Association of body mass index with amnestic and non-amnestic mild cognitive impairment risk in elderly.

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Wang, Feng; Zhao, Minghui; Han, Zhaoli; Li, Dai; Zhang, Shishuang; Zhang, Yongqiang; Kong, Xiaodong; Sun, Ning; Zhang, Qiang; Lei, Ping

2017-09-15

Previous studies focused on the relationship between body mass index and cognitive disorder and obtained many conflicting results. This study explored the potential effects of body mass index on the risk of mild cognitive impairment (amnestic and non-amnestic) in the elderly. The study enrolled 240 amnestic mild cognitive impairment patients, 240 non-amnestic mild cognitive impairment patients and 480 normal cognitive function controls. Data on admission and retrospective data at baseline (6 years ago) were collected from their medical records. Cognitive function was evaluated using Mini-Mental State Examination and Montreal Cognitive Assessment. Being underweight, overweight or obese at baseline was associated with an increased risk of amnestic mild cognitive impairment (OR: 2.30, 95%CI: 1.50 ~ 3.52; OR: 1.74, 95%CI: 1.36 ~ 2.20; OR: 1.71, 95%CI: 1.32 ~ 2.22, respectively). Being overweight or obese at baseline was also associated with an increased risk of non-amnestic mild cognitive impairment (OR: 1.51, 95%CI: 1.20 ~ 1.92; OR: 1.52, 95%CI: 1.21 ~ 1.97, respectively). In subjects with normal weights at baseline, an increased or decreased body mass index at follow-up was associated with an elevated risk of amnestic mild cognitive impairment (OR: 1.80, 95%CI: 1.10 ~ 3.05; OR: 3.96, 95%CI: 2.88 ~ 5.49, respectively), but only an increased body mass index was associated with an elevated risk of non-amnestic mild cognitive impairment (OR: 1.71, 95%CI: 1.16 ~ 2.59). Unhealthy body mass index levels at baseline and follow-up might impact the risk of both types of mild cognitive impairment (amnestic and non-amnestic).

Clinical and biological predictors of Alzheimer's disease in patients with amnestic mild cognitive impairment

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Forlenza,Orestes V.; Diniz,Breno S.; Talib,Leda L.; Radanovic,Marcia; Yassuda,Monica S.; Ojopi,Elida B.; Gattaz,Wagner F.

2010-01-01

OBJECTIVE: To identify predictors of the progression from pre-dementia stages of cognitive impairment in Alzheimer's disease is relevant to clinical management and to substantiate the decision of prescribing antidementia drugs. METHOD: Longitudinal study of a cohort of elderly adults with amnestic mild cognitive impairment and healthy controls, carried out to estimate the risk and characterize predictors of the progression to Alzheimer's disease. RESULTS: Patients with amnestic mild cognitive...

The overlap of delirium with neuropsychiatric symptoms among patients with dementia.

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Hölttä, Eeva; Laakkonen, Marja-Liisa; Laurila, Jouko V; Strandberg, Timo E; Tilvis, Reijo; Kautiainen, Hannu; Pitkälä, Kaisu H

2011-12-01

To study the frequency of overlapping of delirium with neuropsychiatric symptoms (NPS) among patients with dementia, and to investigate the prognostic value of delirium, multiple NPS without delirium, or neither during a 2-year follow-up. We assessed 425 consecutive patients in acute geriatric wards and in seven nursing homes in Helsinki. Those 255 suffering from dementia were examined for NPS of dementia described in the Neuropsychiatric Inventory (delusions, hallucinations, agitation/aggression, depression/low mood, anxiety, euphoria/elation, apathy, disinhibition, irritability/mood changes, and aberrant motor behavior) and for delirium criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Patients were categorized into three groups: delirium with or without multiple NPS (delirium group), multiple NPS without delirium (multiple NPS group), or having neither delirium nor multiple NPS (zero or only one NPS group). A total of 66 patients suffered from delirium according to the DSM-IV, 127 had multiple NPS without delirium, and 62 had neither multiple NPS nor delirium. In the delirium group 61 individuals (92.4%) were deceased or residing in permanent institutional care at the end of the 2-year follow up period, compared to 100 individuals (78.7%) in the multiple NPS group and 48 (77.4%) in the zero or one NPS group (Pearson χ² = 6.64, df 2, p = 0.036). In logistic regression analysis adjusted for age, sex, and comorbidities, delirium was an independent predictor of this composite outcome (OR: 4.3, 95% CI: 1.4-13.6). Patient groups with symptoms of delirium and multiple NPS are highly overlapping. The presence of delirium indicates poor prognosis.

Detecting delirium in elderly outpatients with cognitive impairment

NARCIS (Netherlands)

Stroomer-van Wijk, Anne J. M.; Jonker, Barbara W.; Kok, Rob M.; van der Mast, Roos C.; Luijendijk, Hendrika J.

Background: Delirium may be more prevalent in elderly outpatients than has long been assumed. However, it may be easily missed due to overlap with dementia. Our aim was to study delirium symptoms and underlying somatic disorders in psycho-geriatric outpatients. Methods: We performed a case-control

Delirium in advanced age and dementia: A prolonged refractory course of delirium and lower functional status

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BOETTGER, SOENKE; JENEWEIN, JOSEF; BREITBART, WILLIAM

2017-01-01

Objective The factors associated with persistent delirium, in contrast to resolved delirium, have not been studied well. The aim of our present study was to identify the factors associated with delirium resolution as measured by the Memorial Delirium Assessment Scale (MDAS) and functional improvement as measured by the Karnofsky Performance Status (KPS) scale. Method All subjects were recruited from psychiatric referrals at the Memorial Sloan Kettering Cancer Center (MSKCC). The two study instruments were performed at baseline (T1), at 2–3 days (T2), and at 4–7 days (T3). Subjects with persistent delirium were compared to those with resolved delirium in respect to sociodemographic and medical variables. Results Overall, 26 out of 111 patients had persistent delirium. These patients were older, predominantly male, and had more frequently preexisting comorbid dementia. Among cancer diagnoses and stage of illness, brain cancer and terminal illness contributed to persistent delirium or late response, whereas gastrointestinal cancer was associated with resolved delirium. Among etiologies, infection responded late to delirium management, usually at one week. Furthermore, delirium was more severe in patients with persistent delirium from baseline through one week. At baseline, MDAS scores were 20.1 in persistent delirium compared to 17 to 18.8 in resolved delirium (T2 and T3), and at one week of management (T3), MDAS scores were 15.2 and 4.7 to 7.4, respectively. At one week of management, persistent delirium manifested in more severe impairment in the domains of consciousness, cognition, organization, perception, psychomotor behavior, and sleep–wake cycle. In addition, persistent delirium caused more severe functional impairment. Significance of results In this delirium sample, advanced age and preexisting dementia, as well as brain cancer, terminal illness, infection, and delirium severity contributed to persistent delirium or late response, indicating a prolonged

Association Between Olfactory Dysfunction and Amnestic Mild Cognitive Impairment and Alzheimer Disease Dementia.

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Roberts, Rosebud O; Christianson, Teresa J H; Kremers, Walter K; Mielke, Michelle M; Machulda, Mary M; Vassilaki, Maria; Alhurani, Rabe E; Geda, Yonas E; Knopman, David S; Petersen, Ronald C

2016-01-01

To increase the opportunity to delay or prevent mild cognitive impairment (MCI) or Alzheimer disease (AD) dementia, markers of early detection are essential. Olfactory impairment may be an important clinical marker and predictor of these conditions and may help identify persons at increased risk. To examine associations of impaired olfaction with incident MCI subtypes and progression from MCI subtypes to AD dementia. Participants enrolled in the population-based, prospective Mayo Clinic Study of Aging between 2004 and 2010 were clinically evaluated at baseline and every 15 months through 2014. Participants (N = 1630) were classified as having normal cognition, MCI (amnestic MCI [aMCI] and nonamnestic MCI [naMCI]), and dementia. We administered the Brief Smell Identification Test (B-SIT) to assess olfactory function. Mild cognitive impairment, AD dementia, and longitudinal change in cognitive performance measures. Of the 1630 participants who were cognitively normal at the time of the smell test, 33 died before follow-up and 167 were lost to follow-up. Among the 1430 cognitively normal participants included, the mean (SD) age was 79.5 (5.3) years, 49.4% were men, the mean duration of education was 14.3 years, and 25.4% were APOE ε4 carriers. Over a mean 3.5 years of follow-up, there were 250 incident cases of MCI among 1430 cognitively normal participants. We observed an association between decreasing olfactory identification, as measured by a decrease in the number of correct responses in B-SIT score, and an increased risk of aMCI. Compared with the upper B-SIT quartile (quartile [Q] 4, best scores), hazard ratios (HRs) (95% CI) were 1.12 (0.65-1.92) for Q3 (P = .68); 1.95 (1.25-3.03) for Q2 (P = .003); and 2.18 (1.36-3.51) for Q1 (P = .001) (worst scores; P for trend dementia cases among 221 prevalent MCI cases. The B-SIT score also predicted progression from aMCI to AD dementia, with a significant dose-response with worsening B-SIT quartiles

Association between delirium superimposed on dementia and mortality in hospitalized older adults: A prospective cohort study.

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Thiago J Avelino-Silva

2017-03-01

Full Text Available Hospitalized older adults with preexisting dementia have increased risk of having delirium, but little is known regarding the effect of delirium superimposed on dementia (DSD on the outcomes of these patients. Our aim was to investigate the association between DSD and hospital mortality and 12-mo mortality in hospitalized older adults.This was a prospective cohort study completed in the geriatric ward of a university hospital in São Paulo, Brazil. We included 1,409 hospitalizations of acutely ill patients aged 60 y and over from January 2009 to June 2015. Main variables and measures included dementia and dementia severity (Informant Questionnaire on Cognitive Decline in the Elderly, Clinical Dementia Rating and delirium (Confusion Assessment Method. Primary outcomes were time to death in the hospital and time to death in 12 mo (for the discharged sample. Comprehensive geriatric assessment was performed at admission, and additional clinical data were documented upon death or discharge. Cases were categorized into four groups (no delirium or dementia, dementia alone, delirium alone, and DSD. The no delirium/dementia group was defined as the referent category for comparisons, and multivariate analyses were performed using Cox proportional hazards models adjusted for possible confounders (sociodemographic information, medical history and physical examination data, functional and nutritional status, polypharmacy, and laboratory covariates. Overall, 61% were women and 39% had dementia, with a mean age of 80 y. Dementia alone was observed in 13% of the cases, with delirium alone in 21% and DSD in 26% of the cases. In-hospital mortality was 8% for patients without delirium or dementia, 12% for patients with dementia alone, 29% for patients with delirium alone, and 32% for DSD patients (Pearson Chi-square = 112, p < 0.001. DSD and delirium alone were independently associated with in-hospital mortality, with respective hazard ratios (HRs of 2.14 (95% CI

Prolonged delirium misdiagnosed as a mood disorder.

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Cao, Fei; Salem, Haitham; Nagpal, Caesa; Teixeira, Antonio L

2017-01-01

Delirium can be conceptualized as an acute decline in cognitive function that typically lasts from hours to a few days. Prolonged delirium can also affect patients with multiple predisposing and/or precipitating factors. In clinical practice, prolonged delirium is often unrecognized, and can be misdiagnosed as other psychiatric disorders. We describe a case of a 59-year-old male presenting with behavioral and cognitive symptoms that was first misdiagnosed as a mood disorder in a general hospital setting. After prolonged delirium due to multiple factors was confirmed, the patient was treated accordingly with symptomatic management. He evolved with progressive improvement of his clinical status. Early diagnosis and management of prolonged delirium are important to improve patient prognosis and avoid iatrogenic measures.

Differential Diagnosis in Older Adults: Dementia, Depression, and Delirium.

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Gintner, Gary G.

1995-01-01

Examines three common disorders, dementia, depression, and delirium, which can be particularly difficult to diagnose in older adults. Presents three aspects that are helpful in making a decision: age-related differences, medical issues that need to be ruled out, and assessment methods particularly useful in the diagnostic process. (JPS)

Olfactory identification in amnestic and non-amnestic mild cognitive impairment and its neuropsychological correlates.

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Vyhnalek, Martin; Magerova, Hana; Andel, Ross; Nikolai, Tomas; Kadlecova, Alexandra; Laczo, Jan; Hort, Jakub

2015-02-15

Olfactory identification impairment in amnestic mild cognitive impairment (aMCI) patients is well documented and considered to be caused by underlying Alzheimer's disease (AD) pathology, contrasting with less clear evidence in non-amnestic MCI (naMCI). The aim was to (a) compare the degree of olfactory identification dysfunction in aMCI, naMCI, controls and mild AD dementia and (b) assess the relation between olfactory identification and cognitive performance in aMCI compared to naMCI. 75 patients with aMCI and 32 with naMCI, 26 patients with mild AD and 27 controls underwent the multiple choice olfactory identification Motol Hospital Smell Test with 18 different odors together with a comprehensive neuropsychological examination. Controlling for age and gender, patients with aMCI and naMCI did not differ significantly in olfactory identification and both performed significantly worse than controls (pmemory and visuospatial tests were significantly related to better olfactory identification ability. Conversely, no cognitive measure was significantly related to olfactory performance in naMCI. Olfactory identification is similarly impaired in aMCI and naMCI. Olfactory impairment is proportional to cognitive impairment in aMCI but not in naMCI. Copyright © 2015. Published by Elsevier B.V.

One-year mortality after hip fracture in older individuals: the effects of delirium and dementia.

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Mitchell, Rebecca; Harvey, Lara; Brodaty, Henry; Draper, Brian; Close, Jacqueline

2017-09-01

Delirium is common in older hip fracture patients, yet its association with mortality after hip fracture remains uncertain. This study aimed to determine whether delirium was associated with all-cause one-year mortality after hip fracture in older patients and whether the effect of delirium was independent of dementia status. A retrospective analysis of linked hospitalisation and mortality data for patients aged ≥65 years with a hip fracture during 1 January 2010 to 30 June 2014 in New South Wales, Australia. The association between delirium and mortality after a hip fracture was assessed using Cox proportional hazard regression. There were 4,065 (14.6%) of 27,888 hip fracture hospitalisations identified with delirium during hospitalisation. Individuals with delirium had a higher age-adjusted rate of all-cause one-year mortality after hip fracture compared to individuals without delirium (35.3% versus 23.9%). After adjusting for covariates, the risk of all-cause mortality was increased at one-year post-admission for older individuals compared to those aged 65-69 years, for individuals with multiple comorbidities, dementia (Hazard Ratio (HR): 1.14; 95%CI:1.08-1.20), delirium (HR: 1.19; 95%CI:1.12-1.26), and who had an Intensive Care Unit admission (HR: 1.44; 95%CI:1.31-1.59). Comorbid delirium did not add additional mortality risk for individuals with a hip fracture who have dementia. Delirium identified in hospital was associated with all-cause one-year mortality after hip fracture in older Australians without dementia. As delirium is potentially preventable, better systematic assessment and documentation of a hip fracture patient's cognitive state is warranted to select the most effective strategies to prevent and manage delirium. Copyright © 2017 Elsevier B.V. All rights reserved.

Rational pharmacological approaches for cognitive dysfunction and depression in Parkinson's disease.

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Sandoval-Rincón, Maritza; Sáenz-Farret, Michel; Miguel-Puga, Adán; Micheli, Federico; Arias-Carrión, Oscar

2015-01-01

Parkinson's disease (PD) is not a single entity but rather a heterogeneous neurodegenerative disorder. The present study aims to conduct a critical systematic review of the literature to describe the main pharmacological strategies to treat cognitive dysfunction and major depressive disorder in PD patients. We performed a search of articles cited in PubMed from 2004 to 2014 using the following MeSH terms (Medical subject headings) "Parkinson disease"; "Delirium," "Dementia," "Amnestic," "Cognitive disorders," and "Parkinson disease"; "depression," "major depressive disorder," "drug therapy." We found a total of 71 studies related to pharmacological treatment in cognitive dysfunction and 279 studies for pharmacological treatment in major depressive disorder. After fulfillment of all the inclusion and exclusion criteria, 13 articles remained for cognitive dysfunction and 11 for major depressive disorder, which are presented and discussed in this study. Further research into non-motor symptoms of PD may provide insights into mechanisms of neurodegeneration, and provide better quality of life by using rational drugs.

DELIRIUM PADA PASIEN RAWAT INAP DENGAN SKIZOFRENIA: SEBUAH LAPORAN KASUS

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Made Ayu Dwi Pradnyawati

2014-08-01

Full Text Available Delirium is psychiatric disorder characterized by conciousness state impairment,disorientation, and affective alteration, including cognitive and non-cognitive deficite, anddeveloped in acute onset. Delirium stand in organic mental disorder group, which has manysimilarity of signs and symptoms with psycotic mental disorder as schizophrenia. Delirium,particularly that is not related with alcohol and drug abuse, frequently found in elderly. Somecases of delirium among inpatient psychiatric patients have been reported, but just few furtherstudies have been held on those cases. This case report try to deliver a case of delirium in a65 y.o. inpatient paranoid type schizophrenia. This patient showed sign of severedisorientation during his treatment. In psychiatric assesment, stated male patient withinappropriate appearance, contact avoidance, decrease of conciousness, and severedisorientation. Mood/affect found irritable/appropriate. Patient experienced delution andhallucination. He suspected with undetected dementia as underlying disease.  

A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study.

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Regal, Paul J

2015-01-01

Traditional models for delirium based on the Diagnostic and Statistical Manual for Mental Disorders and its 1990 offspring, the Confusion Assessment Method (CAM), were not designed to distinguish behavioral and psychological symptoms of dementia from rapid cognitive decline. We examined a new diagnostic criterion for delirium plus exclusion of behavioral and psychological symptoms of dementia and recent inattention with a 25% decline in digit span forward (DSF). This was a prospective, randomized controlled trial comparing management of prevalent delirium in general medical with that in geriatric medical wards in a 370-bed hospital north of Sydney. Inclusion criteria were age ≥65 years and prevalent delirium in the emergency department based on: CAM; proof that CAM elements were not better explained by behavioral and psychological symptoms of dementia; proof of recent inattention on DSF; evidence of cognitive decline not due to sedatives or antipsychotics in the emergency department. Measurements included the Instrumental Activities of Daily Living (IADL, 22-item), Selective IADL (8-item), Mini-Mental State Examination, DSF daily, Delirium Index daily, and Apathy Evaluation Scale. Pre-delirium scores from past cognitive tests and best scores were imputed after admission. Relative change (RC) was calculated as absolute change/test range and RC/MPC ratio was calculated as RC after admission/maximal possible change. A total of 130 subjects were recruited but 14 with subsyndromal delirium were excluded, leaving 116 subjects (mean age 83.6 years). Forty-eight percent had prior dementia. RC from pre-delirium to admission was 42% for the Mini-Mental State Examination, 41% for Selective IADL, 34% for 5-DSF, 54% for 6-DSF, and 37% for the Apathy Evaluation Scale. Improvements after admission (RC and RC/MPC ratios) were 32%/98% for 5-DSF, 54%/82% for 6-DSF, and 45%/80% for the Delirium Index. General medicine and geriatric medicine groups had similar outcomes. This

The Cognitive Reserve Model in the Development of Delirium: The Successful Aging After Elective Surgery Study.

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Cizginer, Sevdenur; Marcantonio, Edward; Vasunilashorn, Sarinnapha; Pascual-Leone, Alvaro; Shafi, Mouhsin; Schmitt, Eva M; Inouye, Sharon K; Jones, Richard N

2017-11-01

We evaluated the role of cognitive and brain reserve markers in modifying the risk of postoperative delirium associated with a pathophysiologic marker. The Successful Aging after Elective Surgery study (SAGES) enrolled 556 adults age ≥70 years without dementia scheduled for major surgery. Patients were assessed preoperatively and daily during hospitalization for delirium. We used C-reactive protein (CRP) as a pathophysiologic marker of inflammation, previously associated with delirium. Markers of reserve included vocabulary knowledge, education, cognitive activities, occupation type and complexity, head circumference, intracranial volume, and leisure activities. Vocabulary knowledge, cognitive activities, and education significantly modified the association of CRP and postoperative delirium ( P delirium associated with lower grade inflammatory processes, supporting the role of reserve in delirium.

Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD trial

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Leslie Doug

2011-05-01

Full Text Available Abstract Background Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD. Methods/Design This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD or control (usual care. Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status. Our secondary aim is to describe the costs associated with RESERVE-DSD. Discussion Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation

Tau-PET Binding Distinguishes Patients With Early-stage Posterior Cortical Atrophy From Amnestic Alzheimer Disease Dementia.

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Day, Gregory S; Gordon, Brian A; Jackson, Kelley; Christensen, Jon J; Rosana Ponisio, Maria; Su, Yi; Ances, Beau M; Benzinger, Tammie L S; Morris, John C

2017-01-01

Flortaucipir (tau) positron emission tomography (PET) binding distinguishes individuals with clinically well-established posterior cortical atrophy (PCA) due to Alzheimer disease (AD) from cognitively normal (CN) controls. However, it is not known whether tau-PET binding patterns differentiate individuals with PCA from those with amnestic AD, particularly early in the symptomatic stages of disease. Flortaucipir and florbetapir (β-amyloid) PET imaging were performed in individuals with early-stage PCA (N=5), amnestic AD dementia (N=22), and CN controls (N=47). Average tau and β-amyloid deposition were quantified using standard uptake value ratios and compared at a voxelwise level, controlling for age. PCA patients [median age-at-onset, 59 (51 to 61) years] were younger at symptom onset than similarly staged individuals with amnestic AD [75 (60 to 85) years] or CN controls [73 (61 to 90) years; P=0.002]. Flortaucipir uptake was higher in individuals with early-stage symptomatic PCA versus those with early-stage amnestic AD or CN controls, and greatest in posterior regions. Regional elevations in florbetapir were observed in areas of greatest tau deposition in PCA patients. Flortaucipir uptake distinguished individuals with PCA and amnestic AD dementia early in the symptomatic course. The posterior brain regions appear to be uniquely vulnerable to tau deposition in PCA, aligning with clinical deficits that define this disease subtype.

Tau PET binding distinguishes patients with early-stage posterior cortical atrophy from amnestic Alzheimer disease dementia

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Day, Gregory S.; Gordon, Brian A.; Jackson, Kelley; Christensen, Jon J.; Ponisio, Maria Rosana; Su, Yi; Ances, Beau M; Benzinger, Tammie L.S.; Morris, John C.

