Neuropsychiatric symptoms in elderly inpatients: a multicenter cross-sectional study

Influence of Cognitive Impairment on Rehabilitation Received and Its Mediating Effect on Functional Recovery

BACKGROUND

Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited.

OBJECTIVE

To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy.

METHODS

Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status.

RESULTS

Patients with more severe CI received least total therapy hours (TTH) (MMSE < 17, 13.67±6.58 versus MMSE 17-26, 16.12±7.19 and MMSE > 26, 17.79±8.88 h, p = 0.014) and were less often included in occupational therapy (MMSE < 17, 48.9%versus MMSE 17-26, 65.5%and MMSE > 26, 71.4%, p = 0.019) and group-based physiotherapy (MMSE < 17, 73.3%versus MMSE 17-26, 88.5%and MMSE > 26, 81.2%, p = 0.027). Regression models showed that CI negatively impacted TTH (β= 0.24, p = 0.003) and rehabilitation outcome (β= 0.41, p = 0.008). In the mediation model, TTH accounted for 23.18%(p < 0.001) of the relationship between CI and rehabilitation outcome.

CONCLUSION

Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI.

The Effect of Doll Therapy on Agitation and Cognitive State in Institutionalized Patients With Moderate-to-Severe Dementia: A Randomized Controlled Study

ClinicalTrials.gov, ID: NCT04120103 Retrospectively registered on 8 April 2019.

Orthostatic hypotension assessed by active standing is associated with worse cognition in geriatric rehabilitation inpatients, RESORT

PURPOSE

Geriatric rehabilitation inpatients who suffer from acute and chronic diseases that aggravate blood pressure (BP) dysregulation, may be particularly susceptible to orthostatic hypotension (OH). OH may increase the risk of cerebral small vessel disease and subsequent white matter hyperintensities inducing cognitive impairment (CI). This study investigates the association between OH and cognition in geriatric rehabilitation inpatients.

MATERIALS AND METHODS

Geriatric rehabilitation inpatients of the observational, longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort in Melbourne, Australia, underwent intermittent BP measurements during active standing or partial postural change to sitting (when unable to stand). OH was defined as a systolic BP drop ≥20 mmHg and/or diastolic BP drop ≥10 mmHg within three minutes after postural change. CI included dementia diagnosis, Mini-Mental State Examination (MMSE) score <24 points (categorized as 18-23 (mild CI) and <18 points (severe CI)), Montreal Cognitive Assessment score <26 points or Rowland Universal Dementia Assessment Scale score <23 points.

RESULTS

In geriatric rehabilitation inpatients (n=1232, mean age 82.3 years (SD 8.2), 57.5% female), OH, CI and dementia prevalence was 20.0%, 61.0% and 20.4% respectively. MMSE was scored 18-23 in 32.6% and <18 points in 27.8% of patients (n=1033). In standing patients (51.7%), OH was associated with CI (p=0.045) and dementia (p=0.021), with a trend for MMSE scores <18 points (p=0.080), but not for MMSE scores 18-23 points (p=0.528). No association was found between seated OH and cognition.

CONCLUSION

OH assessed by active standing using intermittent BP measurements was associated with worse cognition in geriatric rehabilitation inpatients.

Development and Characterization of a Porcine Liver Scaffold

The growing number of patients requiring liver transplantation for chronic liver disease cannot be currently met due to a shortage in donor tissue. As such, alternative tissue engineering approaches combining the use of acellular biological scaffolds and different cell populations (hepatic or progenitor) are being explored to augment the demand for functional organs. Our goal was to produce a clinically relevant sized scaffold from a sustainable source within 24 h, while preserving the extracellular matrix (ECM) to facilitate cell repopulation at a later stage. Whole porcine livers underwent perfusion decellularization via the hepatic artery and hepatic portal vein using a combination of saponin, sodium deoxycholate, and deionized water washes resulting in an acellular scaffold with an intact vasculature and preserved ECM. Molecular and immunohistochemical analysis (collagen I and IV and laminin) showed complete removal of any DNA material, together with excellent retention of glycosaminoglycans and collagen. Fourier-transform infrared spectroscopy (FTIR) analysis showed both absence of nuclear material and removal of any detergent residue, which was successfully achieved after additional ethanol gradient washes. Samples of the decellularized scaffold were assessed for cytotoxicity by seeding with porcine adipose-derived mesenchymal stem cells in vitro, these cells over a 10-day period showed attachment and proliferation. Perfusion of the vascular tree with contrast media followed by computed tomography (CT) imaging showed an intact vascular network. In vivo implantation of whole intact nonseeded livers, into a porcine model (as auxiliary graft) showed uniform perfusion macroscopically and histologically. Using this method, it is possible to create an acellular, clinically sized, liver scaffold with intact vasculature in less than 24 h.

