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA,Harvard Medical School, Department of Medicine, Boston, MA, USA,Brigham & Women’s Hospital, Division of Aging, Boston, MA, USA
| | - Alexandra Nothern
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA
| | - Mary Beth Harrington
- Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA,New England Geriatric Research Education and Clinical Center (GRECC), Boston Division, Boston, MA, USA
| | - Colleen E. Jackson
- Psychology Service, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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14
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Silva AR, Regueira P, Cardoso AL, Baldeiras I, Santana I, Cerejeira J. Cognitive Trajectories Following Acute Infection in Older Patients With and Without Cognitive Impairment: An 1-Year Follow-Up Study. Front Psychiatry 2021; 12:754489. [PMID: 34975568 PMCID: PMC8716829 DOI: 10.3389/fpsyt.2021.754489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/24/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction: Dementia is a known risk factor for both delirium and acute systemic infections which may also play a significant role in promoting or accelerating neurodegenerative disease. Infections are both the main causes of hospitalization of dementia patients and can be a major precipitant of delirium but currently it is not possible to predict the risk of cognitive decline in older patients exposed to acute infection. Objectives: We aimed to determine the level of cognitive change at 1-year follow up in individuals with different patterns of cognitive function (dementia, delirium, delirium superimposed on dementia) at the time of their hospitalization due to a systemic infection and to correlate these cognitive patterns with clinical status variables. Methods: We recruited 53 hospitalized geriatric patients with a systemic infection, and we collected 12-months follow up data for 34 patients. These patients were classified in four groups: no cognitive impairment (controls-C), delirium only (D), dementia only (Dem), and delirium superimposed to dementia (DD). Cognitive performance was measured by change in score on the Montreal Cognitive Assessment (MoCA) and delirium was identified using Confusion Assessment Measure (CAM). We examined performance on the MoCA in the first year after hospitalization, controlling for demographic characteristics, coexisting medical conditions, and type of infection. Results: For the 34 patients to whom follow-up data was available, delirium presence in individuals with prior dementia (DD group) was associated with a negative mean change score of 3-point (p < 0.02) at 1 year follow up, whereas dementia patients without delirium had a mean change score of 1.5-point lower at 12-months (p = 0.04), when comparing follow-up and baseline MoCA scores. Cognitively healthy patients did not significantly decrease their MoCA score at follow-up (p = 0.15). MoCA and NPI scores during hospitalization were significantly correlated with the level of cognitive decline in the four groups (r = 0.658, p < 0.01 and r = 0.439, p = 0.02, respectively). Conclusions: Premorbid dementia and delirium superimposed on dementia during hospitalization in older patients with acute infections predict cognitive decline at 1 year following admission. Taken together, our findings suggest a pathophysiological interaction between neurodegenerative changes, acute infection, and delirium.
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Affiliation(s)
- Ana Rita Silva
- Centro de Neurociências e Biologia Celular, University of Coimbra, Coimbra, Portugal
| | - Patrícia Regueira
- Serviço de Psiquiatria, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Luísa Cardoso
- Centro de Neurociências e Biologia Celular, University of Coimbra, Coimbra, Portugal
| | - Inês Baldeiras
- Centro de Neurociências e Biologia Celular, University of Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Centro de Neurociências e Biologia Celular, University of Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Serviço de Neurologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joaquim Cerejeira
- Centro de Neurociências e Biologia Celular, University of Coimbra, Coimbra, Portugal
- Serviço de Psiquiatria, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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15
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Derks CTAJ, Hutten-van den Elsen MMGM, Hakvoort LJ, van Mersbergen MPJ, Schuurmans MJ, Dikken J. Hospital nurses' knowledge regarding older patients: a multicenter study. BMC Nurs 2021; 20:135. [PMID: 34348725 PMCID: PMC8336409 DOI: 10.1186/s12912-021-00604-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing care in hospitals increasingly involves older adults. A nursing workforce able to care for the ageing population is therefore critical for ensuring quality older adult care. Gaining insight in the knowledge and attitudes of nurses regarding older patients in the Netherlands is needed to develop and increase the impact of education- and quality improvement programs which can positively influence nurses' knowledge and attitudes regarding older patients. METHODS A cross-sectional multicenter study was performed. Data was collected in ten tertiary medical teaching hospitals well spread across the Netherlands (89 wards, 2902 nurses). Knowledge levels were measured using the Knowledge about Older Patient-Quiz (KOP-Q), consisting of 30 true-false questions. Knowledge levels of registered nurses are compared with knowledge levels known from literature of first year nursing students; last year nursing students; nurses; and nurse specialist. Potential associated factors considered were: age; sex; education; experience; opinions and preferences. Opinion and preferences regarding working with older patients were measured by three questions: 1) which patient group nurses preferred to work with; 2) how nurses feel about the increase of older patients in the hospital; and 3) whether nurses find it difficult to care for older patients. RESULTS From all wards, a representative sample of 1743 registered hospital nurses working on all 89 wards participated. On all wards, a large range in knowledge levels is observed between nurses, with 37% of nurses presenting knowledge levels comparable with nursing student and 31% of nurses presenting knowledge levels comparable with nurse specialists. Knowledge is related to age (p < .001), work experiences (p < .001), preparatory secondary education (p < .001) and nurses education level (p = .012). A minority (12.5%) prefers working with older patients and most nurses do not find it difficult. CONCLUSIONS This study shows that there is a large diversity in knowledge levels of Dutch hospital nurses in every hospital, on every ward. A majority of nurses demonstrate negative opinions and preferences. This implies that older patients admitted can receive different levels of quality of care on the same day as nurses with different knowledge levels provide care during the various shifts. Findings demonstrate an urgent need for education programs with themes regarding essential care for older patients in the Netherlands.
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Affiliation(s)
| | | | | | | | - Marieke J Schuurmans
- Nursing Science, Julius Center University Medical Center/University Utrecht, Utrecht, the Netherlands
| | - Jeroen Dikken
- Faculty of Health, Nutrition & Sport & Health Innovation Centre of Expertise, The Hague University of Applied Sciences, The Hague, the Netherlands.
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16
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Mychajliw C, Herrmann ML, Suenkel U, Brand K, von Thaler AK, Wurster I, Yilmaz R, Eschweiler GW, Metzger FG. Impaired Executive Function and Depression as Independent Risk Factors for Reported Delirium Symptoms: An Observational Cohort Study Over 8 Years. Front Aging Neurosci 2021; 13:676734. [PMID: 34163350 PMCID: PMC8215445 DOI: 10.3389/fnagi.2021.676734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/21/2021] [Indexed: 12/26/2022] Open
Abstract
Background Acute medical illnesses, surgical interventions, or admissions to hospital in older individuals are frequently associated with a delirium. In this cohort study, we investigated the impact of specific cognitive domains and depression before the occurrence of delirium symptoms in an 8-year observation of older non-hospitalized individuals. Methods In total, we included 807 participants (48–83 years). Deficits in specific cognitive domains were measured using the CERAD test battery, and depressive symptoms were measured using Beck Depression Inventory and the Geriatric Depression Scale (GDS) before the onset of a delirium. Delirium symptoms were retrospectively assessed by a questionnaire based on the established Nursing Delirium Screening Scale. Results Fifty-eight of eight hundred seven participants (7.2%) reported delirium symptoms over the 8-year course of the study. Sixty-nine percent (n = 40) of reported delirium symptoms were related to surgeries. In multivariate regression analysis, impaired executive function was an independent risk factor (p = 0.034) for the occurrence of delirium symptoms. Furthermore, age (p = 0.014), comorbidities [captured by the Charlson Comorbidity Index (CCI)] (p < 0.001), and depression (p = 0.012) were significantly associated with reported delirium symptoms. Conclusion Especially prior to elective surgery or medical interventions, screening for impaired executive function and depression could be helpful to identify patients who are at risk to develop delirium symptoms.