2017-01-01

Background Flortaucipir (tau) PET binding distinguishes individuals with clinically well-established posterior cortical atrophy (PCA) due to Alzheimer disease (AD) from cognitively normal (CN) controls. However, it is not known whether tau PET binding patterns differentiate individuals with PCA from those with amnestic AD, particularly early in the symptomatic stages of disease. Methods Flortaucipir and florbetapir (β-amyloid) PET-imaging were performed in individuals with early-stage PCA (N=5), amnestic AD dementia (N=22), and CN controls (N=47). Average tau and β-amyloid deposition were quantified using standard uptake value ratios and compared at a voxel-wise level, controlling for age. Results PCA patients (median age-at-onset, 59 [51–61] years) were younger at symptom-onset than similarly-staged individuals with amnestic AD (75 [60–85] years) or CN controls (73 [61–90] years; p=0.002). Flortaucipir uptake was higher in individuals with early-stage symptomatic PCA versus those with early-stage amnestic AD or CN controls, and greatest in posterior regions. Regional elevations in florbetapir were observed in areas of greatest tau deposition in PCA patients. Conclusions and Relevance Flortaucipir uptake distinguished individuals with PCA and amnestic AD dementia early in the symptomatic course. The posterior brain regions appear to be uniquely vulnerable to tau deposition in PCA, aligning with clinical deficits that define this disease subtype. PMID:28394771

Worsening Cognitive Impairment and Neurodegenerative Pathology Progressively Increase Risk for Delirium

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Davis, Daniel H.J.; Skelly, Donal T.; Murray, Carol; Hennessy, Edel; Bowen, Jordan; Norton, Samuel; Brayne, Carol; Rahkonen, Terhi; Sulkava, Raimo; Sanderson, David J.; Rawlins, J. Nicholas; Bannerman, David M.; MacLullich, Alasdair M.J.; Cunningham, Colm

2015-01-01

Background Delirium is a profound neuropsychiatric disturbance precipitated by acute illness. Although dementia is the major risk factor this has typically been considered a binary quantity (i.e., cognitively impaired versus cognitively normal) with respect to delirium risk. We used humans and mice to address the hypothesis that the severity of underlying neurodegenerative changes and/or cognitive impairment progressively alters delirium risk. Methods Humans in a population-based longitudinal study, Vantaa 85+, were followed for incident delirium. Odds for reporting delirium at follow-up (outcome) were modeled using random-effects logistic regression, where prior cognitive impairment measured by Mini-Mental State Exam (MMSE) (exposure) was considered. To address whether underlying neurodegenerative pathology increased susceptibility to acute cognitive change, mice at three stages of neurodegenerative disease progression (ME7 model of neurodegeneration: controls, 12 weeks, and 16 weeks) were assessed for acute cognitive dysfunction upon systemic inflammation induced by bacterial lipopolysaccharide (LPS; 100 μg/kg). Synaptic and axonal correlates of susceptibility to acute dysfunction were assessed using immunohistochemistry. Results In the Vantaa cohort, 465 persons (88.4 ± 2.8 years) completed MMSE at baseline. For every MMSE point lost, risk of incident delirium increased by 5% (p = 0.02). LPS precipitated severe and fluctuating cognitive deficits in 16-week ME7 mice but lower incidence or no deficits in 12-week ME7 and controls, respectively. This was associated with progressive thalamic synaptic loss and axonal pathology. Conclusion A human population-based cohort with graded severity of existing cognitive impairment and a mouse model with progressing neurodegeneration both indicate that the risk of delirium increases with greater severity of pre-existing cognitive impairment and neuropathology. PMID:25239680

Rational Pharmacological Approaches for Cognitive Dysfunction and Depression in Parkinson’s Disease

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Sandoval-Rincón, Maritza; Sáenz-Farret, Michel; Miguel-Puga, Adán; Micheli, Federico; Arias-Carrión, Oscar

2015-01-01

Parkinson’s disease (PD) is not a single entity but rather a heterogeneous neurodegenerative disorder. The present study aims to conduct a critical systematic review of the literature to describe the main pharmacological strategies to treat cognitive dysfunction and major depressive disorder in PD patients. We performed a search of articles cited in PubMed from 2004 to 2014 using the following MeSH terms (Medical subject headings) “Parkinson disease”; “Delirium,” “Dementia,” “Amnestic,” “Cognitive disorders,” and “Parkinson disease”; “depression,” “major depressive disorder,” “drug therapy.” We found a total of 71 studies related to pharmacological treatment in cognitive dysfunction and 279 studies for pharmacological treatment in major depressive disorder. After fulfillment of all the inclusion and exclusion criteria, 13 articles remained for cognitive dysfunction and 11 for major depressive disorder, which are presented and discussed in this study. Further research into non-motor symptoms of PD may provide insights into mechanisms of neurodegeneration, and provide better quality of life by using rational drugs. PMID:25873910

The Use of the Modified Telephone Interview for Cognitive Status (TICS-M) in the Detection of Amnestic Mild Cognitive Impairment

OpenAIRE

Cook, Sarah E.; Marsiske, Michael; McCoy, Karin J. M.

2009-01-01

Many screening tools for detecting cognitive decline require in-person assessment, which is often not cost effective or feasible for those with physical limitations. The Modified Telephone Interview for Cognitive Status (TICS-M) has been used for screening dementia, but little is known about its usefulness in detecting amnestic Mild Cognitive Impairment (aMCI). Community-dwelling participants (mean age= 74.9, mean education= 16.1 years) were administered the TICS-M during initial screening an...

Detection of delirium by nurses among long-term care residents with dementia

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Danjou Christine

2008-02-01

Full Text Available Abstract Background Delirium is a prevalent problem in long-term care (LTC facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium. Methods In this prospective study (N = 156, nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses. Results Despite a high prevalence of delirium in this cohort (71.5%, nurses were able to detect the delirium in only a minority of cases (13%. Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (≥ 85 yrs was associated with undetected delirium (OR: 4.1; 90% CI: [1.5–11.0]. Conclusion Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population.

Combining SPECT and Quantitative EEG Analysis for the Automated Differential Diagnosis of Disorders with Amnestic Symptoms

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Yvonne Höller

2017-09-01

Full Text Available Single photon emission computed tomography (SPECT and Electroencephalography (EEG have become established tools in routine diagnostics of dementia. We aimed to increase the diagnostic power by combining quantitative markers from SPECT and EEG for differential diagnosis of disorders with amnestic symptoms. We hypothesize that the combination of SPECT with measures of interaction (connectivity in the EEG yields higher diagnostic accuracy than the single modalities. We examined 39 patients with Alzheimer's dementia (AD, 69 patients with depressive cognitive impairment (DCI, 71 patients with amnestic mild cognitive impairment (aMCI, and 41 patients with amnestic subjective cognitive complaints (aSCC. We calculated 14 measures of interaction from a standard clinical EEG-recording and derived graph-theoretic network measures. From regional brain perfusion measured by 99mTc-hexamethyl-propylene-aminoxime (HMPAO-SPECT in 46 regions, we calculated relative cerebral perfusion in these patients. Patient groups were classified pairwise with a linear support vector machine. Classification was conducted separately for each biomarker, and then again for each EEG- biomarker combined with SPECT. Combination of SPECT with EEG-biomarkers outperformed single use of SPECT or EEG when classifying aSCC vs. AD (90%, aMCI vs. AD (70%, and AD vs. DCI (100%, while a selection of EEG measures performed best when classifying aSCC vs. aMCI (82% and aMCI vs. DCI (90%. Only the contrast between aSCC and DCI did not result in above-chance classification accuracy (60%. In general, accuracies were higher when measures of interaction (i.e., connectivity measures were applied directly than when graph-theoretical measures were derived. We suggest that quantitative analysis of EEG and machine-learning techniques can support differentiating AD, aMCI, aSCC, and DCC, especially when being combined with imaging methods such as SPECT. Quantitative analysis of EEG connectivity could become

Tracking Cognitive Decline in Amnestic Mild Cognitive Impairment and Early-Stage Alzheimer Dementia: Mini-Mental State Examination versus Neuropsychological Battery.

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Kim, Joonho; Na, Han Kyu; Byun, Justin; Shin, Jiwon; Kim, Sungsoo; Lee, Byung Hwa; Na, Duk L

2017-01-01

Although the Mini-Mental State Examination (MMSE), Clinical Dementia Rating-Sum of Boxes (CDR-SOB), and neuropsychological batteries are widely used for evaluating cognitive function, it remains elusive which instrument best reflects the longitudinal disease progression in amnestic mild cognitive impairment (aMCI) and probable Alzheimer disease (AD). We investigated whether changes in these three instruments over time correlate with loss of cortical gray matter volume (cGMV). We retrospectively investigated 204 patients (aMCI, n = 114; AD, n = 90) who had undergone MMSE, CDR-SOB, the dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D), and 3-dimensional T1-weighted magnetic resonance images at least twice. We investigated the partial correlation between annual decline in test scores and percent change of cGMV. In aMCI patients, changes in the SNSB-D total score (r = 0.340, p < 0.001) and CDR-SOB (r = 0.222, p = 0.020), but not MMSE, showed a correlation with cGMV loss, with the SNSB-D total score showing the strongest correlation. In AD patients, decline in all three test scores correlated significantly with cGMV loss, with MMSE exhibiting the strongest correlation (r = 0.464, p < 0.001). In aMCI patients, neuropsychological battery, though time-consuming, was the most adequate tool in tracking disease progression. In AD patients, however, MMSE may be the most effective longitudinal monitoring tool when considering cost-effectiveness. © 2017 S. Karger AG, Basel.

Dynamic working memory performance in individuals with single-domain amnestic mild cognitive impairment.

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Guild, Emma B; Vasquez, Brandon P; Maione, Andrea M; Mah, Linda; Ween, Jon; Anderson, Nicole D

2014-01-01

Previous studies have observed poorer working memory performance in individuals with amnestic mild cognitive impairment than in healthy older adults. It is unclear, however, whether these difficulties are true only of the multiple-domain clinical subtype in whom poorer executive functioning is common. The current study examined working memory, as measured by the self-ordered pointing task (SOPT) and an n-back task, in healthy older adults and adults with single-domain amnestic mild cognitive impairment (aMCI). Individuals with single-domain aMCI committed more errors and required longer to develop an organizational strategy on the SOPT. The single-domain aMCI group did not differ from healthy older adults on the 1-back or 2-back, but had poorer discrimination on the 3-back task. This is, to our knowledge, the first characterization of dynamic working memory performance in a single-domain aMCI group. These results lend support for the idea that clinical amnestic MCI subtypes may reflect different stages on a continuum of progression to dementia and question whether standardized measures of working memory (span tasks) are sensitive enough to capture subtle changes in performance.

Amnestic Disorders

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Kessels, R.P.C.; Savage, G.; Cautin, R.L.; Lilienfeld, S.O.

2015-01-01

Amnestic disorders may involve deficits in the encoding or storage of information in memory, or in retrieval of information from memory. Etiologies vary and include traumatic brain injury, neurodegenerative disease, and psychiatric illness. Different forms of amnesia can be distinguished:

Cerebrospinal Fluid Phosphate in Delirium after Hip Fracture

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Ane-Victoria Idland

2017-09-01

Full Text Available Aims: Phosphate is essential for neuronal activity. We aimed to investigate whether delirium is associated with altered phosphate concentrations in cerebrospinal fluid (CSF and serum. Methods: Seventy-seven patients with hip fracture were assessed for delirium before and after acute surgery. Prefracture dementia was diagnosed by an expert panel. Phosphate was measured in CSF obtained immediately before spinal anesthesia (n = 77 and in serum (n = 47. CSF from 23 cognitively healthy elderly patients undergoing spinal anesthesia was also analyzed. Results: Hip fracture patients with prevalent delirium had higher CSF phosphate concentrations than those without delirium (median 0.63 vs. 0.55 mmol/L, p = 0.001. In analyses stratified on dementia status, this difference was only significant in patients with dementia. Serum phosphate was ∼1 mmol/L; there was no association between serum phosphate concentration and delirium status. CSF phosphate did not correlate with serum levels. Conclusion: Patients with delirium superimposed on dementia have elevated phosphate levels.

Relationship between cognitive and non-cognitive symptoms of delirium.

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Rajlakshmi, Aarya Krishnan; Mattoo, Surendra Kumar; Grover, Sandeep

2013-04-01

To study relationship between the cognitive and the non-cognitive symptoms of delirium. Eighty-four patients referred to psychiatry liaison services and met DSM-IVTR criteria of delirium were assessed using the Delirium Rating Scale Revised-1998 (DRSR-98) and Cognitive Test for Delirium (CTD). The mean DRS-R-98 severity score was 17.19 and DRS-R-98 total score was 23.36. The mean total score on CTD was 11.75. The mean scores on CTD were highest for comprehension (3.47) and lowest for vigilance (1.71). Poor attention was associated with significantly higher motor retardation and higher DRS-R-98 severity scores minus the attention scores. There were no significant differences between those with and without poor attention. Higher attention deficits were associated with higher dysfunction on all other domains of cognition on CTD. There was significant correlation between cognitive functions as assessed on CTD and total DRS-R-98 score, DRS-R-98 severity score and DRS-R-98 severity score without the attention item score. However, few correlations emerged between CTD domains and CTD total scores with cognitive symptom total score of DRS-R-98 (items 9-13) and non-cognitive symptom total score of DRS-R-98 (items 1-8). Our study suggests that in delirium, cognitive deficits are quite prevalent and correlate with overall severity of delirium. Attention deficit is a core symptom of delirium. Copyright © 2012 Elsevier B.V. All rights reserved.

Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology.

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Bottino, Cássio M C; de Pádua, Analuiza Camozzato; Smid, Jerusa; Areza-Fegyveres, Renata; Novaretti, Tânia; Bahia, Valeria S

2011-01-01

In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1) to present the evidence found on Brazilian (LILACS, SCIELO) and International (MEDLINE) databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and2) to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium , and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption.

Core symptoms not meeting criteria for delirium are associated with cognitive and functional impairment and mood and behavior problems in older long-term care residents.

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Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Belzile, Eric; Vu, Minh

2014-07-01

The immediate clinical significance of Confusion Assessment Method (CAM)-defined core symptoms of delirium not meeting criteria for delirium is unclear. This study proposed to determine if such symptoms are associated with cognitive and functional impairment, mood and behavior problems and increased Burden of Care (BOC) in older long-term care (LTC) residents. The study was a secondary analysis of data collected for a prospective cohort study of delirium. Two hundred and fifty-eight LTC residents aged 65 years and older in seven LTC facilities had monthly assessments (for up to six months) of CAM - defined core symptoms of delirium (fluctuation, inattention, disorganized thinking, and altered level of consciousness) and five outcome measures: Mini-Mental State Exam, Barthel Index, Cornell Scale for Depression, Nursing Home Behavioral Problems Scale, and Burden of Care. Associations between core symptoms and the five outcome measures were analyzed using generalized estimating equations. Core symptoms of delirium not meeting criteria for delirium among residents with and without dementia were associated with cognitive and functional impairment and mood and behavior problems but not increased BOC. The associations appear to be intermediate between those of full delirium and no core symptoms and were greater for residents with than without dementia. CAM-defined core symptoms of delirium not meeting criteria for delirium appear to be associated with cognitive and functional impairment and mood and behavior problems in LTC residents with or without dementia. These findings may have implications for the prevention and management of such impairments and problems in LTC settings.

Dementia and cognitive disorder identified at a forensic psychiatric examination - a study from Sweden.

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Ekström, Anette; Kristiansson, Marianne; Björkstén, Karin Sparring

2017-09-18

Few studies have addressed the relationship between dementia and crime. We conducted a study of persons who got a primary or secondary diagnosis of dementia or cognitive disorder in a forensic psychiatric examination. In Sweden, annually about 500 forensic psychiatric examinations are carried out. All cases from 2008 to 2010 with the diagnoses dementia or cognitive disorder were selected from the database of the Swedish National Board of Forensic Medicine. Out of 1471 cases, there were 54 cases of dementia or cognitive disorder. Case files were scrutinized and 17 cases of dementia and 4 cases of cognitive disorder likely to get a dementia diagnosis in a clinical setting were identified and further studied. There were 18 men and 3 women; Median age 66 (n = 21; Range 35-77) years of age. Eleven men but no women had a previous criminal record. There were a total of 38 crimes, mostly violent, committed by the 21 persons. The crimes were of impulsive rather that pre-meditated character. According to the forensic psychiatric diagnoses, dementia was caused by cerebrovascular disorder (n = 4), alcohol or substance abuse (n = 3), cerebral haemorrhage and alcohol (n = 1), head trauma and alcohol (n = 2), Alzheimer's disease (n = 2), Parkinson's disease (n = 1), herpes encephalitis (n = 1) and unspecified (3). Out of four persons diagnosed with cognitive disorder, one also had delusional disorder and another one psychotic disorder and alcohol dependence. An alcohol-related diagnosis was established in ten cases. There were only two cases of Dementia of Alzheimer's type, one of whom also had alcohol intoxication. None was diagnosed with a personality disorder. All but one had a history of somatic or psychiatric comorbidity like head traumas, stroke, other cardio-vascular disorders, epilepsy, depression, psychotic disorders and suicide attempts. In this very ill group, the suggested verdict was probation in one case and different forms of care in the remaining

[Delirium or behavioral and psychological symptoms of dementia in the elderly patient: diagnosis and treatment].

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Breil, D

2010-09-08

Acute confusional state, delirium, occurs in up to 80% of patients in the intensive care unit and is also a common, life-threatening and potentially preventable clinical syndrome among persons who are 65 years of age or older in general hospital. The cause of acute confusional state is typically multifactorial. Delirium and dementia are highly interrelated and dementia is the leading risk factor for delirium. So the key steps to distinguish between delirium and behavioural and psychological symptoms of dementia are to address all evident causes, e.g. dementia, dehydration, infection, polymedication and to prevent complications and treat behavioral symptoms. First nonpharmacologic approaches should be instituted, including a calm, comfortable environment with the use of orienting influences. Pharmacologic management should be reserved for patients whose symptoms would threaten their own safety or the safety of other persons. Therapeutic drug options include modern antidepressants and neuroleptics.

Delirium in elderly people: a review

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Sónia eMartins

2012-06-01

Full Text Available The present review aims to highlight this intricate syndrome, regarding diagnosis, pathophysiology, etiology, prevention and management in elderly people. The diagnosis of delirium is based on clinical observations, cognitive assessment, detailed family history, physical and neurological examination. Clinically, delirium occurs in hyperactive, hypoactive or mixed forms, based on psychomotor behaviour. As an acute confusional state, it is characterized by a rapid onset of symptoms, fluctuating course and an altered level of consciousness, global disturbance of cognition or perceptual abnormalities and evidence of a physical cause.In spite of pathophysiological mechanisms of delirium remaining unclear, current evidence suggests that disruption of neurotransmission, inflammation or acute stress responses might all contribute to the development of this ailment.It usually occurs as a result of a complex interaction of multiple risk factors, such as cognitive impairment/dementia, current hip fracture and presence of severe illness.Despite all of the above, delirium is frequently under-recognized and often misdiagnosed by health professionals. In particular, this happens due to its fluctuating nature, its overlap with dementia and the scarcity of routine formal cognitive assessment in general hospitals.It is also associated with multiple adverse outcomes that have been well documented, such as increased hospital stay, function/cognitive decline, institutionalization and mortality.In this context, early identification of delirium will be essential. Timely and optimal management of people with delirium, should be performed with identification of possible underlying causes, dealing with a suitable care environment and improving education of health professionals. All these can be important factors, which contribute to a decrease in adverse outcomes associated with delirium.

Cognitive-style characteristics as criteria for differential diagnosis of delirium

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I.V. Kuznetsov

2014-08-01

Full Text Available We present a psychological study of the relationship of cognitive styles with the development of delusional formations, overvalued ideas and simulative products in order to develop criteria of delirium differential diagnosis. We examined 118 men, ordered at forensic psychological and psychiatric examination, among them delusional symptoms were found in 68 people, and overvalued ideas in 26 people, 24 people simulated delirium. As a method of research, we used pathopsychological experiment and projective techniques and methods that identify particular cognitive style (TAT, Rorschach, Torrance. We found that delusional patients, unlike those simulating a mental disorder, show field independence cognitive style combined with the rigidity that is characteristic also for patients with endogenous overvalued ideas. In personality disorders, we found combination of field independence with the flexibility or with rigidity.

Alzheimer's-related cortical atrophy is associated with postoperative delirium severity in persons without dementia.

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Racine, Annie M; Fong, Tamara G; Travison, Thomas G; Jones, Richard N; Gou, Yun; Vasunilashorn, Sarinnapha M; Marcantonio, Edward R; Alsop, David C; Inouye, Sharon K; Dickerson, Bradford C

2017-11-01

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. Copyright © 2017 Elsevier Inc. All rights reserved.

DELIRIUM FROM THE GLIOCENTRIC PERSPECTIVE

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Adonis eSfera

2015-05-01

Full Text Available Delirium is an acute state marked by disturbances in cognition, attention, memory, perception, and sleep-wake cycle which is common in elderly. Others have shown an association between delirium and increased mortality, length of hospitalization, cost, and discharge to extended stay facilities (1. Until recently it was not known that after an episode of delirium in elderly, there is a 63% probability of developing dementia at 48 months compared to 8% in patients without delirium (2(3. Currently there are no preventive therapies for delirium, thus elucidation of cellular and molecular underpinnings of this condition may lead to the development of early interventions and thus prevent permanent cognitive damage.In this article we make the case for the role of glia in the pathophysiology of delirium and describe an astrocyte-dependent central and peripheral cholinergic anti-inflammatory shield which may be disabled by astrocytic pathology, leading to neuroinflammation and delirium. We also touch on the role of glia in information processing and neuroimaging.

The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge

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Witlox, Joost; Slor, Chantal J.; Jansen, René W. M. M.; Kalisvaart, Kees J.; van Stijn, Mireille F. M.; Houdijk, Alexander P. J.; Eikelenboom, Piet; van Gool, Willem A.; de Jonghe, Jos F. M.

2013-01-01

Delirium is a risk factor for long-term cognitive impairment and dementia. Yet, the nature of these cognitive deficits is unknown as is the extent to which the persistence of delirium symptoms and presence of depression at follow-up may account for the association between delirium and cognitive

Delirium in the Emergency Department and Its Extension into Hospitalization (DELINEATE) Study: Effect on 6-month Function and Cognition.

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Han, Jin H; Vasilevskis, Eduard E; Chandrasekhar, Rameela; Liu, Xulei; Schnelle, John F; Dittus, Robert S; Ely, E Wesley

2017-06-01

The natural course and clinical significance of delirium in the emergency department (ED) is unclear. We sought to (1) describe the extent to which delirium in the ED persists into hospitalization (ED delirium duration) and (2) determine how ED delirium duration is associated with 6-month functional status and cognition. Prospective cohort study. Tertiary care, academic medical center. ED patients ≥65 years old who were admitted to the hospital. The modified Brief Confusion Assessment Method was used to ascertain delirium in the ED and hospital. Premorbid and 6-month function were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire which ranged from 0 (completely dependent) to 28 (completely dependent). Premorbid and 6-month cognition were determined using the short form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranged from 1 to 5 (severe dementia). Multiple linear regression was performed to determine if ED delirium duration was associated with 6-month function and cognition adjusted for baseline OARS ADL and IQCODE, and other confounders. A total of 228 older ED patients were enrolled. Of the 105 patients who were delirious in the ED, 81 (77.1%) patients' delirium persisted into hospitalization. For every ED delirium duration day, the 6-month OARS ADL decreased by 0.63 points (95% CI: -1.01 to -0.24), indicating poorer function. For every ED delirium duration day, the 6-month IQCODE increased 0.06 points (95% CI: 0.01-0.10) indicating poorer cognition. Delirium in the ED is not a transient event and frequently persists into hospitalization. Longer ED delirium duration is associated with an incremental worsening of 6-month functional and cognitive outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

New DSM-V neurocognitive disorders criteria and their impact on diagnostic classifications of mild cognitive impairment and dementia in a memory clinic setting.

