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Visser FCW, Barmentlo R, Luttmer T, van Zeventer R, van der Werff T, Hempenius L, Verwey NA, van Munster BC. Cognitive Impairment in the Outpatient Setting: Experiences and Views of Medical Specialists. J Am Med Dir Assoc 2024; 25:105035. [PMID: 38796165 DOI: 10.1016/j.jamda.2024.105035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Fleur C W Visser
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Alzheimer Center Groningen, Groningen, the Netherlands.
| | - Roos Barmentlo
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Thomas Luttmer
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Roos van Zeventer
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Tim van der Werff
- University of Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Liesbeth Hempenius
- Medical Center Leeuwarden, Department of Geriatric Medicine, Leeuwarden, the Netherlands
| | - Nicolaas A Verwey
- Medical Center Leeuwarden, Neurology and Geriatric Department, Leeuwarden, the Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Alzheimer Center Groningen, Groningen, the Netherlands; Department of Geriatric Medicine, Martini Hospital, Groningen, the Netherlands
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2
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Haaijer I, Louwes HA, Vrielink JW, Strijkert F, van Munster BC, Ubbink SWJ. Screening and Recognition of Cognitive Impairment in Older People Visiting Hearing Aid Dispensers in the Netherlands. J Am Med Dir Assoc 2024:104958. [PMID: 38442875 DOI: 10.1016/j.jamda.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVES This study aims to determine how prevalent suspected cognitive impairment is in older people visiting hearing aid dispensers, and to assess whether hearing aid dispensers' judgment on cognition was in accordance with the outcome of a cognitive screening. DESIGN This observational study was conducted between April and May 2022. SETTING AND PARTICIPANTS Four private hearing aid retail stores in the Netherlands, where cognitive impairment was screened in people aged ≥60 years. METHODS The Mini-Cog was used for cognitive screening. In addition, hearing aid dispensers were asked to provide their professional judgment if they suspected cognitive impairment. RESULTS Of the total 239 older individuals screened, 133 were men [56%, mean age: 79 years (SD 8.6)], and 51 (21.3%) had abnormal outcomes on the Mini-Cog test. The recognition of possible cognitive impairment by the hearing aid dispensers compared to the outcome of the Mini-Cog resulted in correct predictions for 183 of the 239 individuals. CONCLUSION AND IMPLICATIONS Cognitive screening in hearing-impaired older adults who visit a hearing aid dispenser suggests that cognitive impairment might be present in approximately 1 in 5 individuals. Hearing aid dispensers' response to the presence of a cognitive impairment was in 2 of 3 in accordance with an abnormal outcome on cognitive screening. To improve hearing care for people with cognitive impairment, it might be important to enhance hearing care professionals' recognition of cognitive impairment in older individuals.
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Affiliation(s)
- Iris Haaijer
- Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Henderika A Louwes
- Faculty of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Jelte W Vrielink
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Fijanne Strijkert
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara C van Munster
- Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sander W J Ubbink
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands
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Hemels MEW, Blauw GJ. Geriatric cardiology in one's own backyard? Neth Heart J 2024; 32:68-69. [PMID: 38112990 PMCID: PMC10834392 DOI: 10.1007/s12471-023-01841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Martin E W Hemels
- Department of Cardiology, Rijnstate Hospital Arnhem, Arnhem, The Netherlands.
- Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | - Gerard J Blauw
- Department of Internal Medicine-Geriatrics, Haaglanden Medical Center, Den Haag, The Netherlands
- Department of Internal Medicine-Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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van Nieuwkerk AC, Delewi R, Wolters FJ, Muller M, Daemen M, Biessels GJ. Cognitive Impairment in Patients With Cardiac Disease: Implications for Clinical Practice. Stroke 2023; 54:2181-2191. [PMID: 37272393 DOI: 10.1161/strokeaha.123.040499] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cognitive impairment is common in patients with cardiovascular disease. One in 3 patients presenting at cardiology clinics have some degree of cognitive impairment, depending on the cardiac condition, comorbidities, and age. In up to half of these cases cognitive impairment may go unrecognized; however, it may affect self-management and treatment adherence. The high prevalence of cognitive impairment in patients with cardiac disease is likely due to shared risk factors, as well as direct consequences of cardiac dysfunction on the brain. Moreover, cardiac interventions may have beneficial as well as adverse effects on cognitive functioning. In this review, we describe prevalence and risk factors for cognitive impairment in patients with several common cardiac conditions: heart failure, coronary artery disease, and aortic valve stenosis. We discuss the potential effects of guideline-based treatments on cognition and identify open questions and unmet needs. Given the high prevalence of unrecognized cognitive impairment in cardiac patients, we recommend a stepwise approach to improve detection and management of cognitive impairment.