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Affiliation(s)
- Christian Mychajliw
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany.,Geriatric Center, University Hospital of Tübingen, Tübingen, Germany
| | - Matthias L Herrmann
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany.,Geriatric Center, University Hospital of Tübingen, Tübingen, Germany.,Department of Neurology and Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Suenkel
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Katharina Brand
- Geriatric Center, University Hospital of Tübingen, Tübingen, Germany
| | - Anna-Katharina von Thaler
- Department of Neurology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Department of Neurology, University Hospital of Tübingen, Tübingen, Germany
| | - Isabel Wurster
- Department of Neurology, University Hospital of Tübingen, Tübingen, Germany.,German Center of Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Rezzak Yilmaz
- Department of Neurology, University of Ankara Medical School, Ankara, Turkey
| | - Gerhard W Eschweiler
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany.,Geriatric Center, University Hospital of Tübingen, Tübingen, Germany
| | - Florian G Metzger
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany.,Geriatric Center, University Hospital of Tübingen, Tübingen, Germany.,Vitos Hospital for Psychiatry and Psychotherapy Haina, Haina, Germany
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17
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Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders. Health Qual Life Outcomes 2021; 19:68. [PMID: 33648508 PMCID: PMC7923341 DOI: 10.1186/s12955-021-01690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment. Methods In a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches. Results Of the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects. Conclusions Most outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015.
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Wilson JE, Andrews P, Ainsworth A, Roy K, Ely EW, Oldham MA. Pseudodelirium: Psychiatric Conditions to Consider on the Differential for Delirium. J Neuropsychiatry Clin Neurosci 2021; 33:356-364. [PMID: 34392693 PMCID: PMC8929410 DOI: 10.1176/appi.neuropsych.20120316] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The phenotypes of several psychiatric conditions can very closely resemble delirium; the authors describe such presentations as pseudodelirium. However, because the clinical management of these conditions differs markedly from that of delirium, prompt differentiation is essential. The authors provide an educational review to assist clinicians in identifying and managing psychiatric conditions that may be especially challenging to differentiate from delirium. METHODS Based on clinical experience, the authors identified four psychiatric conditions as among the most difficult to differentiate from delirium: disorganized psychosis, Ganser syndrome, delirious mania, and catatonia. An overview of each condition, description of clinical features, differentiation of specific phenotypes from delirium, and review of clinical management are also provided. RESULTS The thought and behavioral disorganization in disorganized psychosis can be mistaken for the clouded sensorium and behavioral dysregulation encountered in delirium. The fluctuating alertness and apparent confusion in Ganser syndrome resemble delirium's altered arousal and cognitive features. As its name suggests, delirious mania presents as a mixture of hyperactive delirium and mania; additional features may include psychosis, autonomic activation, and catatonia. Both delirium and catatonia have hypokinetic and hyperkinetic variants, and the two syndromes can also co-occur. CONCLUSIONS The clinical presentations of several psychiatric conditions can blend with the phenotype of delirium, at times even co-occurring with it. Detailed evaluation is often required to differentiate such instances of pseudodelirium from delirium proper.
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Affiliation(s)
- Jo Ellen Wilson
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN,Center for Critical Illness, Brain Dysfunction, and Survivorship, Vanderbilt University Medical Center, Nashville, TN,Corresponding author: The Vanderbilt Psychiatric Hospital, 1601 23rd Avenue South, Nashville, TN 37212
| | - Patricia Andrews
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN,Center for Critical Illness, Brain Dysfunction, and Survivorship, Vanderbilt University Medical Center, Nashville, TN
| | | | - Kamalika Roy
- Oregon Health and Science University, Portland, OR
| | - E. Wesley Ely
- Center for Critical Illness, Brain Dysfunction, and Survivorship, Vanderbilt University Medical Center, Nashville, TN,Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN,Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN,Veteran’s Affairs Tennessee Valley, Geriatrics Research, Education and Clinical Center (GRECC), Nashville, TN
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Schmidt NE, Steffen A, Meuser TM. Impairment for Medication Management in Older Adults: Validity of a Family Report Measure. Clin Gerontol 2020; 43:350-362. [PMID: 31826718 DOI: 10.1080/07317115.2019.1703064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Medication nonadherence can have significant consequences for the health of older adults. Difficulty managing medications is often a sign of cognitive impairment, and monitoring is an early caregiving task for family members. This study examined a screening tool for independence in medication management.Methods: Reliability and validity of the screening tool were assessed in a sample of 152 female care partners for a relative aged 65+years.Results: The tool showed sound test-retest reliability, convergent and discriminant validity, and test utility, such that medication assistance was not better predicted by a global rating of cognitive impairment.Conclusions: In context of cognitive impairment, detection of medication mismanagement could be improved in both primary care and specialty health encounters through adoption of this single-item screening tool.Clinical Implications: This single-item report can be used to quickly facilitate discussions of medication management and cognitive impairment screening in office visits. The item also shows promise for efficient measurement of impairment in medication management than typical IADL assessment language.