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Tay, Laura; Lim, Wee Shiong; Chan, Mark; Ali, Noorhazlina; Mahanum, Shariffah; Chew, Pamela; Lim, June; Chong, Mei Sian

2015-08-01

To examine diagnostic agreement between Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) Neurocognitive Disorders (NCDs) criteria and DSM, Fourth Edition (DSM-IV) criteria for dementia and International Working Group (IWG) criteria for mild cognitive impairment (MCI) and DSM-V's impact on diagnostic classifications of NCDs. The authors further examined clinical factors for discrepancy in diagnostic classifications between the different operational definitions. Using a cross-sectional study in tertiary memory clinic, the authors studied consecutive new patients aged 55 years or older who presented with cognitive symptoms. Dementia severity was scored based on the Clinical Dementia Rating scale (CDR). All patients completed neuropsychological evaluation. Agreement in diagnostic classifications between DSM-IV/IWG and DSM-V was examined using the kappa test and AC1 statistic, with multinomial logistic regression for factors contributing to MCI reclassification as major NCDs as opposed to diagnostically concordant MCI and dementia groups. Of 234 patients studied, 166 patients achieved concordant diagnostic classifications, with overall kappa of 0.41. Eighty-six patients (36.7%) were diagnosed with MCI and 131 (56.0%) with DSM-IV-defined dementia. With DSM-V, 40 patients (17.1%) were classified as mild NCDs and 183 (78.2%) as major NCDs, representing a 39.7% increase in frequency of dementia diagnoses. CDR sum-of-boxes score contributed independently to differentiation of MCI patients reclassified as mild versus major NCDs (OR: 0.01; 95% CI: 0-0.09). CDR sum-of-boxes score (OR: 5.18; 95% CI: 2.04-13.15), performance in amnestic (OR: 0.14; 95% CI: 0.06-0.34) and language (Boston naming: OR: 0.52; 95% CI: 0.29-0.94) tests, were independent determinants of diagnostically concordant dementia diagnosis. The authors observed moderate agreement between the different operational definitions and a 40% increase in dementia diagnoses with

Improvement of Screening Accuracy of Mini-Mental State Examination for Mild Cognitive Impairment and Non-Alzheimer's Disease Dementia by Supplementation of Verbal Fluency Performance.

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Kim, Jee Wook; Lee, Dong Young; Seo, Eun Hyun; Sohn, Bo Kyung; Choe, Young Min; Kim, Shin Gyeom; Park, Shin Young; Choo, Il Han; Youn, Jong Chul; Jhoo, Jin Hyeong; Kim, Ki Woong; Woo, Jong Inn

2014-01-01

THIS STUDY AIMED TO INVESTIGATE WHETHER THE SUPPLEMENTATION OF VERBAL FLUENCY: Animal category test (VF) performance can improve the screening ability of Mini-Mental State Examination (MMSE) for mild cognitive impairment (MCI), dementia and their major subtypes. Six hundred fifty-five cognitively normal (CN), 366 MCI [282 amnestic MCI (aMCI); 84 non-amnestic MCI (naMCI)] and 494 dementia [346 Alzheimer's disease (AD); and 148 non-Alzheimer's disease dementia (NAD)] individuals living in the community were included (all aged 50 years and older) in the study. The VF-supplemented MMSE (MMSE+VF) score had a significantly better screening ability for MCI, dementia and overall cognitive impairment (MCI plus dementia) than the MMSE raw score alone. MMSE+VF showed a significantly better ability than MMSE for both MCI subtypes, i.e., aMCI and naMCI. In the case of dementia subtypes, MMSE+VF was better than the MMSE alone for NAD screening, but not for AD screening. The results support the usefulness of VF-supplementation to improve the screening performance of MMSE for MCI and NAD.

Performance of Hippocampus Volumetry with FSL-FIRST for Prediction of Alzheimer's Disease Dementia in at Risk Subjects with Amnestic Mild Cognitive Impairment.

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Suppa, Per; Hampel, Harald; Kepp, Timo; Lange, Catharina; Spies, Lothar; Fiebach, Jochen B; Dubois, Bruno; Buchert, Ralph

2016-01-01

MRI-based hippocampus volume, a core feasible biomarker of Alzheimer's disease (AD), is not yet widely used in clinical patient care, partly due to lack of validation of software tools for hippocampal volumetry that are compatible with routine workflow. Here, we evaluate fully-automated and computationally efficient hippocampal volumetry with FSL-FIRST for prediction of AD dementia (ADD) in subjects with amnestic mild cognitive impairment (aMCI) from phase 1 of the Alzheimer's Disease Neuroimaging Initiative. Receiver operating characteristic analysis of FSL-FIRST hippocampal volume (corrected for head size and age) revealed an area under the curve of 0.79, 0.70, and 0.70 for prediction of aMCI-to-ADD conversion within 12, 24, or 36 months, respectively. Thus, FSL-FIRST provides about the same power for prediction of progression to ADD in aMCI as other volumetry methods.

The effect of bilingualism on amnestic mild cognitive impairment.

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Ossher, Lynn; Bialystok, Ellen; Craik, Fergus I M; Murphy, Kelly J; Troyer, Angela K

2013-01-01

Previous reports have found that lifelong bilingualism is associated with a delay in the onset of dementia, including Dementia of the Alzheimer's Type (DAT). Because amnestic mild cognitive impairment (aMCI) is often a transition stage between normal aging and DAT, our aim in this paper was to establish whether this delay in symptom onset for bilinguals would also be seen in the onset of symptoms of aMCI and whether this delay would be consistent in different subtypes of aMCI. We examined the effect of bilingualism on the age of diagnosis in individuals with single- or multiple-domain aMCI who were administered a battery of neuropsychological tests and questionnaires about their language and social background. Our results showed an interaction between aMCI type and language history. Only individuals diagnosed with single-domain aMCI demonstrated a later age of diagnosis for bilinguals (M = 79.4 years) than monolinguals (M = 74.9 years). This preliminary evidence suggests that the early protective advantage of bilingualism may be specific to single-domain aMCI, which is the type of aMCI most specifically associated with progression to DAT.

Risk factors for delirium – characteristics of patients at risk of delirium in Geriatric Ward

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Iwona Otremba

2016-02-01

Full Text Available Background. Delirium is an acute cognitive disorder comorbid with impaired consciousness and psychomotor activity. It occurs in 30–50% of patients in geriatric wards. It is the most common and least recognized syndrome in geriatrics. Objectives. The aim of the study was to formulate the characteristics of the patient’s risk of developing delirium in the Geriatric Ward. Material and methods . The study included all patients admitted to the Ward from 15 June 2013 until 15 June 2014 (n = 788. In 5% (n = 41 diagnosed symptoms of delirium. Assessment of the need for care – by Barthel, independence by IADL, the pain by VAS or DOLOPLUS, mental status by MMSE, the risk of falling by the “get up and go” test, occurrence of delirium by CAM, depth of delirium by DOM, agitation-sedation by RASS. Results. In the group with symptoms of delirium (n = 41 there were 76% (n = 31 female and 24% (n = 10 male. In 90% (n = 37 the mobility was impaired. By the Barthel 41% (n = 20 had ≤ 40 points, by IADL 78% (n = 32 had ≤ 16 points. 85% (n = 35 has high risk of falling. By VAS 71% (n = 26, (n = 36 – ≥ 4 points, the pain by DOLOPLUS – 16.7 points (15% of the group (n = 5. By MMSE 66% (n = 27 had ≤ 18 points. Delirium in an interview – 61% (n = 24. 61% (n = 26 had used ≥ 5 drugs. Incontinence – 56% (n = 25, bladder catheterization – 27% (n = 11. 83% (n = 34 had ≥ 10 risk factors for delirium. Conclusions . The patient at risk of delirium is the patient with concomitant: dementia, delirium in the past, urinary incontinence, limited mobility and pain, patients taking drugs ≥ 5, involving ≥ 10 risk factors for delirium.

Free and cued recall memory in Parkinson's disease associated with amnestic mild cognitive impairment.

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Alberto Costa

Full Text Available The hypothesis has been advanced that memory disorders in individuals with Parkinson's disease (PD are related to either retrieval or consolidation failure. However, the characteristics of the memory impairments of PD patients with amnestic mild cognitive impairment have not been clarified. This study was aimed at investigating whether memory deficits in PD patients with amnestic mild cognitive impairment (PDaMCI are due to failure of retrieval or consolidation processes. Sixteen individuals with PDaMCI, 20 with amnestic mild cognitive impairment without PD (aMCINPD, and 20 healthy controls were recruited. Participants were administered the Free and Cued Selective Reminding Test. An index of cueing was computed for each subject to capture the advantage in retrieval of cued compared to free recall. Individuals with PDaMCI performed worse than healthy controls on the free recall (p0.10 task, and they performed better than aMCINPD subjects on both recall measures (p0.10 but it was significantly higher than that of the aMCINPD sample (p<0.01. Moreover, PD patients' performance on free recall trials was significantly predicted by scores on a test investigating executive functions (i.e., the Modified Card Sorting Test; p = 0.042. Findings of the study document that, in subjects with amnestic mild cognitive impairment associated to PD, episodic memory impairment is related to retrieval rather than to consolidation failure. The same data suggest that, in these individuals, memory deficits might be due to altered frontal-related executive functioning.

Free and Cued Recall Memory in Parkinson’s Disease Associated with Amnestic Mild Cognitive Impairment

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Costa, Alberto; Monaco, Marco; Zabberoni, Silvia; Peppe, Antonella; Perri, Roberta; Fadda, Lucia; Iannarelli, Francesca; Caltagirone, Carlo; Carlesimo, Giovanni A.

2014-01-01

The hypothesis has been advanced that memory disorders in individuals with Parkinson’s disease (PD) are related to either retrieval or consolidation failure. However, the characteristics of the memory impairments of PD patients with amnestic mild cognitive impairment have not been clarified. This study was aimed at investigating whether memory deficits in PD patients with amnestic mild cognitive impairment (PDaMCI) are due to failure of retrieval or consolidation processes. Sixteen individuals with PDaMCI, 20 with amnestic mild cognitive impairment without PD (aMCINPD), and 20 healthy controls were recruited. Participants were administered the Free and Cued Selective Reminding Test. An index of cueing was computed for each subject to capture the advantage in retrieval of cued compared to free recall. Individuals with PDaMCI performed worse than healthy controls on the free recall (pcued recall (p>0.10) task, and they performed better than aMCINPD subjects on both recall measures (p0.10) but it was significantly higher than that of the aMCINPD sample (precall trials was significantly predicted by scores on a test investigating executive functions (i.e., the Modified Card Sorting Test; p = 0.042). Findings of the study document that, in subjects with amnestic mild cognitive impairment associated to PD, episodic memory impairment is related to retrieval rather than to consolidation failure. The same data suggest that, in these individuals, memory deficits might be due to altered frontal-related executive functioning. PMID:24465977

Prevalence and conversion to dementia of Mild Cognitive Impairment in an elderly Italian population.

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Limongi, Federica; Siviero, Paola; Noale, Marianna; Gesmundo, Antonella; Crepaldi, Gaetano; Maggi, Stefania

2017-06-01

Mild Cognitive Impairment (MCI) represents a significant risk factor for dementia but there are only a few Italian population studies on its prevalence and its rate of conversion to dementia. Aim of this study was to assess the prevalence of MCI, its subtypes, and rates of conversion to dementia 1 year later in an elderly Italian population. The data are based on an Italian multicenter population-based cohort study with both cross-sectional and longitudinal components. Two thousand three hundred thirty-seven individuals over 65 underwent screening, clinical confirmation and 1-year follow-up. The prevalence of MCI was 21.6% and the amnestic multiple domain was the most frequent subtype (63.2%). The conversion rate to dementia was 4.1% and was found only in the amnestic multiple domain and in the unclassifiable subjects, persons with cognitive deficit but neither demented nor with MCI. The prevalence of MCI in this population sample was similar to that found in other population studies using Petersen's modified MCI criteria as well as his original criteria. With regard to conversion to dementia, our results emphasize the importance to better classify the unclassifiable subjects at high risk of progression to dementia and also at risk of being undiagnosed and untreated. MCI is characterized by extreme variability and instability. Data on the prevalence and the rate of conversion from MCI to dementia are difficult to compare given the important differences from study to study especially with regard to the diagnostic criteria utilized and their operationalization.

Quantitative proteomics of delirium cerebrospinal fluid

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Poljak, A; Hill, M; Hall, R J; MacLullich, A M; Raftery, M J; Tai, J; Yan, S; Caplan, G A

2014-01-01

Delirium is a common cause and complication of hospitalization in older people, being associated with higher risk of future dementia and progression of existing dementia. However relatively little data are available on which biochemical pathways are dysregulated in the brain during delirium episodes, whether there are protein expression changes common among delirium subjects and whether there are any changes which correlate with the severity of delirium. We now present the first proteomic analysis of delirium cerebrospinal fluid (CSF), and one of few studies exploring protein expression changes in delirium. More than 270 proteins were identified in two delirium cohorts, 16 of which were dysregulated in at least 8 of 17 delirium subjects compared with a mild Alzheimer's disease neurological control group, and 31 proteins were significantly correlated with cognitive scores (mini-mental state exam and acute physiology and chronic health evaluation III). Bioinformatics analyses revealed expression changes in several protein family groups, including apolipoproteins, secretogranins/chromogranins, clotting/fibrinolysis factors, serine protease inhibitors and acute-phase response elements. These data not only provide confirmatory evidence that the inflammatory response is a component of delirium, but also reveal dysregulation of protein expression in a number of novel and unexpected clusters of proteins, in particular the granins. Another surprising outcome of this work is the level of similarity of CSF protein profiles in delirium patients, given the diversity of causes of this syndrome. These data provide additional elements for consideration in the pathophysiology of delirium as well as potential biomarker candidates for delirium diagnosis. PMID:25369144

Neuropsychological and psychopathological differentiation of delirium

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Gabriel, Alexander

2010-01-01

ICD-10 and DSM-IV differ in their definitions of delirium. The DSM-IV definition centers around a disorder of attention and cognitive functions, whereas ICD-10 describes delirium as a broader neuropsychological and psychopathological syndrome, e.g. hallucinations, emotional and psychomotor disorder. When neuropsychological and psychopathological symptoms of delirium are assessed simultaneously, our question was, if there are core symptoms of delirium, i.e. neuropsychological and psychopat...

Neurocognitive disorders: cluster 1 of the proposed meta-structure for DSM-V and ICD-11.

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Sachdev, P; Andrews, G; Hobbs, M J; Sunderland, M; Anderson, T M

2009-12-01

In an effort to group mental disorders on the basis of aetiology, five clusters have been proposed. In this paper, we consider the validity of the first cluster, neurocognitive disorders, within this proposal. These disorders are categorized as 'Dementia, Delirium, and Amnestic and Other Cognitive Disorders' in DSM-IV and 'Organic, including Symptomatic Mental Disorders' in ICD-10. We reviewed the literature in relation to 11 validating criteria proposed by a Study Group of the DSM-V Task Force as applied to the cluster of neurocognitive disorders. 'Neurocognitive' replaces the previous terms 'cognitive' and 'organic' used in DSM-IV and ICD-10 respectively as the descriptor for disorders in this cluster. Although cognitive/organic problems are present in other disorders, this cluster distinguishes itself by the demonstrable neural substrate abnormalities and the salience of cognitive symptoms and deficits. Shared biomarkers, co-morbidity and course offer less persuasive evidence for a valid cluster of neurocognitive disorders. The occurrence of these disorders subsequent to normal brain development sets this cluster apart from neurodevelopmental disorders. The aetiology of the disorders is varied, but the neurobiological underpinnings are better understood than for mental disorders in any other cluster. Neurocognitive disorders meet some of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster. Further developments in the aetiopathogenesis of these disorders will enhance the clinical utility of this cluster.

Informant-reported cognitive symptoms that predict amnestic mild cognitive impairment

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Malek-Ahmadi Michael

2012-02-01

Full Text Available Abstract Background Differentiating amnestic mild cognitive impairment (aMCI from normal cognition is difficult in clinical settings. Self-reported and informant-reported memory complaints occur often in both clinical groups, which then necessitates the use of a comprehensive neuropsychological examination to make a differential diagnosis. However, the ability to identify cognitive symptoms that are predictive of aMCI through informant-based information may provide some clinical utility in accurately identifying individuals who are at risk for developing Alzheimer's disease (AD. Methods The current study utilized a case-control design using data from an ongoing validation study of the Alzheimer's Questionnaire (AQ, an informant-based dementia assessment. Data from 51 cognitively normal (CN individuals participating in a brain donation program and 47 aMCI individuals seen in a neurology practice at the same institute were analyzed to determine which AQ items differentiated aMCI from CN individuals. Results Forward stepwise multiple logistic regression analysis which controlled for age and education showed that 4 AQ items were strong indicators of aMCI which included: repetition of statements and/or questions [OR 13.20 (3.02, 57.66]; trouble knowing the day, date, month, year, and time [OR 17.97 (2.63, 122.77]; difficulty managing finances [OR 11.60 (2.10, 63.99]; and decreased sense of direction [OR 5.84 (1.09, 31.30]. Conclusions Overall, these data indicate that certain informant-reported cognitive symptoms may help clinicians differentiate individuals with aMCI from those with normal cognition. Items pertaining to repetition of statements, orientation, ability to manage finances, and visuospatial disorientation had high discriminatory power.

The descriptive epidemiology of delirium symptoms in a large population-based cohort study: results from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS).

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Davis, Daniel H J; Barnes, Linda E; Stephan, Blossom C M; MacLullich, Alasdair M J; Meagher, David; Copeland, John; Matthews, Fiona E; Brayne, Carol

2014-07-28

In the general population, the epidemiological relationships between delirium and adverse outcomes are not well defined. The aims of this study were to: (1) construct an algorithm for the diagnosis of delirium using the Geriatric Mental State (GMS) examination; (2) test the criterion validity of this algorithm against mortality and dementia risk; (3) report the age-specific prevalence of delirium as determined by this algorithm. Participant and informant data in a randomly weighted subsample of the Cognitive Function and Ageing Study were taken from a standardized assessment battery. The algorithmic definition of delirium was based on the DSM-IV classification. Outcomes were: proportional hazard ratios for death; odds ratios of dementia at 2-year follow-up. Data from 2197 persons (representative of 13,004) were used, median age 77 years, 64% women. Study-defined delirium was associated with a new dementia diagnosis at two years (OR 8.82, 95% CI 2.76 to 28.2) and death (HR 1.28, 95% CI 1.03 to 1.60), even after adjustment for acute illness severity. Similar associations were seen for study-defined subsyndromal delirium. Age-specific prevalence as determined by the algorithm increased with age from 1.8% in the 65-69 year age group to 10.1% in the ≥85 age group (p delirium, age-specific period prevalence ranged from 8.2% (65-69 years) to 36.1% (≥85 years). These results demonstrate the possibility of constructing an algorithmic diagnosis for study-defined delirium using data from the GMS schedule, with predictive criterion validity for mortality and dementia risk. These are the first population-based analyses able to account prospectively for both illness severity and an earlier study diagnosis of dementia.

Cognitive Blackouts in Mild Cognitive Impairment and Alzheimer’s Dementia

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Georg Adler

2018-02-01

Full Text Available Background: Cognitive blackouts, e.g. moments of amnesia, disorientation, or perplexity may be an early sign of incipient Alzheimer’s dementia (AD. A short questionnaire, the checklist for cognitive blackouts (CCB, was evaluated cross-sectionally in users of a memory clinic. Methods: The CCB was performed in 130 subjects, who further underwent a neuropsychological and clinical examination. Subjective memory impairment and depressive symptoms were assessed. Differences in the CCB score between diagnostic groups and relationships with cognitive performance, depression, and subjective memory impairment were analyzed. Results: The CCB score was increased in mild cognitive impairment of the amnestic type or mild AD and correctly predicted 69.2% of the respective subjects. It was negatively correlated with cognitive performance, positively correlated with depressive symptoms, and substantially increased in subjects who estimated their memory poorer than that of other persons of their age. Discussion: The CCB may be a helpful screening tool for the early recognition of AD.

Frontal white matter hyperintensity predicts lower urinary tract dysfunction in older adults with amnestic mild cognitive impairment and Alzheimer's disease.

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Ogama, Noriko; Yoshida, Masaki; Nakai, Toshiharu; Niida, Shumpei; Toba, Kenji; Sakurai, Takashi

2016-02-01

Lower urinary tract symptoms often limit activities of daily life and impair quality of life in the elderly. The purpose of the present study was to determine whether regional white matter hyperintensity (WMH) can predict lower urinary tract symptoms in elderly with amnestic mild cognitive impairment or Alzheimer's disease. The participants were 461 patients aged 65-85 years diagnosed with amnestic mild cognitive impairment or Alzheimer's disease. Patients and their caregivers were asked about symptoms of lower urinary tract symptoms (urinary difficulty, frequency and incontinence). Cognition, behavior and psychological symptoms of dementia and medication were evaluated. WMH and brain atrophy were analyzed using an automatic segmentation program. Regional WMH was evaluated in the frontal, parietal, temporal and occipital lobes. Patients with urinary incontinence showed significantly greater volume of WMH. WMH increased with age, especially in the frontal lobe. WMH in the frontal lobe was closely associated with urinary incontinence after adjustment for brain atrophy and classical confounding factors. Frontal WMH was a predictive factor for urinary incontinence in older adults with amnestic mild cognitive impairment or Alzheimer's disease. Urinary incontinence in demented older adults is not an incidental event, and careful insight into regional WMH on brain magnetic resonance imaging might greatly help in diagnosing individuals with a higher risk of urinary incontinence. © 2015 Japan Geriatrics Society.

Korean Version of the Delirium Rating Scale-Revised-98: Reliability and Validity

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Ryu, Jian; Lee, Jinyoung; Kim, Hwi-Jung; Shin, Im Hee; Kim, Jeong-Lan; Trzepacz, Paula T.

2011-01-01

Objective The aims of the present study were 1) to standardize the validity and reliability of the Korean version of Delirium Rating Scale-Revised-98 (DRS-R98-K) and 2) to establish the optimum cut-off value, sensitivity, and specificity for discriminating delirium from other non-delirious psychiatric conditions. Methods Using DSM-IV criteria, 157 subjects (69 delirium, 29 dementia, 32 schizophrenia, and 27 other psychiatric patients) were enrolled. Subjects were evaluated using DRS-R98-K, DRS-K, Mini-Mental State Examination (MMSE-K), and Clinical Global Impression-Severity (CGI-S) scale. Results DRS-R98-K total and severity scores showed high correlations with DRS-K. They were significantly different across all groups (p=0.000). However, neither MMSE-K nor CGI-S distinguished delirium from dementia. All DRS-R98-K diagnostic items (#14-16) and items #1 and 2 significantly discriminated delirium from dementia. Cronbach's alpha coefficient revealed high internal consistency for DRS-R98-K total (r=0.91) and severity (r=0.89) scales. Interrater reliability (ICC between 0.96 and 1) was very high. Using receiver operating characteristic analysis, the area under the curve of DRS-R98-K total score was 0.948 between the delirium group and all other groups and 0.873 between the delirium and dementia groups. The best cut-off scores in DRS-R98-K total score were 18.5 and 19.5 between the delirium and the other three groups and 20.5 between the delirium and dementia groups. Conclusion We demonstrated that DRS-R98-K is a valid and reliable instrument for assessing delirium severity and diagnosis and discriminating delirium from dementia and other psychiatric disorders in Korean patients. PMID:21519534

The neuropsychological sequelae of delirium in elderly patients with hip fracture three months after hospital discharge

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Witlox, J.; Slor, C.J.; Jansen, R.W.M.M.; Kalisvaart, K.J.; van Stijn, M.F.M.; Houdijk, A.P.J.; Eikelenboom, P.; van Gool, W.A.; de Jonghe, J.F.M.

2013-01-01

ABSTRACT Background: Delirium is a risk factor for long-term cognitive impairment and dementia. Yet, the nature of these cognitive deficits is unknown as is the extent to which the persistence of delirium symptoms and presence of depression at follow-up may account for the association between

Delirium superimposed on dementia: defining disease states and course from longitudinal measurements of a multivariate index using latent class analysis and hidden Markov chains.