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Affiliation(s)
- Astrid C van Nieuwkerk
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.C.v.N., R.D.)
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.C.v.N., R.D.)
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
| | - Frank J Wolters
- Department of Epidemiology (F.J.W.), Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC (F.J.W.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Majon Muller
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics, the Netherlands (M.M.)
| | - Mat Daemen
- Department of Pathology, Amsterdam University Medical Center, Locations AMC and VUmc, University of Amsterdam, the Netherlands (M.D.)
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center, the Netherlands (G.J.B.)
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5
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Kuipers S, Greving JP, Brunner-La Rocca HP, Gottesman RF, van Oostenbrugge RJ, Williams NL, Jan Biessels G, Jaap Kappelle L. Risk evaluation of cognitive impairment in patients with heart failure: A call for action. IJC HEART & VASCULATURE 2022; 43:101133. [PMID: 36246772 PMCID: PMC9563178 DOI: 10.1016/j.ijcha.2022.101133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022]
Abstract
Background Cognitive impairment (CI) is common in patients with heart failure (HF) and impacts treatment adherence and other aspects of patient life in HF. Recognition of CI in patients with HF is therefore important. We aimed to develop a risk model with easily available patient characteristics, to identify patients with HF who are at high risk to be cognitively impaired and in need for further cognitive investigation. Methods & results The risk model was developed in 611 patients ≥ 60 years with HF from the TIME-CHF trial. Fifty-six (9 %) patients had CI (defined as Hodkinson Abbreviated Mental Test ≤ 7). We assessed the association between potential predictors and CI with least-absolute-shrinkage-and-selection-operator (LASSO) regression analysis. The selected predictors were: older age, female sex, NYHA class III or IV, Charlson comorbidity index ≥ 6, anemia, heart rate ≥ 70 bpm and systolic blood pressure ≥ 145 mmHg. A model that combined these variables had a c-statistic of 0.70 (0.63-0.78). The model was validated in 155 patients ≥ 60 years with HF from the ECHO study. In the validation cohort 51 (33 %) patients had CI (defined as a Mini Mental State Exam ≤ 24). External validation showed an AUC of 0.56 (0.46-0.66). Conclusions This risk model with easily available patient characteristics has poor predictive performance in external validation, which may be due to case-mix variation. These findings underscore the need for active screening and standardized assessment for CI in patients with HF.
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Affiliation(s)
- Sanne Kuipers
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacoba P. Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Cardiovascular Diseases CARIM, University Maastricht, Maastricht, The Netherlands
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Intramural Research Program, NIH, Bethesda, MD, USA1
| | | | - Nicole L. Williams
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L. Jaap Kappelle
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heart-Brain Connection consortium
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Cardiovascular Diseases CARIM, University Maastricht, Maastricht, The Netherlands
- Stroke Branch, National Institute of Neurological Disorders and Stroke, Intramural Research Program, NIH, Bethesda, MD, USA1
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Pons D, Jansen RWMM, Hemels MEW. Cognitive impairment and depression in heart failure: 'cardiological giants'. Neth Heart J 2021; 29:365-367. [PMID: 34142338 PMCID: PMC8271055 DOI: 10.1007/s12471-021-01595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/25/2022] Open
Affiliation(s)
- D Pons
- Department of Geriatric Medicine, Northwest Clinics, Alkmaar, The Netherlands.
| | - R W M M Jansen
- Department of Geriatric Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - M E W Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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