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Affiliation(s)
- Nicholas E Schmidt
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Ann Steffen
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Thomas M Meuser
- Center for Excellence in Aging, University of New England, Biddeford, ME, USA
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Glass OM, Hermida AP, Hershenberg R, Schwartz AC. Considerations and Current Trends in the Management of the Geriatric Patient on a Consultation-Liaison Service. Curr Psychiatry Rep 2020; 22:21. [PMID: 32285305 DOI: 10.1007/s11920-020-01147-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To provide consultation-liaison psychiatrists with an updated resource that can assist in the treatment and management of geriatric patients. RECENT FINDINGS The current available literature has not shown any differences in efficacy between haloperidol and second-generation antipsychotics in patients with delirium. When considering relative advantages of forms of antipsychotic administration, there is no support for a superior safety profile of oral compared to intramuscular or intravenous administration. A recent meta-analysis of four randomized controlled trials concluded that when melatonin was administered to older age patients on medical wards, it significantly prevented the incidence of delirium when compared with the control group. While suvorexant administered nightly to elderly patients in acute care settings may lower the incidence of delirium, larger studies are needed to confirm this finding. Despite the black box warning of increased mortality risk in older patients with dementia, antipsychotics may be used with caution by the consultation-liaison (CL) psychiatrist to treat the neuropsychologic symptoms of dementia including hallucinations and psychosis in the hospital setting. While antidepressant studies have focused primarily on citalopram and escitalopram in the treatment of agitation in the setting of dementia, these two medications have not been adequately compared directly to other SSRIs for this condition. It is therefore not clear whether citalopram and escitalopram are more efficacious in treating agitation in the setting of dementia when compared to other SSRIs. While the evidence supporting trazodone's use is limited, it is generally well tolerated and is an option as a PRN for irritability and agitation in patients with Alzheimer's and mixed dementia. While there is some evidence to support the use of acetylcholinesterase inhibitors for treating cognitive impairments and hallucinations in Lewy body dementia, the usefulness of these agents in other forms of dementia is not well studied, and those studies did not show any benefit in the management of acute agitation. It is important to note that memantine can cause or exacerbate agitation and may be the cause of behavioral dysregulation. There is no evidence to support the routine use of benzodiazepines for behavioral improvement in patients with dementia. Escitalopram and citalopram do have a unique pharmacokinetic properties in the sense that they have been found to have 50-56% plasma protein binding, compared to sertraline, fluoxetine, and paroxetine (95% or more). Pooled analyses suggest that antidepressants are more effective than placebo in reducing the symptoms of post-stroke depression. SSRIs are considered first-line antidepressants in stroke patients, who are often elderly with underlying cardiovascular problems. Although treatment with SSRIs is recommended for post-stroke depression, there are no studies providing conclusive data on the superiority of a specific drug. Older age is associated with a better outcome from ECT, with remission rates of approximately 73% to 90% in patients over 65 years. ECT is the treatment of choice for patients with psychotic depression, and elderly patients with psychotic depression have been shown to have a higher remission rate and faster time to response than depressed patients without psychotic symptoms. With the average life expectancy increase, it is projected that 19 million people will reach the age of 85 or higher, an increase from 5.5 million in 2010. With an increasing older population, psychiatric consultation in the management of geriatric patients is becoming more necessary. Psychiatrists must be aware of the unique considerations in elderly patients. In this article, we provide evidence-based guidance to the CL psychiatrist on major issues relating to the older age patient, highlighting recent trends in treatment. First, we provide background on the evaluation of the medically hospitalized geriatric patient. As rates of medical and psychiatric illnesses increase with advancing age, elderly patients are more likely to be taking a higher number of medications as compared to younger patients, and physicians must pay special attention to polypharmacy, including side effects and drug interactions in this group. Next, we focus on the diagnosis, management, and unique needs of the geriatric patient presenting with common clinical syndromes of delirium, dementia, and depression. Delirium and dementia are among the most common causes of cognitive impairment in clinical settings yet are often either unrecognized or misdiagnosed as they may have similar signs and symptoms. In addition, depression is prevalent in older adults, especially in those with comorbid medical illness. Depression can be fatal as the rates of suicide are higher in later life than in any other age group. Consultation can improve the management of elderly patients and prevent unnecessary nursing home placement.
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Affiliation(s)
| | | | - Rachel Hershenberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Treatment Resistant Depression Program, Emory University, Atlanta, GA, USA
| | - Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
- Psychiatry Consultation-Liaison Service, Grady Memorial Hospital, 80 Jesse Hill Jr. Dr., Atlanta, GA, USA.
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Hercus C, Hudaib AR. Delirium misdiagnosis risk in psychiatry: a machine learning-logistic regression predictive algorithm. BMC Health Serv Res 2020; 20:151. [PMID: 32106845 PMCID: PMC7045404 DOI: 10.1186/s12913-020-5005-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Delirium is a frequent diagnosis made by Consultation-Liaison Psychiatry (CLP). Numerous studies have demonstrated misdiagnosis prior to referral to CLP. Few studies have considered the factors underlying misdiagnosis using multivariate approaches. OBJECTIVES To determine the number of cases referred to CLP, which are misdiagnosed at time of referral, to build an accurate predictive classifier algorithm, using input variables related to delirium misdiagnosis. METHOD A retrospective observational study was conducted at Alfred Hospital in Melbourne, collecting data from a record of all patients seen by CLP for a period of 5 months. Data was collected pertaining to putative factors underlying misdiagnosis. A Machine Learning-Logistic Regression classifier model was built, to classify cases of accurate delirium diagnosis vs. misdiagnosis. RESULTS Thirty five of 74 new cases referred were misdiagnosed. The proposed predictive algorithm achieved a mean Receiver Operating Characteristic (ROC) Area under the curve (AUC) of 79%, an average 72% classification accuracy, 77% sensitivity and 67% specificity. CONCLUSIONS Delirium is commonly misdiagnosed in hospital settings. Our findings support the potential application of Machine Leaning-logistic predictive classifier in health care settings.
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Abstract
Delirium superimposed on dementia is an acute medical illness that is difficult to diagnose because of the similarities of the symptoms to dementia. Delirium can contribute to the suffering of the patient as well as the family and caregiver. An initial holistic assessment of the patient is critical in establishing the cognitive baseline symptoms of delirium. Prevention of delirium can be assisted by ongoing reassessment of the patient for symptoms of delirium. The goal of treatment is to treat the underlying cause of the delirium.
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Affiliation(s)
- Evelyn Parrish
- University of Kentucky College of Nursing, 202 College of Nursing Building, Lexington, KY 40536, USA.
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Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge. BMC Geriatr 2019; 19:261. [PMID: 31604425 PMCID: PMC6787981 DOI: 10.1186/s12877-019-1294-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/26/2019] [Indexed: 01/28/2023] Open
Abstract
Background The three geriatric conditions, depression, dementia and delirium (3D’s), are common among hospitalized older patients and often lead to impairments of activities of daily living. The aim of this study is to explore the impact of depression, dementia and delirium on activities of daily living (ADLs) during and after hospitalization. Methods A prospective cohort study was conducted between 2012 and 2013 in a tertiary medical center in Taiwan. Patients who aged over 65 years and admitted to the geriatric ward were invited to this study. Geriatric Depression Scale Short Form, Mini-Mental State and Confusion Assessment Method were used to identify patients with depression, dementia and delirium on admission, respectively. Barthel Index (BI) was used to evaluate patients’ functional status on admission, at discharge, 30-day, 90-day and 180-day after discharge. Generalized Estimating Equation (GEE) was used to calculate the associations between 3 D’s and BI. Results One-hundred-and-forty-nine patients were included in this study. Twenty-seven patients (18.1%) had depression, 37 (24.8%) had dementia, and 85 (57.0%) had delirium. The study demonstrated that all the geriatric patients with functional decline presented gradual improvements of physical function up to 180 days after discharge. Whether depression exists did not substantially affect functional recovery after discharge, whilst either dementia or delirium could impede elder people functional status. The recovery of functional improvement in delirium or dementia was relatively irreversible when comparing with depression. Once delirium or dementia was diagnosed, poorer functional restore was expected. In brief, intensive work and strategies on modifying delirium or dementia should be put more effort as early as possible. Conclusions Old hospitalized patients with depression can recover well after adequate intervention. We emphasize that early detection of dementia and delirium is imperative in subsequent functional outcome, even if at or before admission. Comprehensive plan must be implemented timely.