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Ciampi, Antonio; Dyachenko, Alina; Cole, Martin; McCusker, Jane

2011-12-01

The study of mental disorders in the elderly presents substantial challenges due to population heterogeneity, coexistence of different mental disorders, and diagnostic uncertainty. While reliable tools have been developed to collect relevant data, new approaches to study design and analysis are needed. We focus on a new analytic approach. Our framework is based on latent class analysis and hidden Markov chains. From repeated measurements of a multivariate disease index, we extract the notion of underlying state of a patient at a time point. The course of the disorder is then a sequence of transitions among states. States and transitions are not observable; however, the probability of being in a state at a time point, and the transition probabilities from one state to another over time can be estimated. Data from 444 patients with and without diagnosis of delirium and dementia were available from a previous study. The Delirium Index was measured at diagnosis, and at 2 and 6 months from diagnosis. Four latent classes were identified: fairly healthy, moderately ill, clearly sick, and very sick. Dementia and delirium could not be separated on the basis of these data alone. Indeed, as the probability of delirium increased, so did the probability of decline of mental functions. Eight most probable courses were identified, including good and poor stable courses, and courses exhibiting various patterns of improvement. Latent class analysis and hidden Markov chains offer a promising tool for studying mental disorders in the elderly. Its use may show its full potential as new data become available.

Cognitive impairment in patients with AIDS – prevalence and severity

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Watkins CC

2015-01-01

Full Text Available Crystal C Watkins,1,2 Glenn J Treisman2 1The Memory Center in Neuropsychiatry, Sheppard Pratt Health System, 2Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: The advent of highly active antiretroviral therapy has prolonged the life expectancy of HIV patients and decreased the number of adults who progress to AIDS and HIV-associated dementia. However, neurocognitive deficits remain a pronounced consequence of HIV/AIDS. HIV-1 infection targets the central nervous system in subcortical brain areas and leads to high rates of delirium, depression, opportunistic central nervous system infections, and dementia. Long-term HIV replication in the brain occurs in astrocytes and microglia, allowing the virus to hide from antiviral medication and later compromise neuronal function. The associated cognitive disturbance is linked to both viral activity and inflammatory and other mediators from these immune cells that lead to the damage associated with HIV-associated neurocognitive disorders, a general term given for these disturbances. We review the severity and prevalence of the neuropsychiatric complications of HIV including delirium, neurobehavioral impairments (depression, minor cognitive-motor dysfunction, and HIV-associated dementia. Keywords: HIV, delirium, depression, HAND, dementia; HIV-associated neurocognitive disorder

Social Cognition Deficits: The Key to Discriminate Behavioral Variant Frontotemporal Dementia from Alzheimer's Disease Regardless of Amnesia?

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Bertoux, Maxime; de Souza, Leonardo Cruz; O'Callaghan, Claire; Greve, Andrea; Sarazin, Marie; Dubois, Bruno; Hornberger, Michael

2016-01-01

Relative sparing of episodic memory is a diagnostic criterion of behavioral variant frontotemporal dementia (bvFTD). However, increasing evidence suggests that bvFTD patients can show episodic memory deficits at a similar level as Alzheimer's disease (AD). Social cognition tasks have been proposed to distinguish bvFTD, but no study to date has explored the utility of such tasks for the diagnosis of amnestic bvFTD. Here, we contrasted social cognition performance of amnestic and non-amnestic bvFTD from AD, with a subgroup having confirmed in vivo pathology markers. Ninety-six participants (38 bvFTD and 28 AD patients as well as 30 controls) performed the short Social-cognition and Emotional Assessment (mini-SEA). BvFTD patients were divided into amnestic versus non-amnestic presentation using the validated Free and Cued Selective Reminding Test (FCSRT) assessing episodic memory. As expected, the accuracy of the FCSRT to distinguish the overall bvFTD group from AD was low (69.7% ) with ∼50% of bvFTD patients being amnestic. By contrast, the diagnostic accuracy of the mini-SEA was high (87.9% ). When bvFTD patients were split on the level of amnesia, mini-SEA diagnostic accuracy remained high (85.1% ) for amnestic bvFTD versus AD and increased to very high (93.9% ) for non-amnestic bvFTD versus AD. Social cognition deficits can distinguish bvFTD and AD regardless of amnesia to a high degree and provide a simple way to distinguish both diseases at presentation. These findings have clear implications for the diagnostic criteria of bvFTD. They suggest that the emphasis should be on social cognition deficits with episodic memory deficits not being a helpful diagnostic criterion in bvFTD.

Memory deficits for facial identity in patients with amnestic mild cognitive impairment (MCI).

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Savaskan, Egemen; Summermatter, Daniel; Schroeder, Clemens; Schächinger, Hartmut

2018-01-01

Faces are among the most relevant social stimuli revealing an encounter's identity and actual emotional state. Deficits in facial recognition may be an early sign of cognitive decline leading to social deficits. The main objective of the present study is to investigate if individuals with amnestic mild cognitive impairment show recognition deficits in facial identity. Thirty-seven individuals with amnestic mild cognitive impairment, multiple-domain (15 female; age: 75±8 yrs.) and forty-one healthy volunteers (24 female; age 71±6 yrs.) participated. All participants completed a human portrait memory test presenting unfamiliar faces with happy and angry emotional expressions. Five and thirty minutes later, old and new neutral faces were presented, and discrimination sensitivity (d') and response bias (C) were assessed as signal detection parameters of cued facial identity recognition. Memory performance was lower in amnestic mild cognitive impairment as compared to control subjects, mainly because of an altered response bias towards an increased false alarm rate (favoring false OLD ascription of NEW items). In both groups, memory performance declined between the early and later testing session, and was always better for acquired happy than angry faces. Facial identity memory is impaired in patients with amnestic mild cognitive impairment. Liberalization of the response bias may reflect a socially motivated compensatory mechanism maintaining an almost identical recognition hit rate of OLD faces in individuals with amnestic mild cognitive impairment.

In-hospital delirium risk assessment, diagnosis and management; medications to avoid

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Andrew Clegg

2013-03-01

Full Text Available Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at

PROTEOMIC AND EPIGENOMIC MARKERS OF SEPSIS-INDUCED DELIRIUM (SID

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Adonis eSfera

2015-10-01

Full Text Available In elderly population sepsis is one of the leading causes of intensive care unit (ICU admissions in the United States. Sepsis-induced delirium (SID is the most frequent cause of delirium in ICU (1. Together delirium and SID represent under recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143 to 152 billion dollars per year (2. The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (3-4. Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium.This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis?

Development of a smartphone application for the objective detection of attentional deficits in delirium.

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Tieges, Zoë; Stíobhairt, Antaine; Scott, Katie; Suchorab, Klaudia; Weir, Alexander; Parks, Stuart; Shenkin, Susan; MacLullich, Alasdair

2015-08-01

Delirium is an acute, severe deterioration in mental functioning. Inattention is the core feature, yet there are few objective methods for assessing attentional deficits in delirium. We previously developed a novel, graded test for objectively detecting inattention in delirium, implemented on a computerized device (Edinburgh Delirium Test Box (EDTB)). Although the EDTB is effective, tests on universally available devices have potential for greater impact. Here we assessed feasibility and validity of the DelApp, a smartphone application based on the EDTB. This was a preliminary case-control study in hospital inpatients (aged 60-96 years) with delirium (N = 50), dementia (N = 52), or no cognitive impairment (N = 54) who performed the DelApp assessment, which comprises an arousal assessment followed by counting of lights presented serially. Delirium was assessed using the Confusion Assessment Method and Delirium Rating Scale-Revised-98 (DRS-R98), and cognition with conventional tests of attention (e.g. digit span) and the short Orientation-Memory-Concentration Test (OMCT). DelApp scores (maximum score = 10) were lower in delirium (scores (median(IQR)): 6 (4-7)) compared to dementia (10 (9-10)) and control groups (10 (10-10), p-values smartphone test for attentional assessment in hospital inpatients with possible delirium, with potential applications in research and clinical practice.

[Delirium in patients with neurological diseases: diagnosis, management and prognosis].

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Hüfner, K; Sperner-Unterweger, B

2014-04-01

Delirium is a common acute neuropsychiatric syndrome. It is characterized by concurrent disturbances of consciousness and attention, perception, reasoning, memory, emotionality, the sleep-wake cycle as well as psychomotor symptoms. Delirium caused by alcohol or medication withdrawal is not the subject of the current review. Specific predisposing and precipitating factors have been identified in delirium which converge in a common final pathway of global brain dysfunction. The major predisposing factors are older age, cognitive impairment or dementia, sensory deficits, multimorbidity and polypharmacy. Delirium is always caused by one or more underlying pathologies which need to be identified. In neurology both primary triggers of delirium, such as stroke or epileptic seizures and also secondary triggers, such as metabolic factors or medication side effects play a major role. Nonpharmacological interventions are important in the prevention of delirium and lead to an improvement in prognosis. Delirium is associated with increased mortality and in the long term the development of cognitive deficits and functional impairment.

[Treatment with psychotropic agents in patients with dementia and delirium : Gap between guideline recommendations and treatment practice].

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Hewer, Walter; Thomas, Christine

2017-02-01

Psychiatric symptoms in dementia and delirium are associated with a substantially reduced quality of life of patients and their families and often challenging for professionals. Pharmacoepidemiological surveys have shown that, in particular, patients living in nursing homes receive prescriptions of psychotropic agents in significant higher frequency than recommended by current guidelines. This article focuses on a critical appraisal of this gap from the point of view of German healthcare services. Narrative review with special reference to the German dementia guideline from 2016 and recently published practice guidelines for delirium in old age in German and English language. The indications for use of psychotropic agents, especially antipsychotics, are defined narrowly in the German dementia guideline. According to this guideline for several psychopathological symptoms evidence based recommendations cannot be given, currently. For delirium several practice guidelines related to different treatment settings have been published recently. Comparable to the German dementia guideline they recommend general medical interventions and nonpharmacological treatment as first line measures and the use of psychotropic agents only under certain conditions. These guidelines differ to some extent regarding the strength of recommendation for psychopharmacological treatment. The guidelines discussed here advocate well-founded a cautious prescription of psychotropic agents in patients with dementia and delirium. This contrasts to everyday practice which is characterized by significantly higher prescription rates. This gap may explained partially by a lack of evidence-based recommendations regarding certain psychopathological symptoms. Most notably, however, epidemiological data disclose an unacceptable rate of hazardous overtreatment with psychotropic agents, especially in long-term care of persons with dementia. In this situation counteractive measures by consequent implementation

Detection of delirium by nurses among long-term care residents with dementia

OpenAIRE

Voyer, Philippe; Richard, Sylvie; Doucet, Lise; Danjou, Christine; Carmichael, Pierre-Hugues

2008-01-01

Abstract Background Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected...

Delirium phenomenology: what can we learn from the symptoms of delirium?

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Gupta, Nitin; de Jonghe, Jos; Schieveld, Jan; Leonard, Maeve; Meagher, David

2008-09-01

This review focuses on phenomenological studies of delirium, including subsyndromal and prodromal concepts, and their relevance to other elements of clinical profile. A Medline search using the keywords delirium, phenomenology, and symptoms for new data articles published in English between 1998 and 2008 was utilized. The search was supplemented by additional material not identified by Medline but known to the authors. Understanding of prodromal and subsyndromal concepts is still in its infancy. The characteristic profile can differentiate delirium from other neuropsychiatric disorders. Clinical (motoric) subtyping holds potential but more consistent methods are needed. Studies are almost entirely cross-sectional in design and generally lack comprehensive symptom assessment. Multiple assessment tools are available but are oriented towards hyperactive features and few have demonstrated ability to distinguish delirium from dementia. There is insufficient evidence linking specific phenomenology with etiology, pathophysiology, management, course, and outcome. Despite the major advancements of the past decade in many aspects of delirium research, further phenomenological work is crucial to targeting studies of causation, pathophysiology, treatment, and prognosis. We identified eight key areas for future studies.

Appropriateness of using a symbol to identify dementia and/or delirium.

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Hines, Sonia; Abbey, Jenny; Wilson, Jacinda; Sacre, Sandy

2010-09-01

The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. Using the methods of the Joanna Briggs Institute, we conducted a systematic search of a wide range of databases, Internet resources and unpublished literature. Papers meeting the inclusion criteria were critically appraised by two independent reviewers. Data were extracted, using the standardised tool from the Joanna Briggs Institute, from those papers considered to be of sufficient quality. Because of significant methodological heterogeneity, no meta-analysis was possible and results are presented narratively instead. From a total of 37 retrieved papers, 18 were found to be of sufficient relevance and quality to be included in the review. There was general consensus among the literature that a symbol for dementia is appropriate in the acute care setting. It was also clear from the research that an abstract symbol, as opposed to one that explicitly attempts to depict dementia, was most acceptable to staff, people with dementia and their carers. Both staff and health consumers seem to have largely positive perceptions and attitudes towards the use of a symbol for dementia. Families and carers of people with dementia are frequently concerned about their loved one wandering away and becoming lost and unable to identify themselves, and these concerns seem to outweigh any reservations they hold about the use of a symbol or some other identifier. In healthcare settings the use of symbols to indicate special needs seems well established and widely accepted. However, regarding the use of a symbol for dementia in the broader community, there remain concerns about issues such as stigmatisation and the potential for victimisation of this vulnerable population and so further research is indicated

Insulin, cognition, and dementia

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Cholerton, Brenna; Baker, Laura D.; Craft, Suzanne

2015-01-01

Cognitive disorders of aging represent a serious threat to the social and economic welfare of current society. It is now widely recognized that pathology related to such conditions, particularly Alzheimer’s disease, likely begins years or decades prior to the onset of clinical dementia symptoms. This revelation has led researchers to consider candidate mechanisms precipitating the cascade of neuropathological events that eventually lead to clinical Alzheimer’s disease. Insulin, a hormone with potent effects in the brain, has recently received a great deal of attention for its potential beneficial and protective role in cognitive function. Insulin resistance, which refers to the reduced sensitivity of target tissues to the favorable effects of insulin, is related to multiple chronic conditions known to impact cognition and increase dementia risk. With insulin resistance-associated conditions reaching epidemic proportions, the prevalence of Alzheimer’s disease and other cognitive disorders will continue to rise exponentially. Fortunately, these chronic insulin-related conditions are amenable to pharmacological intervention. As a result, novel therapeutic strategies that focus on increasing insulin sensitivity in the brain may be an important target for protecting or treating cognitive decline. The following review will highlight our current understanding of the role of insulin in brain, potential mechanisms underlying the link between insulin resistance and dementia, and current experimental therapeutic strategies aimed at improving cognitive function via modifying the brain’s insulin sensitivity. PMID:24070815

Appropriateness of using a symbol to identify dementia and/or delirium: a systematic review.

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Hines, Sonia; Abbey, Jenny; Wilson, Jacinda; Sacre, Sandy

2009-01-01

Alzheimer's Australia contracted the Dementia Collaborative Research Centre - Consumers, Carers and Social Research to conduct a systematic review to explore the appropriateness of a symbol for dementia.The concept of a symbol for people with dementia was an outcome of the Alzheimer's Australia National Consumer Summit on Dementia held in Canberra in October 2005. People living with dementia and their carers identified that a national symbol would be helpful in order to encourage appropriate treatment of people with dementia.Funding was provided as part of the Australian Government's Dementia Initiative to Alzheimer's Australia to work in collaboration with the Queensland University of Technology and Catholic Health Australia to explore, through research, the viability and potential impact of such a symbol in a range of care settings. The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. A literature search was performed using the following databases: Ageline, APAIS Health, CINAHL, Dissertations and Theses Abstracts, Embase, MEDLINE, PsycEXTRAS, PsycINFO, PsycArticles, Current Contents, LegalTrac, Health and Society, Sociological Abstracts, Family and Society, CINCH, and Hein Online databases. The reference lists of articles retrieved were hand searched, as well as a range of literature from health, legal, ethical and emergency services. Grey literature was searched for using a number of Internet sites, and personal email communication with authors of relevant studies and known researchers in the field was initiated. Papers were retrieved if they provided information about attitudes or perceptions towards the appropriateness of symbols, identifiers or alerts used to inform others that someone has dementia, delirium and/or another medical

Bipolar disorder and dementia: where is the link?

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Masouy, Anaïs; Chopard, Gilles; Vandel, Pierre; Magnin, Eloi; Rumbach, Lucien; Sechter, Daniel; Haffen, Emmanuel

2011-03-01

Cognitive disorders appearing in the course of bipolar disease have been identified, and recent studies have defined the neuropsychological characteristics of this pathology, which includes attention, executive function, memory and language disorders. However, questions remain concerning the appearance of dementia symptoms over the course of bipolar disorder in certain patients: is it a chance association or is there a connection between bipolar disorders and dementia? If the latter hypothesis is considered, what is the nature of the dementia, which might be considered as a dementia specific to bipolar disorder? Current clinical, neuropsychological and cerebral imaging data are inconclusive, but similarities with frontotemporal dementia might be highlighted. Functional imaging studies might provide answers as well as more specific tests in neuropsychology. The cause of cognitive damage in bipolar disease also raises questions concerning a neurodevelopmental or neurodegenerative process, because several factors seem to influence cognition and these two processes might occur simultaneously. Long-term studies are necessary to determine whether cognitive deterioration in bipolar disease is stable or progressive. There might also be different neurobiological subgroups of patients with bipolar disease. © 2011 The Authors. Psychogeriatrics © 2011 Japanese Psychogeriatric Society.

Delirium in elderly people

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Inouye, Sharon K.; Westendorp, Rudi G. J.; Saczynski, Jane S.

2014-01-01

Delirium, an acute disorder of attention and cognition, is a common, serious, costly, under-recognized and often fatal condition for seniors. Its diagnosis requires a formal cognitive assessment and history of acute onset of symptoms. Given its typically complex multifactorial etiology, multicomponent nonpharmacologic risk factor approaches have proven to be the most effective strategy for prevention. To date, there is no convincing evidence that pharmacologic prevention or treatment is effective. Drug reduction for sedation and analgesia combined with nonpharmacologic approaches are recommended. Delirium may provide a window to elucidate brain pathophysiology, serving both as a marker of brain vulnerability with decreased reserve and a potential mechanism for permanent cognitive damage. As a potent patient safety indicator, delirium provides a target for system-wide process improvements. Public health priorities will include improvements in coding and reimbursement, improved research funding, and widespread education for clinicians and the public about the importance of delirium. PMID:23992774

DELIRIUM PERIOPERATORIO

Directory of Open Access Journals (Sweden)

Jimena Rodríguez, Dra.

2017-09-01

fluctuating course with inatenttion, lost memory, resless, agitation, sleep disturbances, hearing and visual hallucinations.Management of POD centers on prevention and early diagnostic, general care no pharmacological, anticholinergic and benzodiazepines drugs are not to be used, search metabolic disorders or infection that could be the cause.Multidisciplinary management is critical in order to reduce complications and mortality. Palabras clave: Delirium, alteración cognitiva, geriatría, demencia, cerebro, Key words: Delirium, cognitive impairment, geriatric, dementia, brain

Symptoms of delirium occurring before and after episodes of delirium in older long-term care residents.

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Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Dyachenko, Alina; Belzile, Eric

2012-12-01

To describe Confusion Assessment Method (CAM) core symptoms of delirium occurring before and after incident episodes of delirium in older long-term care (LTC) residents. A secondary objective was to describe the mean number of symptoms before and after episodes by dementia status. Secondary analysis of data collected for a prospective cohort study of delirium, with repeated weekly assessments for up to 6 months. Seven LTC facilities in Montreal and Quebec City, Canada. Forty-one older LTC residents who had at least one CAM-defined incident episode of delirium. The Mini-Mental State Examination (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. The frequency, mean number, type, and duration of CAM core symptoms of delirium occurring before and after incident episodes were examined using descriptive statistics, frequency analysis, and survival analysis. CAM core symptoms of delirium preceded 38 (92.7%) episodes of delirium for many weeks; core symptoms followed 37 (90.2%) episodes for many weeks. Symptoms of inattention and disorganized thinking occurred most commonly. The mean number of symptoms was higher in residents with dementia but not significantly so. CAM core symptoms of delirium were frequent and protracted before and after most incident episodes of delirium in LTC residents with and without dementia. If replicated, these findings have potentially important implications for clinical practice and research in LTC settings. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Memory deficits in amyotrophic lateral sclerosis are not exclusively caused by executive dysfunction: a comparative neuropsychological study of amnestic mild cognitive impairment

OpenAIRE

Machts, Judith; Bittner, Verena; Kasper, Elisabeth; Schuster, Christina; Prudlo, Johannes; Abdulla, Susanne; Kollewe, Katja; Petri, Susanne; Dengler, Reinhard; Heinze, Hans-Jochen; Vielhaber, Stefan; Schoenfeld, Mircea A; Bittner, Daniel M

2014-01-01

Background Recent work suggests that ALS and frontotemporal dementia can occur together and share at least in part the same underlying pathophysiology. However, it is unclear at present whether memory deficits in ALS stem from a temporal lobe dysfunction, or are rather driven by frontal executive dysfunction. In this study we sought to investigate the nature of memory deficits by analyzing the neuropsychological performance of 40 ALS patients in comparison to 39 amnestic mild cognitive impair...

Partial and No Recovery from Delirium in Older Hospitalized Adults: Frequency and Baseline Risk Factors.

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Cole, Martin G; Bailey, Robert; Bonnycastle, Michael; McCusker, Jane; Fung, Shek; Ciampi, Antonio; Belzile, Eric; Bai, Chun

2015-11-01

thought, especially in those with dementia, although delirium symptoms, cognition, and function improved in many participants with partial and no recovery. It may be important to monitor the longer-term course of delirium in older hospitalized adults and develop strategies to ensure full recovery. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

[Depressive disorders in dementia and mild cognitive impairments: is comorbidity a cause or a risk factor?].

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Preuss, U W; Siafarikas, N; Petrucci, M; Wong, W M

2009-07-01

Both depression and dementia occur by themselves or together in elderly subjects aged 65 and above. The aim of this review is to discuss several hypotheses which try to explain the frequent co-occurrence exceeding chance alone, based on a systematic literature search. A series of studies revealed potential biological similarities between both disorders which, however, were not found in all investigations. Lifetime history of depression can be considered as a distant risk factor for dementias. Depression occurs most frequently within one year before and after the onset of dementia, in which the association between both disorders is probably strongest. In a subgroup of subjects with more "cognitive reserve", depression was found to be a consequence of patient's realisation of beginning cognitive deficits. Several studies indicate that depression in Alzheimer and other dementia forms can be considered as a separate disease entity, as the clinical syndrome differs from depression in earlier periods of life. Studies on the therapy of depression in dementia have aroused increasing interest in recent years. Herewith, certain guidelines in the treatment of older patients with antidepressants must be followed.

Risk factors for incident delirium in an acute general medical setting: a retrospective case-control study.

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Tomlinson, Emily Jane; Phillips, Nicole M; Mohebbi, Mohammadreza; Hutchinson, Alison M

2017-03-01

To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium. Retrospective case-control study with two controls per case. An audit tool was used to review medical records of patients admitted to acute medical units for data regarding potential risk factors for delirium. Data were collected between August 2013 and March 2014 at three hospital sites of a healthcare organisation in Melbourne, Australia. Cases were 161 patients admitted to an acute medical ward and diagnosed with incident delirium between 1 January 2012 and 31 December 2013. Controls were 321 patients sampled from the acute medical population admitted within the same time range, stratified for admission location and who did not develop incident delirium during hospitalisation. Identified using logistic regression modelling, predisposing risk factors for incident delirium were dementia, cognitive impairment, functional impairment, previous delirium and fracture on admission. Precipitating risk factors for incident delirium were use of an indwelling catheter, adding more than three medications during admission and having an abnormal sodium level during admission. Multiple risk factors for incident delirium exist; patients with a history of delirium, dementia and cognitive impairment are at greatest risk of developing delirium during hospitalisation. Nurses and other healthcare professionals should be aware of patients who have one or more risk factors for incident delirium. Knowledge of risk factors for delirium has the potential to increase the recognition and understanding of patients who are vulnerable to delirium. Early recognition and

Addenbrooke's cognitive examination III: diagnostic utility for mild cognitive impairment and dementia and correlation with standardized neuropsychological tests.