Effects of a cognitive stimulation program on psychological well-being in a sample of elderly long-term care hospital inpatients

OBJECTIVES

The primary objective of this work is to report the observed changes in psychological well-being in a sample of long-term medically hospitalized patients, after attending a cognitive stimulation program. The secondary aim is to determine if the observed changes were related to previous cognitive level.

METHODS

Inclusion criteria for study participation were to be a long-term care hospital inpatient, to be 65 years old or older, and to be cognitively preserved or with mild cognitive impairment. A total of 176 participants were included and distributed in two groups: Cognitive Stimulation Group (N = 123) and Non-Cognitive Stimulation Group (N = 53). Measures were applied just before the beginning of the program and just when it finished, two months later. Participants of the Non-Cognitive Stimulation Group were re-assessed again after two months.

RESULTS

No differences were found between the two groups in the measures assessed at baseline. After treatment, participants of the Cognitive Stimulation Group improved significantly more in psychological well-being (p < .001) than the ones of the Non-Cognitive Stimulation Group. When unimpaired and mild cognitively impaired participants of the Cognitive Stimulation Group were studied separately, both groups improved their psychological well-being, but the unimpaired experienced a greater effect.

CONCLUSION

Cognitive stimulation plays a role in the improvement of psychological well-being of elderly medically hospitalized patients unimpaired or with mild cognitive impairment. The improvements in psychological well-being were related to the previous cognitive status and to the number of sessions that had been attended.

Effects of aromatherapy on agitation and related caregiver burden in patients with moderate to severe dementia: A pilot study

We examined the effects of aromatherapy on agitation in patients with dementia and evaluated related caregiver burden. Patients and their caregivers from two hospitals in Turkey were selected and divided into an intervention group (n = 14) and a control group (n = 14). Patients were stratified according to their dementia phase and intake of antipsychotic medication. The intervention group received aromatherapy via massage and inhalation at home for 4 weeks. The control group received no intervention. Data were collected using the Neuropsychiatric Inventory (NPI), the Cohen-Mansfield Agitation Inventory (CMAI) and the Zarit Burden Interview (ZBI). At 2 and 4 weeks, the NPI scores were significantly lower in the intervention group (p < 0.05). At 4 weeks, the CMAI and ZBI scores were significantly lower in the intervention group (p < 0.05). In conclusion, after aromatherapy, agitation, neuropsychiatric symptoms, and caregiver distress significantly reduced, and aromatherapy prevented caregiver burden increase.

Sintomas neuropsiquiátricos na doença de Alzheimer: frequência, correlação e ansiedade do cuidador

INTRODUÇÃO: Sintomas neuropsiquiátricos ocorrem em 80-90% dos pacientes com demência, interferem significativamente na autonomia do paciente e ocasionam alta carga física, financeira e emocional ao núcleo familiar, resultando em institucionalização precoce. OBJETIVOS: Identificar sintomas neuropsiquiátricos mais frequentes e de maior gravidade nos pacientes portadores da doença de Alzheimer; especificar quais distúrbios são descritos como mais desgastantes pelo cuidador; e correlacionar os sintomas neuropsiquiátricos. MÉTODOS: Realizou-se estudo transversal, descritivo e exploratório, durante um ano, com idosos com provável doença de Alzheimer, atendidos no ambulatório de geriatria de uma instituição filantrópica de Vitória, que estavam acompanhados do principal cuidador. As duas subescalas brasileiras do Inventário Neuropsiquiátrico foram aplicadas ao acompanhante, e os sintomas foram correlacionados utilizando a correlação de Pearson e Spearman. RESULTADOS: Nos 50 pacientes analisados, o comportamento motor aberrante foi a manifestação mais frequente, enquanto a agitação apresentou maior gravidade entre os pacientes e foi relatada como o sintoma mais desgastante pelos cuidadores, que eram, predominantemente, filhas. Múltiplas correlações entre sintomas foram encontradas, sendo muito fortes: delírio e alucinação; delírio e ansiedade; delírio e disforia; agitação e irritabilidade. CONCLUSÃO: Os resultados reforçam a necessidade de estudos voltados para a abordagem das manifestações neuropsiquiátricas, dada sua alta prevalência e à presença de sintomas concomitantes que geram alto grau de desgaste no cuidador.