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Watt CL, Momoli F, Ansari MT, Sikora L, Bush SH, Hosie A, Kabir M, Rosenberg E, Kanji S, Lawlor PG. The incidence and prevalence of delirium across palliative care settings: A systematic review. Palliat Med 2019; 33:865-877. [PMID: 31184538 PMCID: PMC6691600 DOI: 10.1177/0269216319854944] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. AIM Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. DESIGN This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. DATA SOURCES Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. RESULTS Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer (n = 34) and mixed diagnoses (n = 8) were represented. Delirium point prevalence estimates were 4%-12% in the community, 9%-57% across hospital palliative care consultative services, and 6%-74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings (n = 8) was 42%-88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29-0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. CONCLUSION Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.
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Affiliation(s)
- Christine L Watt
- 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada
| | - Franco Momoli
- 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,4 Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,5 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed T Ansari
- 5 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lindsey Sikora
- 6 Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | - Shirley H Bush
- 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.,3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,7 Bruyère Research Institute, Ottawa, ON, Canada
| | - Annmarie Hosie
- 8 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Erin Rosenberg
- 9 Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,10 Department of Critical Care, The Ottawa Hospital, Ottawa, ON, Canada
| | - Salmaan Kanji
- 3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,11 Department of Pharmacy, The Ottawa Hospital, Ottawa, ON, Canada.,12 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter G Lawlor
- 1 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,2 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.,3 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,7 Bruyère Research Institute, Ottawa, ON, Canada
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Lawlor PG, Rutkowski NA, MacDonald AR, Ansari MT, Sikora L, Momoli F, Kanji S, Wright DK, Rosenberg E, Hosie A, Pereira JL, Meagher D, Rice J, Scott J, Bush SH. A Scoping Review to Map Empirical Evidence Regarding Key Domains and Questions in the Clinical Pathway of Delirium in Palliative Care. J Pain Symptom Manage 2019; 57:661-681.e12. [PMID: 30550832 DOI: 10.1016/j.jpainsymman.2018.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 02/03/2023]
Abstract
CONTEXT Based on the clinical care pathway of delirium in palliative care (PC), a published analytic framework (AF) formulated research questions in key domains and recommended a scoping review to identify evidence gaps. OBJECTIVES To produce a literature map for key domains of the published AF: screening, prognosis and diagnosis, management, and the health-related outcomes. METHODS A standard scoping review framework was used by an interdisciplinary study team of nurse- and physician-delirium researchers, an information specialist, and review methodologists to conduct the review. Knowledge user engagement provided context in refining 19 AF questions. A peer-reviewed search strategy identified citations in Medline, PsycINFO, Embase, and CINAHL databases between 1980 and 2018. Two reviewers independently screened records for inclusion using explicit study eligibility criteria for the population, design, delirium diagnosis, and investigational intent. RESULTS Of 104 studies reporting empirical data and meeting eligibility criteria, most were conducted in patients with cancer (73.1%) and in inpatient PC units (52%). The most frequent study design was a one or more group, nonrandomized trial or cohort (67.3%). Evidence gaps were identified: delirium risk prediction; comparative effectiveness and harms of prevention, variability in delirium management across PC settings, advanced directive and substitute decision-maker input, and transition of care location; and estimating delirium reversibility. Future rigorous primary studies are required to address these gaps and preliminary concerns regarding the quality of extant literature. CONCLUSION Substantial evidence gaps exist, providing opportunities for future research regarding the assessment, prognosis, and management of delirium in PC settings.
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Affiliation(s)
- Peter G Lawlor
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | | | | | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Salmaan Kanji
- Department of Pharmacy, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David K Wright
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Rosenberg
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Department of Critical Care, Ottawa, Ontario, Canada
| | - Annmarie Hosie
- University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jose L Pereira
- Department of Family Medicine, University of Ottawa, Ontario, Canada; Division of Palliative Medicine, McMaster University, Ontario, Canada
| | - David Meagher
- University of Limerick School of Medicine, Limerick, Ireland
| | - Jill Rice
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - John Scott
- The Ottawa Hospital, Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Continuing Care, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Braun T, Thiel C, Schulz RJ, Grüneberg C. Reliability of mobility measures in older medical patients with cognitive impairment. BMC Geriatr 2019; 19:20. [PMID: 30674278 PMCID: PMC6343264 DOI: 10.1186/s12877-019-1036-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/14/2019] [Indexed: 01/06/2023] Open
Abstract
Background Mobility is a key indicator of physical functioning in older people, but there is limited evidence of the reliability of mobility measures in older people with cognitive impairment. This study aimed to examine the test-retest reliability and measurement error of common measurement instruments of mobility and physical functioning in older patients with dementia, delirium or other cognitive impairment. Methods A cross-sectional study was performed in a geriatric hospital. Older acute medical patients with cognitive impairment, indicated by a Mini-Mental State Examination (MMSE) score of ≤24 points, were assessed twice within 1 day by a trained physiotherapist. The following instruments were applied: de Morton Mobility Index, Hierarchical Assessment of Balance and Mobility, Performance-Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed, 5-times chair rise test, 2-min walk test, timed up and go test, Barthel Index mobility subscale and Functional Ambulation Categories. As appropriate, the intraclass correlation coefficient (ICC), Cohen’s kappa, standard error of measurement, limits of agreement and minimal detectable change (MDC) values were estimated. Results Sixty-five older acute medical patients with cognitive impairment participated in the study (mean age: 82 ± 7 years; mean MMSE: 20 ± 4, range: 10 to 24 points). Some participants were physically or cognitively unable to perform the gait speed (46%), 2-min walk (46%), timed up and go (51%) and chair rise (75%) tests. ICC and kappa values were above 0.9 in all instruments except for the gait speed (ICC = 0.86) and chair rise (ICC = 0.72) measures. Measurement error is reported for each instrument. The absolute limits of agreement ranged from 11% (de Morton Mobility Index and Hierarchical Assessment of Balance and Mobility) to 35% (chair rise test). Conclusions The test-retest reliability is sufficient (> 0.7) for group-comparisons in all examined instruments. Most mobility measurements have limited use for individual monitoring of mobility over time in older hospital patients with cognitive impairment because of the large measurement error (> 20% of scale width), even though relative reliability estimations seem sufficient (> 0.9) for this purpose. Trial registration German Clinical Trials Register (DRKS00005591). Registered 2 February 2015. Electronic supplementary material The online version of this article (10.1186/s12877-019-1036-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Braun
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Christian Thiel
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.,Faculty of Sports Science, Training and Exercise Science, Ruhr-University Bochum, Bochum, Germany
| | - Ralf-Joachim Schulz
- Department of Geriatric Medicine, St. Marien-Hospital, Kunibertskloster 11-13, 50668, Cologne, Germany
| | - Christian Grüneberg
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
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Park J, Jeong E, Seomun G. The clock drawing test: A systematic review and meta‐analysis of diagnostic accuracy. J Adv Nurs 2018; 74:2742-2754. [DOI: 10.1111/jan.13810] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 05/21/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
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McCluskey GE, Yates P, Villemagne VL, Rowe C, Szoeke CEI. Self-reported confusion is related to global and regional β-amyloid: data from the Women's healthy ageing project. Brain Imaging Behav 2018; 12:78-86. [PMID: 28108945 DOI: 10.1007/s11682-016-9668-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Disease-modifying treatments for Alzheimer's disease (AD) may require implementation during early stages of β-amyloid accumulation, well before patients have objective cognitive decline. In this study we aimed to assess the clinical value of subjective cognitive impairment (SCI) by examining the cross-sectional relationship between β-amyloid load and SCI. Cerebral β-amyloid and SCI was assessed in a cohort of 112 cognitively normal subjects. Subjective cognition was evaluated using specific questions on memory and cognition and the MAC-Q. Participants had cerebral β-amyloid load measured with 18F-Florbetaben Positron Emission Tomography (PET). No associations were found between measures of subjective memory impairment and cerebral β-amyloid. However, by self-reported confusion was predictive of a higher global β-amyloid burden (p = 0.002), after controlling for confounders. Regional analysis revealed significant associations of confusion with β-amyloid in the prefrontal region (p = 0.004), posterior cingulate and precuneus cortices (p = 0.004) and the lateral temporal lobes (p = 0.001) after controlling for confounders. An in vivo biomarker for AD pathology was associated with SCI by self-reported confusion on cross-sectional analysis. Whilst there has been a large body of research on SMC, our results indicate more research is needed to explore symptoms of confusion.