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Matias-Guiu, Jordi A; Cortés-Martínez, Ana; Valles-Salgado, Maria; Rognoni, Teresa; Fernández-Matarrubia, Marta; Moreno-Ramos, Teresa; Matías-Guiu, Jorge

2017-01-01

Addenbrooke's Cognitive Examination III (ACE-III) is a screening test that was recently validated for diagnosing dementia. Since it assesses attention, language, memory, fluency, and visuospatial function separately, it may also be useful for general neuropsychological assessments. The aim of this study was to analyze the tool's ability to detect early stages of Alzheimer's disease and to examine the correlation between ACE-III scores and scores on standardized neuropsychological tests. Our study included 200 participants categorized as follows: 25 healthy controls, 48 individuals with subjective memory complaints, 47 patients with amnestic mild cognitive impairment and 47 mild Alzheimer's disease, and 33 patients with other neurodegenerative diseases. The ACE-III memory and language domains were highly correlated with the neuropsychological tests specific to those domains (Pearson correlation coefficient of 0.806 for total delayed recall on the Free and Cued Selective Reminding Test vs. 0.744 on the Boston Naming Test). ACE-III scores discriminated between controls and patients with amnestic mild cognitive impairment (AUC: 0.906), and between controls and patients with mild Alzheimer's disease (AUC: 0.978). Our results suggest that ACE-III is a useful neuropsychological test for assessing the cognitive domains of attention, language, memory, and visuospatial function. It also enables detection of Alzheimer's disease in early stages.

Delirium is associated with early postoperative cognitive dysfunction

DEFF Research Database (Denmark)

Rudolph, J.L.; Marcantonio, E.R.; Culley, D.J.

2008-01-01

The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects...

Symptoms of delirium predict incident delirium in older long-term care residents.

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Cole, Martin G; McCusker, Jane; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Dyachenko, Alina; Belzile, Eric

2013-06-01

Detection of long-term care (LTC) residents at risk of delirium may lead to prevention of this disorder. The primary objective of this study was to determine if the presence of one or more Confusion Assessment Method (CAM) core symptoms of delirium at baseline assessment predicts incident delirium. Secondary objectives were to determine if the number or the type of symptoms predict incident delirium. The study was a secondary analysis of data collected for a prospective study of delirium among older residents of seven LTC facilities in Montreal and Quebec City, Canada. The Mini-Mental State Exam (MMSE), CAM, Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for six months. Multivariate Cox regression models were used to determine if baseline symptoms predict incident delirium. Of 273 residents, 40 (14.7%) developed incident delirium. Mean (SD) time to onset of delirium was 10.8 (7.4) weeks. When one or more CAM core symptoms were present at baseline, the Hazard Ratio (HR) for incident delirium was 3.5 (95% CI = 1.4, 8.9). The HRs for number of symptoms present ranged from 2.9 (95% CI = 1.0, 8.3) for one symptom to 3.8 (95% CI = 1.3, 11.0) for three symptoms. The HR for one type of symptom, fluctuation, was 2.2 (95% CI = 1.2, 4.2). The presence of CAM core symptoms at baseline assessment predicts incident delirium in older LTC residents. These findings have potentially important implications for clinical practice and research in LTC settings.

Side Effects - Delirium

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Delirium is a confused mental state. Symptoms may include changes in thinking and sleeping. In cancer patients, it may be caused by medicine, dehydration, or happen at the end of life. Delirium may be mistaken for depression or dementia.

Memory Binding Test Predicts Incident Amnestic Mild Cognitive Impairment.

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Mowrey, Wenzhu B; Lipton, Richard B; Katz, Mindy J; Ramratan, Wendy S; Loewenstein, David A; Zimmerman, Molly E; Buschke, Herman

2016-07-14

The Memory Binding Test (MBT), previously known as Memory Capacity Test, has demonstrated discriminative validity for distinguishing persons with amnestic mild cognitive impairment (aMCI) and dementia from cognitively normal elderly. We aimed to assess the predictive validity of the MBT for incident aMCI. In a longitudinal, community-based study of adults aged 70+, we administered the MBT to 246 cognitively normal elderly adults at baseline and followed them annually. Based on previous work, a subtle reduction in memory binding at baseline was defined by a Total Items in the Paired (TIP) condition score of ≤22 on the MBT. Cox proportional hazards models were used to assess the predictive validity of the MBT for incident aMCI accounting for the effects of covariates. The hazard ratio of incident aMCI was also assessed for different prediction time windows ranging from 4 to 7 years of follow-up, separately. Among 246 controls who were cognitively normal at baseline, 48 developed incident aMCI during follow-up. A baseline MBT reduction was associated with an increased risk for developing incident aMCI (hazard ratio (HR) = 2.44, 95% confidence interval: 1.30-4.56, p = 0.005). When varying the prediction window from 4-7 years, the MBT reduction remained significant for predicting incident aMCI (HR range: 2.33-3.12, p: 0.0007-0.04). Persons with poor performance on the MBT are at significantly greater risk for developing incident aMCI. High hazard ratios up to seven years of follow-up suggest that the MBT is sensitive to early disease.

Cognitive training for dementia

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Konta, Brigitte

2005-12-01

Full Text Available The aim of the HTA report is to evaluate the effectiveness of cognitive training methods to treat cognitive disorders of dementia and other diseases with cognitive deficits. For this purpose, a systematic literature search was carried out first based on the DIMDI superbase retrieval. The identified publications were judged and selected by two independent, methodically competent experts. 33 publications were included in the report. Based on the studies for a normal cognitive development in old age a theory that healthy older people have a considerable capacity reserve for an improved performance in abstract abilities of thinking can be assumed. The first symptoms for older people at risk for dementia are a reduced cognitive capacity reserve. Cognitive training methods therefore focus abilities of abstract memory. Apart from types of dementia another two groups of diseases with cognitive deficits were included in the HTA report: cerebral lesions and schizophrenic psychoses. Studies with mild as well as forms of dementia heavy forms including the Alzheimer disease were included. The described training methods were very heterogeneous with regard to their contents, the temporal sequence and the outcome parameter. The studies were methodically partly contestable. Approximately a third of the studies of all publications could show improvements in the cognitive achievements by the training. Three studies concerning cognitive training methods in case of cerebral lesions were included. All three studies demonstrated a significant improvement in the training group in some outcome parameters. Special cognitive training methods were used for the treatment of cognitive deficits at schizophrenic psychoses. The neurocognitive training (NET, the "Cognitive Remediation Therapy" as well as the strategic training with coaching proved to be effective. The studies, however, were hardly comparable and very heterogeneous in detail. Summarising the cognitive training

Stroke occurring in patients with cognitive impairment or dementia

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Solène Moulin

Full Text Available ABSTRACT One in six patients admitted for stroke was previously demented. These patients have less access to appropriate stroke care, although little is known about their optimal management. Objective To determine how pre-stroke cognitive impairment can be detected, its mechanism, and influence on outcome and management. Methods Literature search. Results (i A systematic approach with the Informant Questionnaire of Cognitive Decline in the Elderly is recommended; (ii Pre-stroke cognitive impairment may be due to brain lesions of vascular, degenerative, or mixed origin; (iii Patients with pre-stroke dementia, have worse outcomes, more seizures, delirium, and depression, and higher mortality rates; they often need to be institutionalised after their stroke; (iv Although the safety profile of treatment is not as good as that of cognitively normal patients, the risk:benefit ratio is in favour of treating these patients like others. Conclusion Patients with cognitive impairment who develop a stroke have worse outcomes, but should be treated like others.

The diagnosis, prevalence and outcome of delirium in a cohort of older people with mental health problems on general hospital wards.

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Whittamore, Kathy H; Goldberg, Sarah E; Gladman, John R F; Bradshaw, Lucy E; Jones, Rob G; Harwood, Rowan H

2014-01-01

This paper aimed to measure the prevalence and outcomes of delirium for patients over 70 admitted to a general hospital for acute medical care and to assess the validity of the Delirium Rating Scale-Revised-98 (DRS-R-98) in this setting. Prospective study in a British acute general hospital providing sole emergency medical services for its locality. We screened consecutive patients over 70 with an unplanned emergency hospital admission and recruited a cohort of 249 patients likely to have mental health problems. They were assessed for health status at baseline and followed over 6 months. A sub-sample of 93 participants was assessed clinically for delirium. 27% (95% confidence interval (CI) 23-31) of all older medical patients admitted to hospital had DRS-diagnosed delirium, and 41% (95% CI 37-45) had dementia (including 19% with co-morbid delirium and dementia). Compared with clinician diagnosis, DRS-R-98 sensitivity was at least 0.75, specificity 0.71. Compared with reversible cognitive impairment, sensitivity was at least 0.50, specificity 0.67. DRS-diagnosed delirium was associated with cognitive impairment, mood, behavioural and psychological symptoms, activities of daily living, and number of drugs prescribed, supporting construct validity. Of those with DRS-diagnosed delirium, 37% died within 6 months (relative risk 1.4, 95% CI 0.97-2.2), 43% had reversible cognitive impairment, but only 25% had clinically important recovery in activities of daily living. Behavioural and psychological symptoms were common and mostly resolved, but new symptoms frequently developed. Delirium is common. Some, but not all, features are reversible. DRS-R-98 has reasonable validity in populations where co-morbid dementia is prevalent. Copyright © 2013 John Wiley & Sons, Ltd.

Sleep and Cognitive Decline: A Strong Bidirectional Relationship. It Is Time for Specific Recommendations on Routine Assessment and the Management of Sleep Disorders in Patients with Mild Cognitive Impairment and Dementia.

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Guarnieri, Biancamaria; Sorbi, Sandro

2015-01-01

Sleep disturbances and disruption of the neural regulation of the sleep-wake rhythm appear to be involved in the cellular and molecular mechanisms of cognitive decline. Although sleep problems are highly prevalent in mild cognitive impairment (MCI) and many types of dementia, they have not been systematically investigated in the clinical setting and are often only investigated by sleep specialists upon individual request. This review discusses sleep disorders in the context of cognitive decline and provides an overview of the clinical diagnosis and management of these disorders in patients with dementia and MCI. Key Messages: Sleep disorders are largely underestimated and do not receive sufficient attention in the global management of dementia patients. Sleep disturbances have a significant impact on cognitive and physical functions in individuals with cognitive decline and may be associated with important psychological distress and depression. They are positively associated with the severity of behavioral problems and cognitive impairment. The recent recommendations by the Sleep Study Group of the Italian Dementia Research Association can be used as a guideline for the clinical assessment and management of sleep disorders in MCI and dementia patients. Sleep disorders should be carefully investigated using an in-depth sleep history, physical examination, questionnaires and clinical scales and should be validated with the support of a direct caregiver. The recommendations for older adults can be used as a framework to guide the diagnosis and treatment of sleep disorders in individuals with dementia and MCI. The management strategy should be based on the choice of different treatments for each sleep problem present in the same patient, while avoiding adverse interactions between treatments. © 2015 S. Karger AG, Basel.

Emotional face recognition deficit in amnestic patients with mild cognitive impairment: behavioral and electrophysiological evidence

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Yang L

2015-08-01

Full Text Available Linlin Yang, Xiaochuan Zhao, Lan Wang, Lulu Yu, Mei Song, Xueyi Wang Department of Mental Health, The First Hospital of Hebei Medical University, Hebei Medical University Institute of Mental Health, Shijiazhuang, People’s Republic of China Abstract: Amnestic mild cognitive impairment (MCI has been conceptualized as a transitional stage between healthy aging and Alzheimer’s disease. Thus, understanding emotional face recognition deficit in patients with amnestic MCI could be useful in determining progression of amnestic MCI. The purpose of this study was to investigate the features of emotional face processing in amnestic MCI by using event-related potentials (ERPs. Patients with amnestic MCI and healthy controls performed a face recognition task, giving old/new responses to previously studied and novel faces with different emotional messages as the stimulus material. Using the learning-recognition paradigm, the experiments were divided into two steps, ie, a learning phase and a test phase. ERPs were analyzed on electroencephalographic recordings. The behavior data indicated high emotion classification accuracy for patients with amnestic MCI and for healthy controls. The mean percentage of correct classifications was 81.19% for patients with amnestic MCI and 96.46% for controls. Our ERP data suggest that patients with amnestic MCI were still be able to undertake personalizing processing for negative faces, but not for neutral or positive faces, in the early frontal processing stage. In the early time window, no differences in frontal old/new effect were found between patients with amnestic MCI and normal controls. However, in the late time window, the three types of stimuli did not elicit any old/new parietal effects in patients with amnestic MCI, suggesting their recollection was impaired. This impairment may be closely associated with amnestic MCI disease. We conclude from our data that face recognition processing and emotional memory is

Delirium in elderly patients: association with educational attainment.

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Martins, Sónia; Paiva, José Artur; Simões, Mário R; Fernandes, Lia

2017-04-01

Among cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium. The study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service. Exclusion criteria were as follows: Glasgow Coma Scale (total≤11), blindness/deafness, inability to communicate or to speak Portuguese. The European Portuguese Version of the Confusion Assessment Method (CAM) was used for delirium assessment. The final sample (n=157) had a mean age of 78.8 (SD=7.6) the majority being female (52.2%), married (51.5%) and with low educational level (49%). According to CAM, 21% of the patients had delirium. The delirium group presented the fewest years of education (median 1 vs. 4), with statistical significance (p=0.003). Delirium was more frequent among male patients [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.12-0.86; p=0.023], as well as those patients with lower education (OR 0.76; 95% CI 0.62-0.95; p=0.016), and with respiratory disease (OR 3.35; 95% CI 1.20-9.33; p=0.020), after controlling for age and medication. Similar to previous studies, these findings point to a negative correlation between education and delirium. This study appears as an attempt to contribute to the knowledge about the role of cognitive reserve in risk of delirium, particularly because is the first one that has been carried out in an IMCU, with lower educated elderly patients. Further studies are needed to clarify this relationship considering other markers (e.g. cognitive activities), which can contribute to the definition of preventive strategies.

Association between baseline cognitive impairment and postoperative delirium in elderly patients undergoing surgery for adult spinal deformity.

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Adogwa, Owoicho; Elsamadicy, Aladine A; Vuong, Victoria D; Fialkoff, Jared; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2018-01-01

OBJECTIVE Postoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis. METHODS Elderly patients 65 years and older undergoing a planned elective spinal surgery for correction of adult degenerative scoliosis were enrolled in this study. Preoperative cognition was assessed using the validated Saint Louis University Mental Status (SLUMS) examination. SLUMS comprises 11 questions, with a maximum score of 30 points. Mild cognitive impairment was defined as a SLUMS score between 21 and 26 points, while severe cognitive impairment was defined as a SLUMS score of ≤ 20 points. Normal cognition was defined as a SLUMS score of ≥ 27 points. Delirium was assessed daily using the Confusion Assessment Method (CAM) and rated as absent or present on the basis of CAM. The incidence of delirium was compared in patients with and without baseline cognitive impairment. RESULTS Twenty-two patients (18%) developed delirium postoperatively. Baseline demographics, including age, sex, comorbidities, and perioperative variables, were similar in patients with and without delirium. The length of in-hospital stay (mean 5.33 days vs 5.48 days) and 30-day hospital readmission rates (12.28% vs 12%) were similar between patients with and without delirium, respectively. Patients with preoperative cognitive impairment (i.e., a lower SLUMS score) had a higher incidence of postoperative delirium. One- and 2-year patient reported outcomes scores were similar in patients with and without delirium. CONCLUSIONS

Mild cognitive impairment as a risk factor for Parkinson's disease dementia.

Science.gov (United States)

Hoogland, Jeroen; Boel, Judith A; de Bie, Rob M A; Geskus, Ronald B; Schmand, Ben A; Dalrymple-Alford, John C; Marras, Connie; Adler, Charles H; Goldman, Jennifer G; Tröster, Alexander I; Burn, David J; Litvan, Irene; Geurtsen, Gert J

2017-07-01

The International Parkinson and Movement Disorder Society criteria for mild cognitive impairment in PD were recently formulated. The aim of this international study was to evaluate the predictive validity of the comprehensive (level II) version of these criteria by assessment of their contribution to the hazard of PD dementia. Individual patient data were selected from four separate studies on cognition in PD that provided information on demographics, motor examination, depression, neuropsychological examination suitable for application of level II criteria, and longitudinal follow-up for conversion to dementia. Survival analysis evaluated the predictive value of level II criteria for cognitive decline toward dementia as expressed by the relative hazard of dementia. A total of 467 patients were included. The analyses showed a clear contribution of impairment according to level II mild cognitive impairment criteria, age, and severity of PD motor symptoms to the hazard of dementia. There was a trend of increasing hazard of dementia with declining neuropsychological performance. This is the first large international study evaluating the predictive validity of level II mild cognitive impairment criteria for PD. The results showed a clear and unique contribution of classification according to level II criteria to the hazard of PD dementia. This finding supports their predictive validity and shows that they contribute important new information on the hazard of dementia, beyond known demographic and PD-specific factors of influence. © 2017 International Parkinson and Movement Disorder Society. © 2017 International Parkinson and Movement Disorder Society.

Affective functioning after delirium in elderly hip fracture patients.

Science.gov (United States)

Slor, Chantal J; Witlox, Joost; Jansen, René W M M; Adamis, Dimitrios; Meagher, David J; Tieken, Esther; Houdijk, Alexander P J; van Gool, Willem A; Eikelenboom, Piet; de Jonghe, Jos F M

2013-03-01

Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge. Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups. This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.

Is anemia associated with cognitive impairment and delirium among older acute surgical patients?

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Myint, Phyo Kyaw; Owen, Stephanie; McCarthy, Kathryn; Pearce, Lyndsay; Moug, Susan J; Stechman, Michael J; Hewitt, Jonathan; Carter, Ben

2018-03-01

The determinants of cognitive impairment and delirium during acute illness are poorly understood, despite being common among older people. Anemia is common in older people, and there is ongoing debate regarding the association between anemia, cognitive impairment and delirium, primarily in non-surgical patients. Using data from the Older Persons Surgical Outcomes Collaboration 2013 and 2014 audit cycles, we examined the association between anemia and cognitive outcomes in patients aged ≥65 years admitted to five UK acute surgical units. On admission, the Confusion Assessment Method was carried out to detect delirium. Cognition was assessed using the Montreal Cognitive Assessment, and two levels of impairment were defined as Montreal Cognitive Assessment cognitive impairment or delirium. The adjusted odds ratios of cognitive impairment were 0.95 (95% CI 0.56-1.61) and 1.00 (95% CI 0.61-1.64) for the Montreal Cognitive Assessment cognitive outcomes among older people in this acute surgical setting. Considering the retrospective nature of the study and possible lack of power, findings should be taken with caution. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 The Authors Geriatrics & Gerontology International published by John Wiley & Sons Australia, Ltd on behalf of Japan Geriatrics Society.

Is Delirium the Cognitive Harbinger of Frailty in Older Adults? A Review about the Existing Evidence

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Giuseppe Bellelli

2017-11-01

Full Text Available Frailty is a clinical syndrome defined by the age-related depletion of the individual’s homeostatic reserves, determining an increased susceptibility to stressors and disproportionate exposure to negative health changes. The physiological systems that are involved in the determination of frailty are mutually interrelated, so that when decline starts in a given system, implications may also regard the other systems. Indeed, it has been shown that the number of abnormal systems is more predictive of frailty than those of the abnormalities in any particular system. Delirium is a transient neurocognitive disorder, characterized by an acute onset and fluctuating course, inattention, cognitive dysfunction, and behavioral abnormalities, that complicates one out of five hospital admissions. Delirium is independently associated with the same negative outcomes of frailty and, like frailty, its pathogenesis is usually multifactorial, depending on complex inter-relationships between predisposing and precipitating factors. By definition, a somatic cause should be identified, or at least suspected, to diagnose delirium. Delirium and frailty potentially share multiple pathophysiologic mechanisms and pathways, meaning that they could be thought of as the two sides to the same coin. This review aims at summarizing the existing evidence, referring both to human and animal models, to postulate that delirium may represent the cognitive harbinger of a state of frailty in older persons experiencing an acute clinical event.

Prevalence of Mild Cognitive Impairment and Dementia in Saudi Arabia: A Community-Based Study.

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Alkhunizan, Muath; Alkhenizan, Abdullah; Basudan, Loay

2018-01-01

The age of the population in Saudi Arabia is shifting toward elderly, which can lead to an increased risk of mild cognitive impairment (MCI) and dementia. The aim of this study is to determine the prevalence of cognitive impairment (MCI and dementia) among elderly patients in a community-based setting in Riyadh, Saudi Arabia. In this cross-sectional study, we included patients aged 60 years and above who were seen in the Family Medicine Clinics affiliated with King Faisal Specialist Hospital and Research Centre. Patients with delirium, active depression, and patients with a history of severe head trauma in the past 3 months were excluded. Patients were interviewed during their regular visit by a trained physician to collect demographic data and to administer the validated Arabic version of the Montreal Cognitive Assessment (MoCA) test. One hundred seventy-one Saudi patients were recruited based on a calculated sample size for the aim of this study. The mean age of included sample was 67 ± 6 years. The prevalence of cognitive impairment was 45%. The prevalence of MCI was 38.6% and the prevalence of dementia was 6.4%. Age, low level of education, hypertension, and cardiovascular disease were risk factors for cognitive impairment. Prevalence of MCI and dementia in Saudi Arabia using MoCA were in the upper range compared to developed and developing countries. The high rate of risk factors for cognitive impairment in Saudi Arabia is contributing to this finding.

Missed diagnosis-persistent delirium

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Aseem Mehra

2014-01-01

Full Text Available Delirium is in general considered as an acute short lasting reversible neuropsychiatric syndrome. However, there is some evidence to suggest that in a small proportion of cases delirium may be a chronic or persistent condition. However, making this diagnosis requires clinical suspicion and ruling other differential diagnosis. In this report, we present a case of a 55-year-old man who had cognitive symptoms, psychotic symptoms and depressive symptoms along with persistent hypokalemia and glucose intolerance. He was seen by 3 psychiatrists with these symptoms and was initially diagnosed as having depressive disorder and later diagnosis of bipolar affective disorder (current episode mania, and psychosis were considered by the third psychiatrist. However, despite the presence of persistent neurocognitive deficits, evening worsening of symptoms, hypokalemia and glucose intolerance diagnosis of delirium was not suspected.

Delirium in the geriatric unit: proton-pump inhibitors and other risk factors.

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Otremba, Iwona; Wilczyński, Krzysztof; Szewieczek, Jan

2016-01-01

Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. Evaluate specific factors for development of delirium in a geriatric ward setting. Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54-5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44-3.65; Pfall incidents (OR =1.76; CI =1.17-2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11-2.53; P=0.014). Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.

Neuropsychological predictors of dementia in late-life major depressive disorder.