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Affiliation(s)
- Georgia E McCluskey
- Centre for Medical Research, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, 3050, Australia
| | - Paul Yates
- Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Victor L Villemagne
- Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, VIC, 3084, Australia
| | - Christopher Rowe
- Department of Nuclear Medicine and Centre for PET, Austin Health, Heidelberg, VIC, 3084, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, 3050, Australia
| | - Cassandra E I Szoeke
- Centre for Medical Research, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia. .,Department of Medicine, University of Melbourne, Parkville, VIC, 3050, Australia. .,Institute for Health and Ageing, Melbourne, 3000, Australia.
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Braun T, Grüneberg C, Thiel C, Schulz RJ. Measuring mobility in older hospital patients with cognitive impairment using the de Morton Mobility Index. BMC Geriatr 2018; 18:100. [PMID: 29685107 PMCID: PMC5913915 DOI: 10.1186/s12877-018-0780-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mobility is a key outcome in older patients with cognitive impairment. The de Morton Mobility Index (DEMMI) is an established measure of older people’s mobility that is promising for use in older patients with cognitive impairment. The aim of this study was to examine the DEMMI’s psychometric properties in older patients with dementia, delirium or other cognitive impairment. Methods This cross-sectional study was performed in a geriatric hospital and includes older acute medical patients with cognitive impairment indicated by a Mini Mental State Examination (MMSE) score ≤ 24 points. A Rasch analysis was performed to check the DEMMI’s unidimensionality. Construct validity was assessed by testing 13 hypotheses about expected correlations between the DEMMI and outcome measures of similar or related constructs, and about expected differences of DEMMI scores between groups differing in mobility related characteristics. Administration times were recorded. Results A sample of 153 patients with mild (MMSE 19–24 points; 63%) and moderate (MMSE: 10–18 points; 37%) cognitive impairment was included (age range: 65–99 years; mean MMSE: 19 ± 4, range: 8–24 points; diagnosis of dementia and delirium: 40% and 18%, respectively). Rasch analysis indicated unidimensionality with an overall fit to the model (P = 0.107). Internal consistency reliability was excellent (Cronbach’s alpha = 0.92). Eleven out of 13 (85%) hypotheses on construct validity were confirmed. The DEMMI showed good feasibility, and no adverse events occurred. The mean administration time of 5 min (range: 1–10) was not influenced by the level of cognitive impairment. In contrast to some other comparator instruments, no floor or ceiling effects were evident for the DEMMI. Conclusions Results indicate sufficient psychometric properties of the DEMMI in older patients with cognitive impairment. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015. Electronic supplementary material The online version of this article (10.1186/s12877-018-0780-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Braun
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany. .,University of Cologne, Medical Faculty, Cologne, Germany. .,St. Marien-Hospital, Department of Geriatric Medicine, Cologne, Germany.
| | - Christian Grüneberg
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Christian Thiel
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
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Effect of short-term exposure to ambient air particulate matter on incidence of delirium in a surgical population. Sci Rep 2017; 7:15461. [PMID: 29133855 PMCID: PMC5684401 DOI: 10.1038/s41598-017-15280-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023] Open
Abstract
Delirium remains an independent risk factor for morbidity and mortality among older surgical adults. Recent research has shed light on the relationship between pollution and dementia, yet little is known about the health impacts of particulate matter (PM) on delirium. Therefore, we aim to further explore association of PM and delirium among surgical population. We conducted a time-stratified case-crossover study. Electronic hospitalization summary reports derived from 26 major cities in China between 1 January 2014 and 31 December 2015 were used. Conditional logistic regression were applied to explore the association between perioperative PM exposure and delirium. A total of 559 surgical patients with delirium were identified. Both PM2.5 and SO2 on the day of surgery had a negative impact, with an interquartile range (IQR) increase in PM2.5 (47.5 μg/m3) and SO2 (22.2 μg/m3) significantly associated with an 8.79% (95% confidence interval [CI], 0.01–18.47%, P < 0.05) and 16.83% (95% CI, 0.10–36.35%, P < 0.05) increase in incidence of delirium, respectively. PM on other days during the perioperative period showed no significant impact. The present study showed that short-term exposure to ambient air PM on the day of surgery increased the incidence of delirium in a surgical population during hospitalization.
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Hou CJ, Huang MW, Zhou JY, Hsu PC, Zeng JH, Chen YT. The application of individual virtual nostalgic game design to the evaluation of cognitive function. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2586-2589. [PMID: 29060428 DOI: 10.1109/embc.2017.8037386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The aim of this study was to develop a task set based on personalized material for nostalgic experience, which could detect cognitive ability via a virtual experience system combined with Kinect somatosensory interactive operation applications without the user wearing any accessory input device. Fifty-nine subjects participated in the experiment. The receiver operating characteristic curve of the game system was statistically analyzed for determining the best cutoff-point in the cognitive function assessment. Correlation analysis and regression analysis were used to explore the correlations between the results and the clinical cognitive assessment scales. According to the MoCA scores, the results showed that the accuracy of the system was 86.4% in evaluating mild cognitive impairment. The system seems feasible and was strongly correlated with clinical cognitive assessment scales. We anticipate that daily use of our system could keep track of changes of cognitive function of the elderly in home life.