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Potter, Guy G; Wagner, H Ryan; Burke, James R; Plassman, Brenda L; Welsh-Bohmer, Kathleen A; Steffens, David C

2013-03-01

Major depressive disorder is a likely risk factor for dementia, but some cases of major depressive disorder in older adults may actually represent a prodrome of this condition. The purpose of this study was to use neuropsychological test scores to predict conversion to dementia in a sample of depressed older adults diagnosed as nondemented at the time of neuropsychological testing. Longitudinal, with mean follow-up of 5.45 years. Outpatient depression treatment study at Duke University. Thirty nondemented individuals depressed at the time of neuropsychological testing and later diagnosed with incident dementia; 149 nondemented individuals depressed at the time of neuropsychological testing and a diagnosis of cognitively normal. All participants received clinical assessment of depression, were assessed to rule out prevalent dementia at the time of study enrollment, completed neuropsychological testing at the time of study enrollment, and were diagnosed for cognitive disorders on an annual basis. Nondemented, acutely depressed older adults who converted to dementia during the study period exhibited broadly lower cognitive performances at baseline than acutely depressed individuals who remained cognitively normal. Discriminant function analysis indicated that 2 neuropsychological tests, Recognition Memory (from the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery) and Trail Making B, best predicted dementia conversion. Depressed older adults with cognitive deficits in the domains of memory and executive functions during acute depression are at higher risk for developing dementia. Some cases of late-life depression may reflect a prodrome of dementia in which clinical manifestation of mood changes may co-occur with emerging cognitive deficits. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Abstract Word Definition in Patients with Amnestic Mild Cognitive Impairment

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Kim, Soo Ryon; Baek, Min Jae; Kim, HyangHee

2015-01-01

The aims of this study were to investigate concrete and abstract word definition ability (1) between patients with amnestic mild cognitive impairment (aMCI) and normal adults and (2) between the aMCI subtypes (i.e., amnestic single-domain MCI and amnestic multidomain MCI; asMCI and amMCI) and normal controls. The 68 patients with aMCI (29 asMCI and 39 amMCI) and 93 age- and education-matched normal adults performed word definition tasks composed of five concrete (e.g., train) and five abstract nouns (e.g., jealousy). Task performances were analyzed on total score, number of core meanings, and number of supplementary meanings. The results were as follows. First, the aMCI patients scored significantly poorer than the normal controls in only abstract word definition. Second, both subtypes of aMCI performed worse than the controls in only abstract word definition. In conclusion, a definition task of abstract rather than concrete concepts may provide richer information to show semantic impairment of aMCI. PMID:26347214

Abstract Word Definition in Patients with Amnestic Mild Cognitive Impairment

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Soo Ryon Kim

2015-01-01

Full Text Available The aims of this study were to investigate concrete and abstract word definition ability (1 between patients with amnestic mild cognitive impairment (aMCI and normal adults and (2 between the aMCI subtypes (i.e., amnestic single-domain MCI and amnestic multidomain MCI; asMCI and amMCI and normal controls. The 68 patients with aMCI (29 asMCI and 39 amMCI and 93 age- and education-matched normal adults performed word definition tasks composed of five concrete (e.g., train and five abstract nouns (e.g., jealousy. Task performances were analyzed on total score, number of core meanings, and number of supplementary meanings. The results were as follows. First, the aMCI patients scored significantly poorer than the normal controls in only abstract word definition. Second, both subtypes of aMCI performed worse than the controls in only abstract word definition. In conclusion, a definition task of abstract rather than concrete concepts may provide richer information to show semantic impairment of aMCI.

Limbic and Basal Ganglia Neuroanatomical Correlates of Gait and Executive Function: Older Adults With Mild Cognitive Impairment and Intact Cognition.

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McGough, Ellen L; Kelly, Valerie E; Weaver, Kurt E; Logsdon, Rebecca G; McCurry, Susan M; Pike, Kenneth C; Grabowski, Thomas J; Teri, Linda

2018-04-01

This study aimed to examine differences in spatiotemporal gait parameters between older adults with amnestic mild cognitive impairment and normal cognition and to examine limbic and basal ganglia neural correlates of gait and executive function in older adults without dementia. This was a cross-sectional study of 46 community-dwelling older adults, ages 70-95 yrs, with amnestic mild cognitive impairment (n = 23) and normal cognition (n = 23). Structural magnetic resonance imaging was used to attain volumetric measures of limbic and basal ganglia structures. Quantitative motion analysis was used to measure spatiotemporal parameters of gait. The Trail Making Test was used to assess executive function. During fast-paced walking, older adults with amnestic mild cognitive impairment demonstrated significantly slower gait speed and shorter stride length compared with older adults with normal cognition. Stride length was positively correlated with hippocampal, anterior cingulate, and nucleus accumbens volumes (P function was positively correlated with hippocampal, anterior cingulate, and posterior cingulate volumes (P older adults with normal cognition, those with amnestic mild cognitive impairment demonstrated slower gait speed and shorter stride length, during fast-paced walking, and lower executive function. Hippocampal and anterior cingulate volumes demonstrated moderate positive correlation with both gait and executive function, after adjusting for age. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) discuss gait performance and cognitive function in older adults with amnestic mild cognitive impairment versus normal cognition, (2) discuss neurocorrelates of gait and executive function in older adults without dementia, and (3) recognize the importance of assessing gait speed and cognitive function in the clinical management of older

Performance of the modified Richmond Agitation Sedation Scale in identifying delirium  in older ED patients.

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Grossmann, Florian F; Hasemann, Wolfgang; Kressig, Reto W; Bingisser, Roland; Nickel, Christian H

2017-09-01

Delirium in older emergency department (ED) patients is associated with severe negative patient outcomes and its detection is challenging for ED clinicians. ED clinicians need easy tools for delirium detection. We aimed to test the performance criteria of the modified Richmond Agitation Sedation Scale (mRASS) in identifying delirium in older ED patients. The mRASS was applied to a sample of consecutive ED patients aged 65 or older by specially trained nurses during an 11-day period in November 2015. Reference standard delirium diagnosis was based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria, and was established by geriatricians. Performance criteria were computed. Analyses were repeated in the subsamples of patients with and without dementia. Of 285 patients, 20 (7.0%) had delirium and 41 (14.4%) had dementia. The sensitivity of an mRASS other than 0 to detect delirium was 0.70 (95% confidence interval, CI, 0.48; 0.85), specificity 0.93 (95% CI 0.90; 0.96), positive likelihood ratio 10.31 (95% CI 6.06; 17.51), negative likelihood ratio 0.32 (95% CI 0.16; 0.63). In the sub-sample of patients with dementia, sensitivity was 0.55 (95% CI 0.28; 0.79), specificity 0.83 (95% CI 0.66; 0.93), positive likelihood ratio 3.27 (95% CI 1.25; 8.59), negative likelihood ratio 0.55 (95% CI 0.28; 1.06). The sensitivity of the mRASS to detect delirium in older ED patients was low, especially in patients with dementia. Therefore its usefulness as a stand-alone screening tool is limited. Copyright © 2017 Elsevier Inc. All rights reserved.

Deconstructing Dementia and Delirium Hospital Practice: Using Cultural Historical Activity Theory to Inform Education Approaches

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Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

2015-01-01

Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The…

Defining delirium for the International Classification of Diseases, 11th Revision.

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Meagher, David J; Maclullich, Alasdair M J; Laurila, Jouko V

2008-09-01

The development of ICD-11 provides an opportunity to update the description of delirium according to emerging data that have added to our understanding of this complex neuropsychiatric syndrome. Synthetic article based on published work considered by the authors to be relevant to the definition of delirium. The current DSM-IV definition of delirium is preferred to the ICD-10 because of its greater inclusivity. Evidence does not support major changes in the principal components of present definitions but a number of key issues for the updated definition were identified. These include better account of non-cognitive features, more guidance for rating contextual diagnostic items, clearer definition regarding the interface with dementia, and accounting for illness severity, clinical subtypes and course. Development of the ICD definition of delirium can allow for more targeted research and clinical effort.

Cognitive Training Using a Novel Memory Game on an iPad in Patients with Amnestic Mild Cognitive Impairment (aMCI).

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Savulich, George; Piercy, Thomas; Fox, Chris; Suckling, John; Rowe, James B; O'Brien, John T; Sahakian, Barbara J

2017-08-01

Cognitive training is effective in patients with mild cognitive impairment but does not typically address the motivational deficits associated with older populations with memory difficulties. We conducted a randomized controlled trial of cognitive training using a novel memory game on an iPad in 42 patients with a diagnosis of amnestic mild cognitive impairment assigned to either the cognitive training (n=21; 8 hours of gameplay over 4 weeks) or control (n=21; clinic visits as usual) groups. Significant time-by-pattern-by-group interactions were found for cognitive performance in terms of the number of errors made and trials needed on the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning task (P=.044; P=.027). Significant time-by-group interactions were also found for the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning first trial memory score (P=.002), Mini-Mental State Examination (P=.036), the Brief Visuospatial Memory Test (P=.032), and the Apathy Evaluation Scale (P=.026). Within-group comparisons revealed highly specific effects of cognitive training on episodic memory. The cognitive training group maintained high levels of enjoyment and motivation to continue after each hour of gameplay, with self-confidence and self-rated memory ability improving over time. Episodic memory robustly improved in the cognitive training group. "Gamified" cognitive training may also enhance visuospatial abilities in patients with amnestic mild cognitive impairment. Gamification maximizes engagement with cognitive training by increasing motivation and could complement pharmacological treatments for amnestic mild cognitive impairment and mild Alzheimer's disease. Larger, more controlled trials are needed to replicate and extend these findings. © The Author 2017. Published by Oxford University Press on behalf of CINP.

Body Mass Index in Different Dementia Disorders: Results from the Swedish Dementia Quality Registry (SveDem

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Gerd Faxén-Irving

2014-04-01

Full Text Available Background: Most patients with dementia lose body weight over the course of the disease and have a lower body mass index (BMI than subjects with normal cognition. Aims: To examine body mass index and how it correlates with cognitive status, age and gender in patients with different dementia disorders. Materials and Methods: Data from newly diagnosed dementia patients in the Swedish Dementia Quality Registry (SveDem and recorded information about age, gender, cognitive status and BMI was analyzed using independent samples t tests and one-way analysis of variance. Results: A total of 12,015 patients, 7,121 females and 4,894 males were included in the study. The average BMI was 24. More than a quarter of the patients had a BMI of Conclusion: At the time of diagnosis, patients with various dementia disorders had a BMI within the normal range. However, a significant number had a BMI in a lower, suboptimal range for older persons stressing the need for nutritional assessment as part of the dementia work up. Further analyses with longitudinal follow-up are needed to investigate BMI changes over time.

Does my older cancer patient have cognitive impairment?

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Snaedal, Jon

2018-05-01

Cancer and impaired cognition are both frequent conditions in old age and consequently coexist to certain degree. The prevalence of impaired cognition increases sharply after the age of 65 and the more advanced form of cognitive impairment; dementia, is exceeding 30% by the age of 85years. Adequate cognition is crucial for understanding important facts and for giving consent for intervention. There are many different stages of cognitive impairment, ranging from subjective cognitive impairment to severe dementia. The mildest stages of cognitive impairment are sometimes reversible but in more severe stages, there is brain damage of some kind, most frequently caused by neurodegenerative disorder such as Alzheimer's disease. Therefore, some kind of evaluation of cognition should be offered to all older individuals with cancer and in need for intervention. In this evaluation, information should also be sought from a close relative. In the earlier stages of cognitive impairment, the individual usually retains ability to give consent and understands information given but in later stages of dementia, a surrogate decision maker is needed. In milder stages of dementia, an individual evaluation is needed for decision of capability for consent. A specific diagnosis of a disorder such as Alzheimer's disease does not in itself preclude the individual from giving consent, the degree of cognitive impairment, impaired judgement and poor insight are more decisive in this regard. It is also important to know the difference of delirium, most often a time limited condition and dementia that usually is progressive. Copyright © 2017 Elsevier Inc. All rights reserved.

Clinical-pathologic correlations in vascular cognitive impairment and dementia.

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Flanagan, Margaret; Larson, Eric B; Latimer, Caitlin S; Cholerton, Brenna; Crane, Paul K; Montine, Kathleen S; White, Lon R; Keene, C Dirk; Montine, Thomas J

2016-05-01

The most common causes of cognitive impairment and dementia are Alzheimer's disease (AD) and vascular brain injury (VBI), either independently, in combination, or in conjunction with other neurodegenerative disorders. The contribution of VBI to cognitive impairment and dementia, particularly in the context of AD pathology, has been examined extensively yet remains difficult to characterize due to conflicting results. Describing the relative contribution and mechanisms of VBI in dementia is important because of the profound impact of dementia on individuals, caregivers, families, and society, particularly the stability of health care systems with the rapidly increasing age of our population. Here we discuss relationships between pathologic processes of VBI and clinical expression of dementia, specific subtypes of VBI including microvascular brain injury, and what is currently known regarding contributions of VBI to the development and pathogenesis of the dementia syndrome. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. Copyright © 2015 Elsevier B.V. All rights reserved.

Mild cognitive impairment and dementia in a heterogeneous elderly ...

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2School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa ... governmental organisation (NGO) and cater for frail care, ... criteria for Dementia, Major Depression and Delirium. Face.

Drawing Disorders in Alzheimer's Disease and Other Forms of Dementia.

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Trojano, Luigi; Gainotti, Guido

2016-04-21

Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.

Turning education into action: Impact of a collective social education approach to improve nurses' ability to recognize and accurately assess delirium in hospitalized older patients.

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Travers, Catherine; Henderson, Amanda; Graham, Fred; Beattie, Elizabeth

2018-03-01

Although cognitive impairment including dementia and delirium is common in older hospital patients, it is not well recognized or managed by hospital staff, potentially resulting in adverse events. This paper describes, and reports on the impact of a collective social education approach to improving both nurses' knowledge of, and screening for delirium. Thirty-four experienced nurses from six hospital wards, became Cognition Champions (CogChamps) to lead their wards in a collective social education process about cognitive impairment and the assessment of delirium. At the outset, the CogChamps were provided with comprehensive education about dementia and delirium from a multidisciplinary team of clinicians. Their knowledge was assessed to ascertain they had the requisite understanding to engage in education as a collective social process, namely, with each other and their local teams. Following this, they developed ward specific Action Plans in collaboration with their teams aimed at educating and evaluating ward nurses' ability to accurately assess and care for patients for delirium. The plans were implemented over five months. The broader nursing teams' knowledge was assessed, together with their ability to accurately assess patients for delirium. Each ward implemented their Action Plan to varying degrees and key achievements included the education of a majority of ward nurses about delirium and the certification of the majority as competent to assess patients for delirium using the Confusion Assessment Method. Two wards collected pre-and post-audit data that demonstrated a substantial improvement in delirium screening rates. The education process led by CogChamps and supported by educators and clinical experts provides an example of successfully educating nurses about delirium and improving screening rates of patients for delirium. ACTRN 12617000563369. Copyright © 2018 Elsevier Ltd. All rights reserved.

Assessment of inattention in the context of delirium screening: one size does not fit all!

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Voyer, Philippe; Champoux, Nathalie; Desrosiers, Johanne; Landreville, Philippe; Monette, Johanne; Savoie, Maryse; Carmichael, Pierre-Hugues; Richard, Sylvie; Bédard, Annick

2016-08-01

Despite its high prevalence and deleterious consequences, delirium often goes undetected in older hospitalized patients and long-term care (LTC) residents. Inattention is a core symptom of this syndrome. The aim of this study was to explore the usefulness of ten simple and objective attention tests that would enable efficient delirium screening among this population. This was a secondary analysis (n = 191) of a validation study conducted in one acute care hospital (ACH) and one LTC facility among older adults with, or without, cognitive impairment. The attention test tasks (n = 10) were drawn from the Concentration subscale the Hierarchic Dementia Scale (HDS). Delirium was defined as meeting the criteria for DSM-5 delirium. The Confusion Assessment Method (CAM) was used to determine the presence of delirium symptoms. The Months of the Year Backward (MOTYB) test, which 57% of participants completed successfully, showed the best balance between sensitivity and specificity (82.6%; 95% CI [61.2-95.0], and 62.5%; 95% CI [54.7-69.8] respectively) for the entire group. Subgroup analyses revealed that no test had both sensitivity and specificity over 50% in participants with cognitive impairment indicated in their medical chart. Our results revealed that these tests varied greatly in performance and none can be earmarked to become a single-item screening tool for delirium among older patients and residents with, or without, cognitive impairment. The presence of premorbid cognitive impairment may necessitate more extensive assessments of delirium, especially when a change in general status or mental state is observed.

Analysis of affective disorders in patients with vascular dementia

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D. V. Zakharchenko

2012-01-01

Full Text Available The outpatient records of 147 patients followed up for diagnosed vascular dementia were analyzed to assess the relationship between affective disorders and severe cognitive impairments. It was found that 7% of the examinees had a history of depressive states. Estimating the development time for vascular dementia could divide the patients into 2 groups: 1 60% of the patients in whom cognitive impairments began to determine its clinical picture just within the first 2 years after identification of affective disorders and 2 40%, in whom cognitive impairments occurred 10—20 years later. In both groups, mental disorders occurred at an equal age in the presence of depressive disorders; in Group 1, vascular dementia developed nearly twice as often as that in Group 2. At the same time, the occurrence of cognitive impairments in Group 1 patients just in the early disease stages is indicative of the organic genesis of affective disorders, as confirmed by the moderately rapid progression of psychopathological symptoms, such as sharpening of personality traits, increased rigidity of psychic processes, emotional lability, variations in affective symptomatology, inadequate remissions, and the presence of neurological symptoms. Another type of a ratio of depressive to severe cognitive disorders was found in the elderly persons in Group 2. The long existence of affective disorders without signs of cognitive diminution leads one to say that they have recurrent depressive disorder with further addition of a comorbid vascular process. These patients showed a fairly high severity of affective pathology that was responsible for more frequent admissions, as well as a phase course with relatively pure remissions without any clear intellectual-mnestic reduction and a predominance of hysterical character traits.

Advancing the Neurophysiological Understanding of Delirium.

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Shafi, Mouhsin M; Santarnecchi, Emiliano; Fong, Tamara G; Jones, Richard N; Marcantonio, Edward R; Pascual-Leone, Alvaro; Inouye, Sharon K

2017-06-01

Delirium is a common problem associated with substantial morbidity and increased mortality. However, the brain dysfunction that leads some individuals to develop delirium in response to stressors is unclear. In this article, we briefly review the neurophysiologic literature characterizing the changes in brain function that occur in delirium, and in other cognitive disorders such as Alzheimer's disease. Based on this literature, we propose a conceptual model for delirium. We propose that delirium results from a breakdown of brain function in individuals with impairments in brain connectivity and brain plasticity exposed to a stressor. The validity of this conceptual model can be tested using Transcranial Magnetic Stimulation in combination with Electroencephalography, and, if accurate, could lead to the development of biomarkers for delirium risk in individual patients. This model could also be used to guide interventions to decrease the risk of cerebral dysfunction in patients preoperatively, and facilitate recovery in patients during or after an episode of delirium. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

A behavioral rehabilitation intervention for amnestic Mild Cognitive Impairment

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Greenaway, Melanie C.; Hanna, Sherrie M.; Lepore, Susan W.; Smith, Glenn E.

2010-01-01

Individuals with amnestic Mild Cognitive Impairment (MCI) currently have few treatment options for combating their memory loss. The Memory Support System (MSS) is a calendar and organization system with accompanying 6-week curriculum designed for individuals with progressive memory impairment. Ability to learn the MSS and its utility were assessed in 20 participants. Participants were significantly more likely to successfully use the calendar system after training. Ninety-five percent were compliant with the MSS at training completion, and 89% continued to be compliant at follow-up. Outcome measures revealed a medium effect size for improvement in functional ability. Subjects further reported improved independence, self-confidence, and mood. This initial examination of the MSS suggests that with appropriate training, individuals with amnestic MCI can and will use a memory notebook system to help compensate for memory loss. These results are encouraging that the MSS may help with the symptoms of memory decline in MCI. PMID:18955724

Association of Cognitive and Noncognitive Symptoms of Delirium: A Study from Consultation-liaison Psychiatry Set-up.

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Grover, Sandeep; Mehra, Aseem; Chakrabarti, Subho; Avasthi, Ajit

2016-12-01

This study aims to evaluate the cognitive functions of patients with delirium using Hindi Mental Status Examination (HMSE), to study the correlation of cognitive functions assessed by HMSE with noncognitive symptoms as assessed using Delirium Rating Scale-Revised 1998 (DRS-R-98) and to study the association of cognitive functions assessed using HMSE and DRS-R98. A total of 76 consecutive patients fulfilling the diagnosis of delirium were evaluated on DRS-R-98, HMSE, and Short Informant Questionnaire on Cognitive Decline in the Elderly (retrospective IQCODE). The mean DRS-R-98 score 33.9 (standard deviation [SD] - 7.2) and the mean DRS-R-98 severity score was 25.9 (SD - 7.2). The mean score on HMSE was 19.3 (7.98). There were significant correlations of all the domains of HMSE with DRS-R-98 total score, DRS-R-98 severity score, DRS-R-98 cognitive subscale score, DRS-R-98 noncognitive domain subscale score, and DRS severity score without attention score. When the association of each item of DRS-R-98 and HMSE was evaluated, except for the items of delusions, lability of affect and motor retardation, there were significant negative association between all the items of DRS-R-98 and HMSE, indicating that higher severity of cognitive symptoms as assessed on HMSE is associated with higher severity of all the cognitive symptoms and most of the noncognitive symptoms as assessed by DRS-R-98. The present study suggests that attention deficits in patients with delirium influence the severity of cognitive and noncognitive symptoms of delirium. Further, the present study suggests an increase in the severity of cognitive symptoms in other domains is also associated with an increase in the severity of noncognitive symptoms of delirium.

Factors associated with a depressive disorder in Alzheimer's disease are different from those found for other dementia disorders.

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Barca, Maria Lage; Engedal, Knut; Laks, Jerson; Selbaek, Geir

2012-01-01

This study explores factors associated with depression in Alzheimer's disease (AD) compared with mild cognitive impairment (MCI) and other dementia disorders. In a prospective study we included 195 patients: 31 with MCI, 112 with AD and 52 with other dementias. According to the ICD-10 and the DSM-IV criteria, 88 (44.1%) and 59 (30.3%), respectively, had a depressive disorder. An adjusted multiple regression analysis showed that previous depression (p depression in AD patients. Severity of dementia (p depressive disorder in a group of patients with frontotemporal dementia, vascular dementia, or dementia due to Lewy Body disease or Parkinson's disease. We found different factors associated with a depressive disorder in AD compared to those found for other dementia disorders.

Cholinergic imaging in dementia spectrum disorders

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Roy, Roman; Niccolini, Flavia; Pagano, Gennaro; Politis, Marios [Institute of Psychiatry, Psychology and Neuroscience, King' s College London, Neurodegeneration Imaging Group, Department of Basic and Clinical Neuroscience, London (United Kingdom)

2016-07-15

The multifaceted nature of the pathology of dementia spectrum disorders has complicated their management and the development of effective treatments. This is despite the fact that they are far from uncommon, with Alzheimer's disease (AD) alone affecting 35 million people worldwide. The cholinergic system has been found to be crucially involved in cognitive function, with cholinergic dysfunction playing a pivotal role in the pathophysiology of dementia. The use of molecular imaging such as SPECT and PET for tagging targets within the cholinergic system has shown promise for elucidating key aspects of underlying pathology in dementia spectrum disorders, including AD or parkinsonian dementias. SPECT and PET studies using selective radioligands for cholinergic markers, such as [{sup 11}C]MP4A and [{sup 11}C]PMP PET for acetylcholinesterase (AChE), [{sup 123}I]5IA SPECT for the α{sub 4}β{sub 2} nicotinic acetylcholine receptor and [{sup 123}I]IBVM SPECT for the vesicular acetylcholine transporter, have been developed in an attempt to clarify those aspects of the diseases that remain unclear. This has led to a variety of findings, such as cortical AChE being significantly reduced in Parkinson's disease (PD), PD with dementia (PDD) and AD, as well as correlating with certain aspects of cognitive function such as attention and working memory. Thalamic AChE is significantly reduced in progressive supranuclear palsy (PSP) and multiple system atrophy, whilst it is not affected in PD. Some of these findings have brought about suggestions for the improvement of clinical practice, such as the use of a thalamic/cortical AChE ratio to differentiate between PD and PSP, two diseases that could overlap in terms of initial clinical presentation. Here, we review the findings from molecular imaging studies that have investigated the role of the cholinergic system in dementia spectrum disorders. (orig.)

Cholinergic imaging in dementia spectrum disorders

International Nuclear Information System (INIS)

Roy, Roman; Niccolini, Flavia; Pagano, Gennaro; Politis, Marios

2016-01-01

The multifaceted nature of the pathology of dementia spectrum disorders has complicated their management and the development of effective treatments. This is despite the fact that they are far from uncommon, with Alzheimer's disease (AD) alone affecting 35 million people worldwide. The cholinergic system has been found to be crucially involved in cognitive function, with cholinergic dysfunction playing a pivotal role in the pathophysiology of dementia. The use of molecular imaging such as SPECT and PET for tagging targets within the cholinergic system has shown promise for elucidating key aspects of underlying pathology in dementia spectrum disorders, including AD or parkinsonian dementias. SPECT and PET studies using selective radioligands for cholinergic markers, such as [ 11 C]MP4A and [ 11 C]PMP PET for acetylcholinesterase (AChE), [ 123 I]5IA SPECT for the α 4 β 2 nicotinic acetylcholine receptor and [ 123 I]IBVM SPECT for the vesicular acetylcholine transporter, have been developed in an attempt to clarify those aspects of the diseases that remain unclear. This has led to a variety of findings, such as cortical AChE being significantly reduced in Parkinson's disease (PD), PD with dementia (PDD) and AD, as well as correlating with certain aspects of cognitive function such as attention and working memory. Thalamic AChE is significantly reduced in progressive supranuclear palsy (PSP) and multiple system atrophy, whilst it is not affected in PD. Some of these findings have brought about suggestions for the improvement of clinical practice, such as the use of a thalamic/cortical AChE ratio to differentiate between PD and PSP, two diseases that could overlap in terms of initial clinical presentation. Here, we review the findings from molecular imaging studies that have investigated the role of the cholinergic system in dementia spectrum disorders. (orig.)

A Family-Focused Delirium Educational Initiative With Practice and Research Implications.

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Paulson, Christina May; Monroe, Todd; McDougall, Graham J; Fick, Donna M

2016-01-01

Delirium is burdensome and psychologically distressing for formal and informal caregivers, yet family caregivers often have very little understanding or knowledge about delirium. As part of a large multisite intervention study, the Early Nurse Detection of Delirium Superimposed on Dementia (END-DSD), the authors identified a need for family educational materials. This educational initiative's purpose was to develop a delirium admission brochure for family members to aid in the prevention and earlier identification of delirium during hospitalization. A brochure was developed using an iterative approach with an expert panel. Following three iterations, a final brochure was approved. The authors found that an iterative expert consensus approach can be used to develop a brochure for families. Major content areas were helping families understand the difference between delirium and dementia, signs and symptoms of delirium, causes of delirium, and strategies family members can use to prevent delirium. A caregiver-focused educational brochure is one intervention to use in targeting older adults hospitalized with delirium.

A reorientation strategy for reducing delirium in the critically ill. Results of an interventional study.

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Colombo, R; Corona, A; Praga, F; Minari, C; Giannotti, C; Castelli, A; Raimondi, F

2012-09-01

A wide variability in the approach towards delirium prevention and treatment in the critically ill results from the dearth of prospective randomised studies. We launched a two-stage prospective observational study to assess delirium epidemiology, risk factors and impact on patient outcome, by enrolling all patients admitted to our Intensive Care Unit (ICU) over a year. The first step - from January to June 2008 was the observational phase, whereas the second one from July to December 2008 was interventional. All the patients admitted to our ICU were recruited but those with pre-existing cognitive disorders, dementia, psychosis and disability after stroke were excluded from the data analysis. Delirium assessment was performed according with Confusion Assessment Method for the ICU twice per day after sedation interruption. During phase 2, patients underwent both a re-orientation strategy and environmental, acoustic and visual stimulation. We admitted a total of respectively 170 (I-ph) and 144 patients (II-ph). The delirium occurrence was significantly lower in (II-ph) 22% vs. 35% in (I-ph) (P=0.020). A Cox's Proportional Hazard model found the applied reorientation strategy as the strongest protective predictors of delirium: (HR 0.504, 95% C.I. 0.313-0.890, P=0.034), whereas age (HR 1.034, 95% CI: 1.013-1.056, P=0.001) and sedation with midazolam plus opiate (HR 2.145, 95% CI: 2.247-4.032, P=0.018) were negative predictors. A timely reorientation strategy seems to be correlated with significantly lower occurrence of delirium.

Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

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Otremba I

2016-04-01

Full Text Available Iwona Otremba, Krzysztof Wilczyński, Jan SzewieczekDepartment of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, PolandBackground: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies.Objective: Evaluate specific factors for development of delirium in a geriatric ward setting.Methods: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men, admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed.Results: Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001, preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001, previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001, previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006, and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014.Conclusion: Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.Keywords: delirium

Frequency and Severity of Semantic Deficits in a Consecutive Memory Clinic Cohort

DEFF Research Database (Denmark)

Vogel, Asmus; Johannsen, Peter; Stokholm, Jette

2014-01-01

Background/Aim: Semantic memory deficits have been shown in dementia and mild cognitive impairment (MCI) by group comparisons. The aim of this study is to investigate the frequency of impairments on tests with semantic content in patients with dementia, MCI (amnestic and non-amnestic) and affective......). However, patients with affective disorders also had mild impairments on tests tapping semantic memory (25% were impaired on the most sensitive tests). Impairments on the Famous faces test were more frequently found in dementia and MCI as compared to patients with affective disorders. Conclusion: Short...... tests with semantic memory content are sensitive to changes in dementia and MCI, but impairments on such tests may also be found in other diseases, e.g. affective disorders. © 2014 S. Karger AG, Basel....

Delirium in Hospitalized Patients: Implications of Current Evidence on Clinical Practice and Future Avenues for Research—A Systematic Evidence Review

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Khan, Babar A.; Zawahiri, Mohammed; Campbell, Noll L.; Fox, George C.; Weinstein, Eric J.; Nazir, Arif; Farber, Mark O.; Buckley, John D.; MacLullich, Alasdair; (UK), MRCP; Boustani, Malaz A.

2013-01-01

BACKGROUND Despite the significant burden of delirium among hospitalized adults, critical appraisal of systematic data on delirium diagnosis, pathophysiology, treatment, prevention, and outcomes is lacking. PURPOSE To provide evidence-based recommendations for delirium care to practitioners, and identify gaps in delirium research. DATA SOURCES Medline, PubMed, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems fromJanuary 1966 to April 2011. STUDY SELECTION All published systematic evidence reviews (SERs) on delirium were evaluated. DATA EXTRACTION Three reviewers independently extracted the data regarding delirium risk factors, diagnosis, prevention, treatment, and outcomes, and critically appraised each SER as good, fair, or poor using the United States Preventive Services Task Force criteria. DATA SYNTHESIS Twenty-two SERs graded as good or fair provided the data. Age, cognitive impairment, depression, anticholinergic drugs, and lorazepam use were associated with an increased risk for developing delirium. The Confusion Assessment Method (CAM) is reliable for delirium diagnosis outside of the intensive care unit. Multicomponent nonpharmacological interventions are effective in reducing delirium incidence in elderly medical patients. Low-dose haloperidol has similar efficacy as atypical antipsychotics for treating delirium. Delirium is associated with poor outcomes independent of age, severity of illness, or dementia. CONCLUSION Delirium is an acute, preventable medical condition with short- and long-term negative effects on a patient’s cognitive and functional states. PMID:22684893

Environmental factors predict the severity of delirium symptoms in long-term care residents with and without delirium.

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McCusker, Jane; Cole, Martin G; Voyer, Philippe; Vu, Minh; Ciampi, Antonio; Monette, Johanne; Champoux, Nathalie; Belzile, Eric; Dyachenko, Alina

2013-04-01

To identify potentially modifiable environmental factors (including number of medications) associated with changes over time in the severity of delirium symptoms and to explore the interactions between these factors and resident baseline vulnerability. Prospective, observational cohort study. Seven long-term care (LTC) facilities. Two hundred seventy-two LTC residents aged 65 and older with and without delirium. Weekly assessments (for up to 6 months) of the severity of delirium symptoms using the Delirium Index (DI), environmental risk factors, and number of medications. Baseline vulnerability measures included a diagnosis of dementia and a delirium risk score. Associations between environmental factors, medications, and weekly changes in DI were analyzed using a general linear model with correlated errors. Six potentially modifiable environmental factors predicted weekly changes in DI (absence of reading glasses, aids to orientation, family member, and glass of water and presence of bed rails and other restraints) as did the prescription of two or more new medications. Residents with dementia appeared to be more sensitive to the effects of these factors. Six environmental factors and prescription of two or more new medications predicted changes in the severity of delirium symptoms. These risk factors are potentially modifiable through improved LTC clinical practices. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

The Incidence of Delirium in Patients After Surgery in Recovery Room

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Leila M juybari

2012-10-01

Full Text Available Background and objective: Delirium is an acute and transient disorder in the function of the brain. Although the main core of this syndrome is consciousness disorder and deficiencies in attention and concentration, the general deficiency is seen in all psychological areas of thinking, temperament, cognition, language, speaking, sleeping, and mental-motional and other cognitive areas. Delirium is often seen in recovery room and is a predictor of post-operative delirium in the general ward. This study was conducted to determine the incidence of delirium in patients after surgery in the recovery room.Materials and Methods: This descriptive cross-sectional study was conducted on 75 patients after general and orthopedic surgery and in the recovery room of the educational-therapeutic center of Gorgan in 1389 using the DESC-Nu nursing delirium screening scale. Data was analyzed using chi-square descriptive and analytical statistics and T-test.Results: Among the 75 studied patients in the recovery room after orthopedic surgery and general surgery, 53.3% were women with a mean age of 48.7. The mean surgery duration was 129.21 minutes. 26.6% had been under spinal anesthesia and 73.3% had been under general anesthesia. Delirium was observed in 30.6% of all the patients. Delirium was observed in 21.3% of patients having orthopedic surgery and 9.3% of the patients having general surgery. Delirium had a significant statistical relation with the variables of age, gender, and type of surgery (p<0.05.Conclusion: This study showed that 30.6% of patients had delirium. Male and older patients having orthopedic surgery were more vulnerable. Therefore, usual assessment of delirium in recovery room to identify patients with delirium can be a guide of nurses’ appropriate care of patients after surgery.

Cognitive Profiles of Patients with Mild Cognitive Impairment or Dementia in Alzheimer's or Parkinson's Disease

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Helmut Hildebrandt

2013-04-01

Full Text Available Background: Alzheimer's disease (AD and Parkinson's disease (PD are associated with severe cognitive decline, but it is still unclear to what extent they become functionally more similar over time. Methods: We compared amnestic mild cognitively impaired (aMCI; n = 29 patients to mild cognitively impaired (MCI PD patients (n = 25, and patients with AD (n = 34 to patients with PD dementia (PDD; n = 15 with respect to cognitive functioning and mood. Results: aMCI patients were impaired in episodic memory, while MCI PD patients showed deficits in visuoconstruction and attention. AD and PDD patients showed comparable deficits on tests for language, attention and visuoconstruction. However, unlike PDD patients but similar to aMCI patients, AD patients showed a characteristic memory impairment, especially commission errors on recognition tasks, whereas PDD patients scored higher on the depressive mood questionnaire. Conclusions: In advanced stages of both diseases, the pattern of functional deficits associated with parietal and temporal lobe functions (attention, visuoconstruction and language is similar. However, specific differences, already present in the early stage (recognition errors in AD, associated with mediobasal temporal lobe functioning, and depressed mood in PDD, associated with non-motor basal ganglia loops, are also observed in the late stage.

Stop. Think. Delirium! A quality improvement initiative to explore utilising a validated cognitive assessment tool in the acute inpatient medical setting to detect delirium and prompt early intervention.

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Malik, Angela; Harlan, Todd; Cobb, Janice

2016-11-01

The paper examines the ability of nursing staff to detect delirium and apply early intervention to decrease adverse events associated with delirium. To characterise nursing practices associated with staff knowledge, delirium screening utilising the Modified Richmond Assessment Sedation Score (mRASS), and multicomponent interventions in an acute inpatient medical unit. Delirium incidence rates are up to 60% in frail elderly hospitalised patients. Under-recognition and inconsistent management of delirium is an international problem. Falls, restraints, and increased hospital length of stay are linked to delirium. A descriptive study. Exploration of relationships between cause and effect among cognitive screening, knowledge assessment and interventions. Success in identifying sufficient cases of delirium was not evident; however, multicomponent interventions were applied to patients with obvious symptoms. An increase in nursing knowledge was demonstrated after additional training. Delirium screening occurred in 49-61% of the target population monthly, with challenges in compliance and documentation of screening and interventions. Technological capabilities for trending mRASS results do not exist within the current computerised patient record system. Delirium screening increases awareness of nursing staff, prompting more emphasis on early intervention in apparent symptoms. Technological support is needed to effectively document and visualise trends in screening results. The study imparts future research on the effects of cognitive screening on delirium prevention and reduction in adverse patient outcomes. Evidence-based literature reveals negative patient outcomes associated with delirium. However, delirium is highly under-recognised indicating future research is needed to address nursing awareness and recognition of delirium. Additional education and knowledge transformation from research to nursing practice are paramount in the application of innovative strategies

SCOPA-Cognition Cutoff Value for Detection of Parkinson's Disease Dementia

NARCIS (Netherlands)

Verbaan, Dagmar; Jeukens-Visser, Martine; Van Laar, Teus; van Rooden, Stephanie M.; Van Zwet, Erik W.; Marinus, Johan; van Hilten, Jacobus J.

2011-01-01

The SCOPA-Cognition is a reliable and valid test to evaluate cognitive functioning in Parkinson's disease and is widely used in clinical and research settings. Recently, the Movement Disorder Society introduced criteria for Parkinson's disease dementia. The objective of the present study was to use

Delirium symptoms are associated with decline in cognitive function between ages 53 and 69 years: Findings from a British birth cohort study.

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Tsui, Alex; Kuh, Diana; Richards, Marcus; Davis, Daniel

2017-11-21

Few population studies have investigated whether longitudinal decline after delirium in mid-to-late life might affect specific cognitive domains. Participants from a birth cohort completing assessments of search speed, verbal memory, and the Addenbrooke's Cognitive Examination at age 69 were asked about delirium symptoms between ages 60 and 69 years. Linear regression models estimated associations between delirium symptoms and cognitive outcomes. Period prevalence of delirium between 60 and 69 years was 4% (95% confidence interval 3.2%-4.9%). Self-reported symptoms of delirium over the seventh decade were associated with worse scores in the Addenbrooke's Cognitive Examination (-1.7 points; 95% confidence interval -3.2, -0.1; P = .04). In association with delirium symptoms, verbal memory scores were initially lower, with subsequent decline in search speed by the age of 69 years. These effects were independent of other Alzheimer's risk factors. Delirium symptoms may be common even at relatively younger ages, and their presence may herald cognitive decline, particularly in search speed, over this time period. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Detection and Differentiation of Frontotemporal Dementia and Related Disorders From Alzheimer Disease Using the Montreal Cognitive Assessment.

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Coleman, Kristy K L; Coleman, Brenda L; MacKinley, Julia D; Pasternak, Stephen H; Finger, Elizabeth C

2016-01-01

The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool used by practitioners worldwide. The efficacy of the MoCA for screening frontotemporal dementia (FTD) and related disorders is unknown. The objectives were: (1) to determine whether the MoCA detects cognitive impairment (CI) in FTD subjects; (2) to determine whether Alzheimer disease (AD) and FTD subtypes and related disorders can be parsed using the MoCA; and (3) describe longitudinal MoCA performance by subtype. We extracted demographic and testing data from a database of patients referred to a cognitive neurology clinic who met criteria for probable AD or FTD (N=192). Logistic regression was used to determine whether dementia subtypes were associated with overall scores, subscores, or combinations of subscores on the MoCA. Initial MoCA results demonstrated CI in the majority of FTD subjects (87%). FTD subjects (N=94) performed better than AD subjects (N=98) on the MoCA (mean scores: 18.1 vs. 16.3; P=0.02). Subscores parsed many, but not all subtypes. FTD subjects had a larger decline on the MoCA within 13 to 36 months than AD subjects (P=0.02). The results indicate that the MoCA is a useful tool to identify and track progression of CI in FTD. Further, the data informs future research on scoring models for the MoCA to enhance cognitive screening and detection of FTD patients.

Cognitive screening in Parkinson's disease: Comparison of the Parkinson Neuropsychometric Dementia Assessment (PANDA) with 3 other short scales.

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Gasser, A-I; Calabrese, P; Kalbe, E; Kessler, J; Rossier, P

2016-02-01

Cognitive screening is crucial in Parkinson's disease (PD). However, there is still a lack of short tools in French. In this study, we aimed to compare the Parkinson Neuropsychometric Dementia Assessment (PANDA) with the Mini Mental Parkinson (MMP), the Mini Mental State Examination (MMSE) and the Clock Test in French-speaking patients. We also aimed to propose cut-off scores for cognitive impairment and dementia for the French language version of the PANDA. Fifty-one patients with PD took the PANDA, the MMSE, the MMP, and the Clock Test. They also underwent extensive neuropsychological testing by a neuropsychologist who was blinded to the above-mentioned screening test results. Patients were classified as either having normal cognition (n=15), mild cognitive impairment (n=20) or dementia (n=16). When compared with the three other screening tools, the PANDA exhibited the highest area under the curve (AUC) for both cognitive disorders and dementia. Using the cut-off scores proposed for the German version, the PANDA had 94% specificity and 100% sensitivity for dementia and 100% and 72%, respectively for cognitive disorders. In our study, the PANDA exhibited a higher discriminative power than the three other tests in detecting cognitive disorders and dementia. In PD patients, the PANDA should thus be considered for the detection of cognitive impairment in routine clinical practice. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Investigating Simulated Driving Errors in Amnestic Single- and Multiple-Domain Mild Cognitive Impairment.

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Hird, Megan A; Vesely, Kristin A; Fischer, Corinne E; Graham, Simon J; Naglie, Gary; Schweizer, Tom A

2017-01-01

The areas of driving impairment characteristic of mild cognitive impairment (MCI) remain unclear. This study compared the simulated driving performance of 24 individuals with MCI, including amnestic single-domain (sd-MCI, n = 11) and amnestic multiple-domain MCI (md-MCI, n = 13), and 20 age-matched controls. Individuals with MCI committed over twice as many driving errors (20.0 versus 9.9), demonstrated difficulty with lane maintenance, and committed more errors during left turns with traffic compared to healthy controls. Specifically, individuals with md-MCI demonstrated greater driving difficulty compared to healthy controls, relative to those with sd-MCI. Differentiating between different subtypes of MCI may be important when evaluating driving safety.

Nonliteral language in Alzheimer dementia: a review.

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Rapp, Alexander M; Wild, Barbara

2011-03-01

The use of nonliteral language in clinical assessment, especially testing the patients' ability to interpret proverbs, has a long tradition in psychiatry. However, its diagnostic sensitivity and specificity in dementias is not yet clear. The aim of this review article is to examine the current evidence on nonliteral/figurative language (proverb, metaphor, metonymy, idiom, irony, sarcasm) comprehension in Alzheimer's disease and related disorders. A comprehensive literature search identified 25 studies (16 proverb, 3 metaphor, 0 metonymy, 5 idiom, 3 sarcasm) on nonliteral language comprehension in dementia. Studies predominantly indicate a deficit. Most studies investigated Alzheimer's dementia. Applied correctly, nonliteral language is a worthwhile diagnostic tool to evaluate language and abstract thinking in dementias. During assessment, familiarity testing (e.g., by asking "are you familiar with the proverb XY") is obligatory. Still, future research is needed in several areas: evidence on decline of nonliteral language over the course of the illness is limited. So far, almost no studies delineated proverb comprehension in high risk populations such as patients with mild cognitive impairment. Currently, there is a lack of studies addressing performance in direct comparison to relevant differential diagnosis like older-age depression, delirium, brain lesion, or other psychiatric conditions.

Association between fully automated MRI-based volumetry of different brain regions and neuropsychological test performance in patients with amnestic mild cognitive impairment and Alzheimer's disease.

Science.gov (United States)

Arlt, Sönke; Buchert, Ralph; Spies, Lothar; Eichenlaub, Martin; Lehmbeck, Jan T; Jahn, Holger

2013-06-01

Fully automated magnetic resonance imaging (MRI)-based volumetry may serve as biomarker for the diagnosis in patients with mild cognitive impairment (MCI) or dementia. We aimed at investigating the relation between fully automated MRI-based volumetric measures and neuropsychological test performance in amnestic MCI and patients with mild dementia due to Alzheimer's disease (AD) in a cross-sectional and longitudinal study. In order to assess a possible prognostic value of fully automated MRI-based volumetry for future cognitive performance, the rate of change of neuropsychological test performance over time was also tested for its correlation with fully automated MRI-based volumetry at baseline. In 50 subjects, 18 with amnestic MCI, 21 with mild AD, and 11 controls, neuropsychological testing and T1-weighted MRI were performed at baseline and at a mean follow-up interval of 2.1 ± 0.5 years (n = 19). Fully automated MRI volumetry of the grey matter volume (GMV) was performed using a combined stereotactic normalisation and segmentation approach as provided by SPM8 and a set of pre-defined binary lobe masks. Left and right hippocampus masks were derived from probabilistic cytoarchitectonic maps. Volumes of the inner and outer liquor space were also determined automatically from the MRI. Pearson's test was used for the correlation analyses. Left hippocampal GMV was significantly correlated with performance in memory tasks, and left temporal GMV was related to performance in language tasks. Bilateral frontal, parietal and occipital GMVs were correlated to performance in neuropsychological tests comprising multiple domains. Rate of GMV change in the left hippocampus was correlated with decline of performance in the Boston Naming Test (BNT), Mini-Mental Status Examination, and trail making test B (TMT-B). The decrease of BNT and TMT-A performance over time correlated with the loss of grey matter in multiple brain regions. We conclude that fully automated MRI

Ecological validity of virtual reality daily living activities screening for early dementia: longitudinal study.

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Tarnanas, Ioannis; Schlee, Winfried; Tsolaki, Magda; Müri, René; Mosimann, Urs; Nef, Tobias

2013-08-06

Dementia is a multifaceted disorder that impairs cognitive functions, such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviors. In most cases, individuals with dementia experience difficulties interacting with physical and social environments. The purpose of this study was to establish ecological validity and initial construct validity of a fire evacuation Virtual Reality Day-Out Task (VR-DOT) environment based on performance profiles as a screening tool for early dementia. The objectives were (1) to examine the relationships among the performances of 3 groups of participants in the VR-DOT and traditional neuropsychological tests employed to assess executive functions, and (2) to compare the performance of participants with mild Alzheimer's-type dementia (AD) to those with amnestic single-domain mild cognitive impairment (MCI) and healthy controls in the VR-DOT and traditional neuropsychological tests used to assess executive functions. We hypothesized that the 2 cognitively impaired groups would have distinct performance profiles and show significantly impaired independent functioning in ADL compared to the healthy controls. The study population included 3 groups: 72 healthy control elderly participants, 65 amnestic MCI participants, and 68 mild AD participants. A natural user interface framework based on a fire evacuation VR-DOT environment was used for assessing physical and cognitive abilities of seniors over 3 years. VR-DOT focuses on the subtle errors and patterns in performing everyday activities and has the advantage of not depending on a subjective rating of an individual person. We further assessed functional capacity by both neuropsychological tests (including measures of attention, memory, working memory, executive functions, language, and depression). We also evaluated performance in finger tapping, grip strength, stride length, gait speed, and chair stands separately and

Cognitive and motor symptoms in dementia: focus on dementia with Lewy bodies.