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Lehmann SW, Brooks WB, Popeo D, Wilkins KM, Blazek MC. Development of Geriatric Mental Health Learning Objectives for Medical Students: A Response to the Institute of Medicine 2012 Report. Am J Geriatr Psychiatry 2017. [PMID: 28642002 DOI: 10.1016/j.jagp.2017.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
America is aging as the population of older adults increases. The shortage of geriatric mental health specialists means that most geriatric mental healthcare will be provided by physicians who do not have specialty training in geriatrics. The Institute of Medicine Report of 2012 highlighted the urgent need for development of national competencies and curricula in geriatric mental health for all clinicians. Virtually all physicians can expect to treat older patients with mental health symptoms, yet currently there are no widely accepted learning objectives in geriatric mental health specific for medical students. The authors describe the development of a set of such learning objectives that all medical students should achieve by graduation. The iterative process included initial drafting by content experts from five medical schools with input and feedback from a wider group of geriatric psychiatrists, geriatricians, internists, and medical educators. The final document builds upon previously published work and includes specific knowledge, attitudes and skills in six key domains: Normal Aging, Mental Health Assessment of the Geriatric Patient, Psychopharmacology, Delirium, Depression, and Dementia. These objectives address a pressing need, providing a framework for national standards and curriculum development.
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Affiliation(s)
- Susan W Lehmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - William B Brooks
- Department of Psychiatry, University of South Alabama School of Medicine, Mobile, AL
| | - Dennis Popeo
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Kirsten M Wilkins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Mary C Blazek
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI
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Wilkins KM, Blazek MC, Brooks WB, Lehmann SW, Popeo D, Wagenaar D. Six Things All Medical Students Need to Know About Geriatric Psychiatry (and How To Teach Them). ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:693-700. [PMID: 28255854 DOI: 10.1007/s40596-017-0691-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/15/2017] [Indexed: 06/06/2023]
Affiliation(s)
| | - Mary C Blazek
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - Susan W Lehmann
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dennis Popeo
- New York University School of Medicine, New York, NY, USA
| | - Deborah Wagenaar
- Michigan State University Colleges of Human and Osteopathic Medicine, East Lansing, MI, USA
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Otani VHO, Otani TZDS, Freirias A, Calfat ELDB, Aoki PS, Cordeiro Q, Kanaan RAA, Cross S, Liersch-Sumskis S, Uchida RR. Misidentification of mental health symptoms in presence of organic diseases and delirium during psychiatric liaison consulting. Int J Psychiatry Clin Pract 2017; 21:215-220. [PMID: 28326870 DOI: 10.1080/13651501.2017.1301483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify predictors of misidentification of organic mental disorders and delirium in patients undergoing psychiatric liaison consultation. METHODS Data were collected at Santa Casa de São Paulo between July of 2009 and March of 2013. We included in our analysis all inpatients for whom the requesting service judged that a psychiatric consultation was required for a possible mental health condition. Outcomes of interest were the instances of misidentification where a condition was initially deemed to be of a psychiatric nature, whereas the final diagnosis by the liaison psychiatric team was of an organic disease or delirium. Our predictors were the clinical specialty of the requesting service, requester and patient characteristics. A series of generalised linear models were used to evaluate misidentification risks. RESULTS A total of 947 subjects met our inclusion criteria, 14.6% having a final liaison diagnosis of organic mental disorder and 8.1% of delirium. Older patients were significantly associated with increased risk of misidentification for both organic conditions (OR 3.01 - 95% CI 2.01, 4.5) and delirium (OR 3.92 - 2.4, 6.39). CONCLUSIONS Educational interventions in general hospitals focused on preventing psychiatric misdiagnosis should target in-hospital services where patients tend to be older.
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Affiliation(s)
| | | | - Andrea Freirias
- a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil
| | | | | | - Quirino Cordeiro
- a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil
| | - Richard A A Kanaan
- b Chair of Psychiatry, Austin Health , University of Melbourne , Melbourne , Australia
| | - Sean Cross
- c Maudsley Simulation, South London & Maudsley Foundation NHS Trust , Lambeth Hospital , London , UK
| | - Susan Liersch-Sumskis
- d School of Nursing, Faculty of Science, Medicine and Health University of Wollongong , Wollongong , Australia
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Alzheimer's-related cortical atrophy is associated with postoperative delirium severity in persons without dementia. Neurobiol Aging 2017; 59:55-63. [PMID: 28846882 DOI: 10.1016/j.neurobiolaging.2017.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 01/31/2023]
Abstract
Patients with dementia due to Alzheimer's disease (AD) have increased risk of developing delirium. This study investigated the relationship between a magnetic resonance imaging (MRI)-derived biomarker associated with preclinical AD and postoperative delirium. Participants were older adults (≥70 years) without dementia who underwent preoperative MRI and elective surgery. Delirium incidence and severity were evaluated daily during hospitalization. Cortical thickness was averaged across a published set of a priori brain regions to derive a measure known as the "AD signature." Logistic and linear regression was used, respectively, to test whether the AD signature was associated with delirium incidence in the entire sample (N = 145) or with the severity of delirium among those who developed delirium (N = 32). Thinner cortex in the AD signature did not predict incidence of delirium (odds ratio = 1.15, p = 0.38) but was associated with greater delirium severity among those who developed delirium (b = -1.2, p = 0.014). These results suggest that thinner cortices, perhaps reflecting underlying neurodegeneration due to preclinical AD, may serve as a vulnerability factor that increases severity once delirium occurs.
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Sahin S, Okluoglu Önal T, Cinar N, Bozdemir M, Çubuk R, Karsidag S. Distinguishing Depressive Pseudodementia from Alzheimer Disease: A Comparative Study of Hippocampal Volumetry and Cognitive Tests. Dement Geriatr Cogn Dis Extra 2017; 7:230-239. [PMID: 28868066 PMCID: PMC5566711 DOI: 10.1159/000477759] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/18/2017] [Indexed: 12/24/2022] Open
Abstract
Background and Aim Depressive pseudodementia (DPD) is a condition which may develop secondary to depression. The aim of this study was to contribute to the differential diagnosis between Alzheimer disease (AD) and DPD by comparing the neurocognitive tests and hippocampal volume. Materials and Methods Patients who met criteria of AD/DPD were enrolled in the study. All patients were assessed using the Wechsler Memory Scale (WMS), clock-drawing test, Stroop test, Benton Facial Recognition Test (BFRT), Boston Naming Test, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Hippocampal volume was measured by importing the coronal T1-weighted magnetic resonance images to the Vitrea 2 workstation. Results A significant difference was found between the AD and DPD groups on the WMS test, clock-drawing test, Stroop test, Boston Naming Test, MMSE, GDS, and left hippocampal volume. A significant correlation between BFRT and bilateral hippocampal volumes was found in the AD group. No correlation was found among parameters in DPD patients. Conclusions Our results suggest that evaluation of facial recognition and left hippocampal volume may provide more reliable evidence for distinguishing DPD from AD. Further investigations combined with functional imaging techniques including more patients are needed.
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Affiliation(s)
- Sevki Sahin
- Department of Neurology, Faculty of Medicine, Maltepe University, Istanbul, Turkey
| | - Tugba Okluoglu Önal
- Department of Neurology, Faculty of Medicine, Maltepe University, Istanbul, Turkey
| | - Nilgun Cinar
- Department of Neurology, Faculty of Medicine, Maltepe University, Istanbul, Turkey
| | - Meral Bozdemir
- Department of Psychology, Faculty of Humanities and Social Sciences, Maltepe University, Istanbul, Turkey
| | - Rahmi Çubuk
- Department of Radiology, Faculty of Medicine, Maltepe University, Istanbul, Turkey
| | - Sibel Karsidag
- Department of Neurology, Faculty of Medicine, Maltepe University, Istanbul, Turkey
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Silva MWB, Sousa-Muñoz RL, Frade HC, Fernandes PA, Magalhães ADO. Sundown syndrome and symptoms of anxiety and depression in hospitalized elderly. Dement Neuropsychol 2017; 11:154-161. [PMID: 29213507 PMCID: PMC5710684 DOI: 10.1590/1980-57642016dn11-020008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sundown syndrome is characterized by the sudden appearance of neuropsychiatric
symptoms such as agitation, confusion and anxiety in a chronologic fashion,
usually during late afternoon or early evening.
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Affiliation(s)
| | - Rilva Lopes Sousa-Muñoz
- Doutora pela Universidade Federal da Paraíba e Orientadora da Pesquisa. Departamento de Medicina Interna
| | | | - Priscilla Alencar Fernandes
- Fernandes, Priscila; Graduando em Medicina pela Universidade Federal da Paraíba. Graduando em Nutrição pelo Instituto Superior de Teologia Aplicada
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Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1167-1178. [PMID: 28083669 DOI: 10.1007/s00198-016-3881-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs). INTRODUCTION The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures. METHODS Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis. RESULTS The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45-1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11-1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43-2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95-1.83). CONCLUSIONS FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.
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Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan.
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The Missing Record of Mental Status in Written Sign-Outs. J Patient Saf 2017; 15:e40-e43. [PMID: 28098585 DOI: 10.1097/pts.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the study was to determine how frequently mental status and mental status changes are documented in the written patient summary ("sign-out") provided to covering physicians. PATIENTS AND METHODS This was a retrospective cohort study of general medical patients hospitalized between March 16, 2009, and March 15, 2010, conducted at 2 teaching hospitals. Participants included patients with mental status change adverse events (MSAEs) and their providers. Chart review was performed to identify patients with MSAEs and details about these events. Sign-outs were reviewed for documentation of mental status. Main outcome measures were (1) proportion of patients with MSAEs who had mental status ever recorded in sign-out entries and (2) the proportion of patients with MSAEs whose change in mental status was recorded in the sign-out. RESULTS Sixty-eight patients had MSAEs and were included in the sample. Fifty percent of MSAEs were attributed to medications; 75% of these events were first detected by nurses. Only 25% of patients with MSAEs had their change in mental status recorded in sign-outs. CONCLUSIONS Recording mental status in written sign-outs is uncommon. Particularly concerning is that patients with MSAEs identified by chart review seldom had sign-outs that reflected those events. Interventions should be designed to increase the recording of this information in sign-outs.
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Lamont S, Stewart C, Chiarella M. Documentation of Capacity Assessment and Subsequent Consent in Patients Identified With Delirium. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:547-555. [PMID: 27468831 DOI: 10.1007/s11673-016-9741-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Delirium is highly prevalent in the general hospital patient population, characterized by acute onset, fluctuating levels of consciousness, and global impairment of cognitive functioning. Mental capacity, its assessment and subsequent consent are therefore prominent within this cohort, yet under-explored. AIM This study of patients with delirium sought to determine the processes by which consent to medical treatment was attempted, how capacity was assessed, and any subsequent actions thereafter. METHOD A retrospective documentation review of patients identified as having a delirium for the twelve months February 2013 to January 2014 was undertaken. Inclusion and exclusion criteria were used; demographic and descriptive data collected. A total of n=1153 patients were identified with n=310 meeting inclusion criteria. RESULT A random sample of one hundred patients were subsequently reviewed. One third of patients (n=33) had documentation relating to consent, while four patients had documentation relating to capacity. Median delirium duration was three days, with treatment refusal occurring in twenty-two patients and "duty of care" being used as an apparent beneficent related treatment framework in twelve patients. CONCLUSIONS While impaired decision-making was indicated, the review was unable to indicate what patient characteristics flag the need for capacity assessment. Documentation relating to consent processes (whether patient or substitute) appeared deficient for this cohort.
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Affiliation(s)
- Scott Lamont
- Prince of Wales Hospital, Level 1 East Wing, Edmund Blackett Building, Sydney, NSW, 2031, Australia.
| | - Cameron Stewart
- Sydney Law School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Mary Chiarella
- Sydney Nursing School, The University of Sydney, Sydney, NSW, 2006, Australia
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Prick AE, de Lange J, Scherder E, Twisk J, Pot AM. The effects of a multicomponent dyadic intervention on the mood, behavior, and physical health of people with dementia: a randomized controlled trial. Clin Interv Aging 2016; 11:383-95. [PMID: 27099480 PMCID: PMC4820235 DOI: 10.2147/cia.s95789] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The effects of a multicomponent dyadic intervention on the mood, behavior, and physical health of people with dementia living in the community were evaluated in a randomized controlled trial. This multicomponent dyadic intervention is a translated and adapted version of an intervention that has been shown to be effective for people with dementia in the US. PATIENTS AND METHODS People with dementia living in the community and their family caregivers (N=111 caregiver-care recipient dyads) were randomly assigned to the intervention and comparison group. The intervention group received home-based physical exercise training, psycho-education, communication skills training, and pleasant activities training during 3 months directed at both the person with dementia and the caregiver. Mood, behavior, and physical health were measured at baseline, 3 months, and 6 months. The effects of the study were determined by using generalized estimating equations based on an intention-to-treat analysis. RESULTS Analyses showed no beneficial effects over time on any of the outcome measures. CONCLUSION This study showed no effects. The negative results in this study compared to the study that has been carried out in the US might be explained by the translation, adaptation, and shortening of the intervention used in the US, and a different social context. In addition, the results might be explained by the lack of room for improvement and by experiencing the intervention as too much of a burden. Furthermore, improving physical health might only be effective if the physical exercises are of moderate-to-high-intensity and are tailored in accordance with participants' preferences and needs. For future studies, because dyads often commented positively about the pleasure and support they received, it might also be valuable to measure quality of life outcomes such as relationship quality, pleasure, and self-esteem in dyadic focused interventions.
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Affiliation(s)
- Anna-Eva Prick
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands
| | - Jacomine de Lange
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Erik Scherder
- Department of Clinical Neuropsychology, Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands
| | - Jos Twisk
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Anne Margriet Pot
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, Faculty of Psychology and Education, VU University, Amsterdam, the Netherlands; Program on Ageing, Institute of Mental Health and Addiction, Utrecht, the Netherlands; School of Psychology, University of Queensland, Brisbane, QLD, Australia
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Abstract
Patients who have dementia with Lewy bodies (DLB) and undergo surgery may develop aggravated postoperative cognitive dysfunction or postoperative delirium. Many patients with DLB respond poorly to surgery and anesthesia, and their conditions may worsen if they have other medical complications along with dementia. They may also face high risk of prolonged hospital stay, increased medical problems and/or mortality, causing significant physical, psychosocial, and financial burdens on individuals, family members, and society. Anesthesia, pain medications, old age, and surgery-related stresses are usually held responsible for the complications; however, the exact causes are still not fully understood. Literature on surgery-related complications for patients with DLB appears to be inadequate, and hence the topic merits detailed and systematic research. This article reviews postoperative complications and various surgery-related risk factors for DLB in light of other dementias such as Alzheimer's disease, as their neuropathologic features overlap with those of DLB.
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Affiliation(s)
- Farzana Pervin
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carolyn Edwards
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol F Lippa
- Drexel University College of Medicine, Philadelphia, PA, USA
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Yaghmour SM, Gholizadeh L. Review of Nurses’ Knowledge of Delirium, Dementia and Depressions (3Ds): Systematic Literature Review. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojn.2016.63020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol 2015; 14:823-832. [PMID: 26139023 DOI: 10.1016/s1474-4422(15)00101-5] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/27/2015] [Accepted: 05/18/2015] [Indexed: 02/02/2023]
Abstract
Delirium and dementia are two of the most common causes of cognitive impairment in older populations, yet their interrelation remains poorly understood. Previous studies have shown that dementia is the leading risk factor for delirium and that delirium is an independent risk factor for subsequent development of dementia. However, a major area of controversy is whether delirium is simply a marker of vulnerability to dementia, whether the effect of delirium is solely related to its precipitating factors, or whether delirium itself can cause permanent neuronal damage and lead to dementia. Ultimately, all of these hypotheses are likely to be true. Emerging evidence from epidemiological, clinicopathological, neuroimaging, biomarker, and experimental studies lends support to a strong relation between delirium and dementia, and to both shared and distinct pathological mechanisms. New preventive and therapeutic approaches that target delirium might offer a sought-after opportunity for early intervention, preservation of cognitive reserve, and prevention of irreversible cognitive decline in ageing.
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Affiliation(s)
- Tamara G Fong
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, UCL, London, UK
| | - Matthew E Growdon
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Asha Albuquerque
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Sharon K Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.
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Abstract
Purpose of review Our review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care. Recent findings Delirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for delirium. Formal guidelines for delirium screening and management have been rigorously developed for intensive care, and may serve as a model for other settings. Given that palliative sedation is often required for the management of refractory delirium at the end of life, a version of the Richmond Agitation-Sedation Scale, modified for palliative care, has undergone preliminary validation. Summary Although formal systematic delirium screening with brief but sensitive tools is strongly advocated for patients in palliative and supportive care, it requires critical evaluation in terms of clinical outcomes, including patient comfort. Randomized controlled trials are needed to inform the development of guidelines for the management of delirium in this setting.
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Abstract
OBJECTIVES Delirium shares symptoms with some mental illnesses. This may lead to misdiagnosis of delirium in psychiatric patients and a risk of inadequate management. Moreover, literature on delirium in psychiatric patients is sparse. The aim was to analyse possible changes in the diagnostic incidence of delirium in psychiatric patients from 1995 to 2011, and to investigate the patients with regard to sex, age, and type of patient. METHODS All first time ever diagnoses of delirium among psychiatric patients were identified in the nationwide Danish Psychiatric Central Research Register (DPCRR) from 1995 to 2011. The delirium diagnoses include (1) delirium unspecified, (2) delirium with dementia, and (3) drug-related delirium, all in accordance with International Classification of Diseases-10. The incidence rates were age standardised. RESULTS A total of 15 680 persons diagnosed with delirium for the first time were identified in the DPCRR between 1995 and 2011. The total incidence rate of delirium has decreased, reaching 8.4/1000 person-years in 2011. In 2011, 2.6% of the demented patients were diagnosed with delirium with dementia. Diagnosis of delirium is significantly more common in men, and the three groups of delirium showed a characteristic age distribution. CONCLUSION Our incidences were markedly lower when compared with previous studies. This suggests a possible underdiagnosis of delirium in psychiatric hospitals and should be investigated further, as delirium is a serious state and identifying the syndrome is important for sufficient treatment.
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Al-Adawi S, Braidy N, Essa M, Al-Azri F, Hussain S, Al-Sibani N, Al-Khabouri J, Al-Asmi A, Al-Mashani A. Cognitive profiles in patients with multi-infarct dementia: an omani study. Dement Geriatr Cogn Dis Extra 2014; 4:271-82. [PMID: 25202321 PMCID: PMC4154192 DOI: 10.1159/000363621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Studies on neurocognitive impairment among patients presenting with multi-infarct dementia (MID) have received little attention from non-Western societies, and the Arab world is no exception. To our knowledge, this is the first study to characterize neurocognitive, affective and vegetative functioning in patients with MID in Oman. Methods In this study, we recruited 20 Omani patients presenting with MID and age- and gender-matched controls at the outpatient clinic of the Department of Behavioral Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman. In addition to the collection of clinical and demographic information, various cognitive batteries were administered to the consenting participants, including those indexing nonverbal reasoning abilities, working memory (attention, concentration and recall) and executive functioning. Questionnaires that elicit the affective range and the quality of sleep were also administered. Results Compared with the matched healthy subjects, the patients diagnosed with MID significantly differed in the presently operationalized indices of visuospatial function, semantic memory and affective and vegetative functioning. In contrast, episodic memory and some attentional capacities were not significantly different compared with the control subjects. Conclusions The present study was explorative and clinically designed to describe neurocognitive functioning in patients with MID seeking consultation at a tertiary care center in Oman. Our data are necessary for planning and setting up community services and health care programs for demented patients in a society where dementia is a growing silent epidemic.
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Affiliation(s)
- Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine and Health Sciences, Muscat, Oman
| | - Nady Braidy
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, N.S.W., Australia
| | - Musthafa Essa
- Department of Food Science and Nutrition, CAMS, Sultan Qaboos University, Muscat, Oman
| | - Faisal Al-Azri
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Samir Hussain
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Nasser Al-Sibani
- Al-Masara Hospital, Ministry of Health, Ministry of Health, Muscat, Oman
| | - Jabar Al-Khabouri
- Department of Neurology, Royal Hospital, Ministry of Health, Muscat, Oman
| | - Abdullah Al-Asmi
- Department of Neurology, Royal Hospital, Ministry of Health, Muscat, Oman
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Klinedinst NJ, Resnick B. Volunteering and depressive symptoms among residents in a continuing care retirement community. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 57:52-71. [PMID: 24313849 DOI: 10.1080/01634372.2013.867294] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This descriptive study examined the relationship between volunteer activities, depressive symptoms, and feelings of usefulness among older adults using path analysis. Survey data was collected via interview from residents of a continuing care retirement community. Neither feelings of usefulness nor volunteering were directly associated with depressive symptoms. Volunteering was directly associated with feelings of usefulness and indirectly associated with depressive symptoms through total physical activity. Age, fear of falling, pain, physical activity, and physical resilience explained 31% of the variance in depressive symptoms. Engaging in volunteer work may be beneficial for increasing feelings of usefulness and indirectly improving depressive symptoms among older adults.
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