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Lingler, Jennifer Hagerty; Kaufer, Daniel I

2002-09-01

To describe the clinical syndrome called dementia with Lewy bodies (DLB) and highlight its common and unique characteristics with respect to diagnosis and management. Review of the scientific literature including psychiatric literature, reports of clinical trials, and clinical practice guidelines. DLB is a clinical and histopathologic disease, which is second only to Alzheimer's disease (AD) as a cause of dementia in older adults. The clinical syndrome of DLB includes cognitive and motor deterioration reminiscent of symptoms associated with AD and Parkinson's disease (PD) respectively. The late life intersection of cognitive and motor symptoms can present significant challenges in the primary care setting. Recognizing key features of common neurodegenerative disorders is essential to accurately diagnosing and appropriately treating the growing population of older adults who suffer from AD, PD, and DLB.

New horizons in the pathogenesis, assessment and management of delirium

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Maclullich, Alasdair M. J.; Anand, Atul; Davis, Daniel H. J.; Jackson, Thomas; Barugh, Amanda J.; Hall, Roanna J.; Ferguson, Karen J.; Meagher, David J.; Cunningham, Colm

2013-01-01

Delirium is one of the foremost unmet medical needs in healthcare. It affects one in eight hospitalised patients and is associated with multiple adverse outcomes including increased length of stay, new institutionalisation, and considerable patient distress. Recent studies also show that delirium strongly predicts future new-onset dementia, as well as accelerating existing dementia. The importance of delirium is now increasingly being recognised, with a growing research base, new professional international organisations, increased interest from policymakers, and greater prominence of delirium in educational and audit programmes. Nevertheless, the field faces several complex research and clinical challenges. In this article we focus on selected areas of recent progress and/or uncertainty in delirium research and practice. (i) Pathogenesis: recent studies in animal models using peripheral inflammatory stimuli have begun to suggest mechanisms underlying the delirium syndrome as well as its link with dementia. A growing body of blood and cerebrospinal fluid studies in humans have implicated inflammatory and stress mediators. (ii) Prevention: delirium prevention is effective in the context of research studies, but there are several unresolved issues, including what components should be included, the role of prophylactic drugs, and the overlap with general best care for hospitalised older people. (iii) Assessment: though there are several instruments for delirium screening and assessment, detection rates remain dismal. There are no clear solutions but routine screening embedded into clinical practice, and the development of new rapid screening instruments, offer potential. (iv) Management: studies are difficult given the heterogeneity of delirium and currently expert and comprehensive clinical care remains the main recommendation. Future studies may address the role of drugs for specific elements of delirium. In summary, though facing many challenges, the field continues

Biochemical Markers of Physical Exercise on Mild Cognitive Impairment and Dementia

DEFF Research Database (Denmark)

Jensen, Camilla Steen; Hasselbalch, Steen Gregers; Waldemar, Gunhild

2015-01-01

BACKGROUND: The cognitive effects of physical exercise in patients with dementia disorders or mild cognitive impairment have been examined in various studies; however the biochemical effects of exercise from intervention studies are largely unknown. The objective of this systematic review...

Category verbal fluency performance may be impaired in amnestic mild cognitive impairment

Directory of Open Access Journals (Sweden)

Márcio Luiz Figueredo Balthazar

Full Text Available Abstract To study category verbal fluency (VF for animals in patients with amnestic mild cognitive impairment (aMCI, mild Alzheimer disease (AD and normal controls. Method: Fifteen mild AD, 15 aMCI, and 15 normal control subjects were included. Diagnosis of AD was based on DSM-IV and NINCDS-ADRDA criteria, while aMCI was based on the criteria of the International Working Group on Mild Cognitive Impairment, using CDR 0.5 for aMCI and CDR 1 for mild AD. All subjects underwent testing of category VF for animals, lexical semantic function (Boston Naming-BNT, CAMCOG Similarities item, WAIS-R forward and backward digit span, Rey Auditory Verbal Learning (RAVLT, Mini-Mental Status Examination (MMSE, and other task relevant functions such as visual perception, attention, and mood state (with Cornell Scale for Depression in Dementia. Data analysis used ANOVA and a post-hoc Tukey test for intergroup comparisons, and Pearson's coefficient for correlations of memory and FV tests with other task relevant functions (statistical significance level was p<0.05. Results: aMCI patients had lower performance than controls on category VF for animals and on the backward digit span subtest of WAIS-R but higher scores compared with mild AD patients. Mild AD patients scored significantly worse than aMCI and controls across all tests. Conclusion: aMCI patients may have poor performance in some non-memory tests, specifically category VF for animals in our study, where this could be attributable to the influence of working memory.

[Differentiating early dementia from major depression with the Spanish version of the Addenbrooke's Cognitive Examination].

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Roca, M; Torralva, T; López, P; Marengo, J; Cetkovich, M; Manes, F

In clinical practice it is often difficult to establish whether cognitive impairment is secondary to an affective disorder or a dementing process. To describe the cognitive performance on the Spanish version of the Addenbrooke's Cognitive Examination (ACE) of patients with early dementia and depression. 77 patients with early dementia (53 Alzheimer disease; 24 frontotemporal dementia), 17 patients with major depression and 54 healthy volunteers were tested with the Spanish version of the ACE. Alzheimer disease and frontotemporal dementia groups were significantly lower than the control group and the major depression group. When the major depression group was compared with the control group no significant differences were found. The cognitive performance in the ACE is different in patients with early dementia and patient with depression.

Intracranial stenosis in cognitive impairment and dementia.

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Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

2017-06-01

Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

The importance of early recognition and timely treatment of delirium in intensive care units

Directory of Open Access Journals (Sweden)

Stašević-Karličić Ivana

2016-01-01

Full Text Available Delirium is connected to bad short-term (the increase in hospital mortality rate and hospital days and long-term outcomes (disfunctionality, institutionalisation, cognitive damage and post hospital-release dementia. The objective of this study is to determine whether there are possible incompatibilities of treatment of delirium with the recommendations in the guides of good clinical practice from developed countries. The grounded method was used in the study. The so called principal sampling of 17 psychiatrists, anesthesiologists and registered nurses was conducted. Afterwards, the unstructured interviews with the selectees were conducted, transcribed and analyzed immediately through coding, category and concept detection. Having completed this, the theoretical sampling of new interview examinees was conducted. Their analysis enabled the concepts to be linked into a working theory and graphically displayed. The new sampling, the new interviews and their analysis were then continued interactively until the saturation of the working theory was achieved and the final version of the theory was formulated based on the findings reached through the interviews. Having completed the principal sampling and coding of the transcripts led the researches to the saturation of the theory through the separation of eight categories: A - Delirium as a sign of system infection, B - Therapy - Anaesthesiologists administer benzodiazepines, whereas psychiatrists administer antipsychotics, C - An inconspicuous onset of delirium is overlooked, D - Bleeding as the cause of delirium, E -Anticholinergics as a cause of delirium, F - Misunderstanding the nature of delirium by anaesthesiologists, G -Being aware that the patient is vitally endangered, and H - The nurses apply enhanced health care measures. Delirium is a syndrome which can be prevented in 30 -40% of cases (50. An etiological treatment would help avoid complicating delirium's clinical picture and would very much

Cognitive assessment of older people

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Young, John; Meagher, David; MacLullich, Alasdair J

2011-01-01

peer-reviewed Cognitive assessment involves examination of higher cortical functions, particularly memory, attention, orientation, language, executive function (planning activities), and praxis (sequencing of activities). This article will focus on cognitive assessment of older people (those aged over about 65 years) in the context of possible dementia, delirium, and depression. These are common and serious clinical syndromes affecting older people, and accurate cognit...

Subjective cognitive complaints included in diagnostic evaluation of dementia helps accurate diagnosis in a mixed memory clinic cohort

DEFF Research Database (Denmark)

Salem, L C; Vogel, Asmus Mejling; Ebstrup, J

2015-01-01

OBJECTIVE: Our objective was to examine the quantity and profile of subjective cognitive complaints in young patients as compared with elderly patients referred to a memory clinic. METHODS: Patients were consecutively recruited from the Copenhagen University Hospital Memory Clinic at Rigshospitalet....... In total, 307 patients and 149 age-matched healthy controls were included. Patients were classified in 4 diagnostic groups: dementia, mild cognitive impairment, affective disorders and no cognitive impairment. Subjective memory was assessed with subjective memory complaints (SMC) scale. Global cognitive...... with dementia have a significantly higher level and a different profile of subjective cognitive complaints as compared with elderly patients with dementia. Furthermore, young patients, diagnosed with an affective disorder, had the highest level of subjective cognitive complaints of all patients in a memory...

Mild cognitive impairment: applicability of research criteria in a memory clinic and characterization of cognitive profile.

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Alladi, Suvarna; Arnold, Robert; Mitchell, Joanna; Nestor, Peter J; Hodges, John R

2006-04-01

We explored the applicability of recently proposed research criteria for mild cognitive impairment (MCI) in a memory clinic and changes in case definition related to which memory tests are used and the status of general cognitive function in MCI. A total of 166 consecutive GP referrals to the Cambridge Memory Clinic underwent comprehensive neuropsychological and psychiatric evaluation. Of 166 cases, 42 were excluded (significant depression 8, established dementia 29 and other disorders 5). Of 124 non-demented, non-depressed patients, 72 fulfilled Petersen's criteria for amnestic MCI based upon verbal memory performance [the Rey Auditory Verbal Learning Test (RAVLT)] and 90 met criteria if performance on verbal and/or non-verbal memory tests [the Rey figure recall or the Paired Associates Learning test (PAL)] was considered. Of the 90 broadly defined MCI cases, only 25 had pure amnesia: other subtle semantic and/or attention deficits were typically present. A further 12 were classed as non-amnestic MCI and 22 as 'worried well'. Definition of MCI varies considerably dependent upon the tests used for case definition. The majority have other cognitive deficits despite normal performance on the Mini-mental State Examination (MMSE) and intact activities of daily living (ADL) and fit within multi-domain MCI. Pure amnesic MCI is rare.

Rule induction performance in amnestic mild cognitive impairment and Alzheimer's dementia: examining the role of simple and biconditional rule learning processes.

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Oosterman, Joukje M; Heringa, Sophie M; Kessels, Roy P C; Biessels, Geert Jan; Koek, Huiberdina L; Maes, Joseph H R; van den Berg, Esther

2017-04-01

Rule induction tests such as the Wisconsin Card Sorting Test require executive control processes, but also the learning and memorization of simple stimulus-response rules. In this study, we examined the contribution of diminished learning and memorization of simple rules to complex rule induction test performance in patients with amnestic mild cognitive impairment (aMCI) or Alzheimer's dementia (AD). Twenty-six aMCI patients, 39 AD patients, and 32 control participants were included. A task was used in which the memory load and the complexity of the rules were independently manipulated. This task consisted of three conditions: a simple two-rule learning condition (Condition 1), a simple four-rule learning condition (inducing an increase in memory load, Condition 2), and a complex biconditional four-rule learning condition-inducing an increase in complexity and, hence, executive control load (Condition 3). Performance of AD patients declined disproportionately when the number of simple rules that had to be memorized increased (from Condition 1 to 2). An additional increment in complexity (from Condition 2 to 3) did not, however, disproportionately affect performance of the patients. Performance of the aMCI patients did not differ from that of the control participants. In the patient group, correlation analysis showed that memory performance correlated with Condition 1 performance, whereas executive task performance correlated with Condition 2 performance. These results indicate that the reduced learning and memorization of underlying task rules explains a significant part of the diminished complex rule induction performance commonly reported in AD, although results from the correlation analysis suggest involvement of executive control functions as well. Taken together, these findings suggest that care is needed when interpreting rule induction task performance in terms of executive function deficits in these patients.

Leisure activities, cognition and dementia.

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Wang, Hui-Xin; Xu, Weili; Pei, Jin-Jing

2012-03-01

Accumulated evidence shows that leisure activities have a positive impact on cognitive function and dementia. This review aimed to systematically summarize the current evidence on this topic taking into account the limitations of the studies and biological plausibility for the underlying mechanisms linking cognition, dementia and leisure activities, with special attention on mental, physical and social activities. We included only longitudinal studies, with a follow-up time of at least 2 years, published in English from 1991 to March 2011 on leisure activities and cognition (n=29) or dementia (n=23) and provided some evidence from intervention studies on the topic. A protective effect of mental activity on cognitive function has been consistently reported in both observational and interventional studies. The association of mental activity with the risk of dementia was robust in observational studies but inconsistent in clinical trials. The protective effect of physical activity on the risk of cognitive decline and dementia has been reported in most observational studies, but has been less evident in interventional studies. Current evidence concerning the beneficial effect of other types of leisure activities on the risk of dementia is still limited and results are inconsistent. For future studies it is imperative that the assessment of leisure activities is standardized, for example, the frequency, intensity, duration and the type of activity; and also that the cognitive test batteries and the definition of cognitive decline are harmonized/standardized. Further, well designed studies with long follow-up times are necessary. This article is part of a Special Issue entitled: Imaging Brain Aging and Neurodegenerative disease. Copyright © 2011 Elsevier B.V. All rights reserved.

Postoperative delirium and postoperative cognitive dysfunction in the elderly - what are the differences?

DEFF Research Database (Denmark)

Krenk, L; Rasmussen, L S

2011-01-01

Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities of postoperat......Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities...... of postoperative cognitive decline, delirium and postoperative cognitive dysfunction, which are often reported as being part of the same continuum. Although there are similarities in the predisposing factors, it seems unlikely that they share the same pathophysiology. Both have multifactorial pathogenesis...... but differ in numerous other ways, with delirium being well-defined and acute in onset and postoperative cognitive dysfunction (POCD) being subtler and with longer duration. This review aims to provide an overview of the differences in the diagnosis of the two entities and to illustrate the methodological...

Everyday episodic memory in amnestic mild cognitive impairment: a preliminary investigation

OpenAIRE

LAWLOR, BRIAN; COEN, ROBERT; O'MARA, SHANE MICHAEL

2011-01-01

PUBLISHED Background: Decline in episodic memory is one of the hallmark features of Alzheimer's disease (AD) and is also a defining feature of amnestic Mild Cognitive Impairment (MCI), which is posited as a potential prodrome of AD. While deficits in episodic memory are well documented in MCI, the nature of this impairment remains relatively under-researched, particularly for those domains with direct relevance and meaning for the patient's daily life. In order to fully explore the impa...

Everyday episodic memory in amnestic mild cognitive impairment: a preliminary investigation

OpenAIRE

Irish, Muireann; Lawlor, Brian A; Coen, Robert F; O'Mara, Shane M

2011-01-01

Abstract Background Decline in episodic memory is one of the hallmark features of Alzheimer's disease (AD) and is also a defining feature of amnestic Mild Cognitive Impairment (MCI), which is posited as a potential prodrome of AD. While deficits in episodic memory are well documented in MCI, the nature of this impairment remains relatively under-researched, particularly for those domains with direct relevance and meaning for the patient's daily life. In order to fully explore the impact of di...

Delirium diagnosis defined by cluster analysis of symptoms versus diagnosis by DSM and ICD criteria: diagnostic accuracy study.

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Sepulveda, Esteban; Franco, José G; Trzepacz, Paula T; Gaviria, Ana M; Meagher, David J; Palma, José; Viñuelas, Eva; Grau, Imma; Vilella, Elisabet; de Pablo, Joan

2016-05-26

Information on validity and reliability of delirium criteria is necessary for clinicians, researchers, and further developments of DSM or ICD. We compare four DSM and ICD delirium diagnostic criteria versions, which were developed by consensus of experts, with a phenomenology-based natural diagnosis delineated using cluster analysis of delirium features in a sample with a high prevalence of dementia. We also measured inter-rater reliability of each system when applied by two evaluators from distinct disciplines. Cross-sectional analysis of 200 consecutive patients admitted to a skilled nursing facility, independently assessed within 24-48 h after admission with the Delirium Rating Scale-Revised-98 (DRS-R98) and for DSM-III-R, DSM-IV, DSM-5, and ICD-10 criteria for delirium. Cluster analysis (CA) delineated natural delirium and nondelirium reference groups using DRS-R98 items and then diagnostic systems' performance were evaluated against the CA-defined groups using logistic regression and crosstabs for discriminant analysis (sensitivity, specificity, percentage of subjects correctly classified by each diagnostic system and their individual criteria, and performance for each system when excluding each individual criterion are reported). Kappa Index (K) was used to report inter-rater reliability for delirium diagnostic systems and their individual criteria. 117 (58.5 %) patients had preexisting dementia according to the Informant Questionnaire on Cognitive Decline in the Elderly. CA delineated 49 delirium subjects and 151 nondelirium. Against these CA groups, delirium diagnosis accuracy was highest using DSM-III-R (87.5 %) followed closely by DSM-IV (86.0 %), ICD-10 (85.5 %) and DSM-5 (84.5 %). ICD-10 had the highest specificity (96.0 %) but lowest sensitivity (53.1 %). DSM-III-R had the best sensitivity (81.6 %) and the best sensitivity-specificity balance. DSM-5 had the highest inter-rater reliability (K =0.73) while DSM-III-R criteria were the least

Geriatric depression and its relation with cognitive impairment and dementia.

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Dillon, Carol; Tartaglini, María Florencia; Stefani, Dorina; Salgado, Pablo; Taragano, Fernando E; Allegri, Ricardo F

2014-01-01

Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (pdepressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (pdepression. Beck Depression Inventory (BDI) and Mini Mental State Examination (MMSE) were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, DLA and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The impact of sepsis, delirium, and psychological distress on self-rated cognitive function in ICU survivors-a prospective cohort study.

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Brück, Emily; Schandl, Anna; Bottai, Matteo; Sackey, Peter

2018-01-01

Many intensive care unit (ICU) survivors develop psychological problems and cognitive impairment. The relation between sepsis, delirium, and later cognitive problems is not fully elucidated, and the impact of psychological symptoms on cognitive function is poorly studied in ICU survivors. The primary aim of this study was to examine the relationship between sepsis, ICU delirium, and later self-rated cognitive function. A second aim was to investigate the association between psychological problems and self-rated cognitive function 3 months after the ICU stay. Patients staying more than 24 h at the general ICU at the Karolinska University Hospital Solna, Stockholm, Sweden, were screened for delirium with the Confusion Assessment Method-ICU (CAM-ICU) during their ICU stay. Sepsis incidence and severity were recorded. Three months later, 216 patients received the Cognitive Failures Questionnaire (CFQ), Hospital Anxiety and Depression Scale (HADS), and Post-Traumatic Stress Symptoms-10 (PTSS-10) questionnaires via postal mail. One hundred twenty-five patients (60%) responded to all questionnaires. Among respondents, the incidence of severe sepsis or septic shock was 42%. The overall incidence of delirium was 34%. Patients with severe sepsis/septic shock had a higher incidence of delirium, with an odds ratio (OR) of 3.7 (95% confidence interval (CI), 1.7-8.1). Self-rated cognitive problems 3 months post-ICU were found in 58% of the patients. We did not find any association between sepsis or delirium and late self-rated cognitive function. However, there was a correlation between psychological symptoms and self-rated cognitive function, with the strongest correlation between PTSS-10 scores and CFQ scores ( r  = 0.53; p  cognitive function 3 months after the ICU stay. Ongoing psychological symptoms, particularly post-traumatic stress was associated with worse self-rated cognitive function. Psychological symptoms need to be taken into account when assessing

COGNITIVE RESERVE IN DEMENTIA: IMPLICATIONS FOR COGNITIVE TRAINING

Directory of Open Access Journals (Sweden)

Sara eMondini

2016-04-01

Full Text Available Cognitive reserve (CR is a potential mechanism to cope with brain damage. The aim of this study was to evaluate the effect of cognitive reserve on a cognitive training (CT in a group of patients with dementia. 86 participants with mild to moderate dementia were identified by their level of CR quantified by the Cognitive Reserve Index questionnaire (CRIq and underwent a cycle of CT. A global measure of cognition (MMSE was obtained before (T0 and after (T1 the training. Multiple linear regression analyses highlighted CR as a significant factor able to predict changes in cognitive performance after the CT. In particular, patients with lower CR benefited from a CT program more than those with high CR. These data show that CR can modulate the outcome of a CT program and that it should be considered as a predictive factor of neuropsychological rehabilitation training efficacy in people with dementia.

A case of topical opioid-induced delirium mistaken as behavioural and psychological symptoms of dementia in demented state.

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Ito, Go; Kanemoto, Kousuke

2013-06-01

In Japan, indications for opioid analgesics, once exclusively used as pain killers for patients suffering from malignant cancer, have been expanded for a wide range of pain. Herein we report a patient with opioid-induced delirium associated with the administration of buprenorphine patches that was well below the indicated therapeutic range limit. An 82-year-old woman was referred to us from an orthopaedic practitioner for uncontrollable behavioural problems apparently caused by the beginning of dementia; the patient had gradually developed disorientation, visual hallucinations, and delusions. Laboratory and imaging findings excluded common causes of delirium including Alzheimer's disease and diffuse Lewy body disease. Detailed questioning revealed that the patient's confused state appeared following a buprenorphine patch dose increase and subsequently disappeared after administration was stopped. Delirium has not been reported as a side-effect in clinical trials of buprenorphine patches. However, our findings in this case show that even topical opioids can precipitate the development of a delirious state in elderly patients. © 2013 The Authors. Psychogeriatrics © 2013 Japanese Psychogeriatric Society.

Depressive Symptoms and Risk of Postoperative Delirium.

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Smith, Patrick J; Attix, Deborah K; Weldon, B Craig; Monk, Terri G

2016-03-01

Previous studies have shown that elevated depressive symptoms are associated with increased risk of postoperative delirium. However, to our knowledge no previous studies have examined whether different components of depression are differentially predictive of postoperative delirium. One thousand twenty patients were screened for postoperative delirium using the Confusion Assessment Method and through retrospective chart review. Patients underwent cognitive, psychosocial, and medical assessments preoperatively. Depression was assessed using the Geriatric Depression Scale-Short Form. Thirty-eight patients developed delirium (3.7%). Using a factor structure previously validated among geriatric medical patients, the authors examined three components of depression as predictors of postoperative delirium: negative affect, cognitive distress, and behavioral inactivity. In multivariate analyses controlling for age, education, comorbidities, and cognitive function, the authors found that greater behavioral inactivity was associated with increased risk of delirium (OR: 1.95 [1.11, 3.42]), whereas negative affect (OR: 0.65 [0.31, 1.36]) and cognitive distress (OR: 0.95 [0.63, 1.43]) were not. Different components of depression are differentially predictive of postoperative delirium among adults undergoing noncardiac surgery. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Objective assessment of attention in delirium: a narrative review.

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Tieges, Zoë; Brown, Laura J E; MacLullich, Alasdair M J

2014-12-01

Inattention is a core feature of delirium, and valid assessment of attention is central to diagnosis. Methods of measuring attention in delirium can be divided into two broad categories: (i) objective neuropsychological testing; and (ii) subjective grading of behaviour during interview and clinical examination. Here, we review and critically evaluate studies of objective neuropsychological testing of attention in delirium. We examine the implications of these studies for delirium detection and monitoring in clinical practice and research, and how these studies inform understanding of the nature of attentional deficits in delirium. Searches of MEDLINE and ISI Web of Knowledge databases were performed to identify studies in which objective tests of attention had been administered to patients with delirium, who had been diagnosed using DSM or ICD criteria. Sixteen publications were identified. The attention tests administered in these studies were grouped into the following categories: measures of attention span, vigilance tests, other pen-and-paper tests (e.g. Trail Making Test) and computerised tests of speeded reaction, vigilance and sustained attention. Patients with delirium showed deficits on all tasks, although most tasks were not considered pure measures of attention. Five papers provided data on differential diagnosis from dementia. Cancellation tests, spatial span tests and computerised tests of sustained attention discriminated delirium from dementia. Five studies presented reliability or validity statistics. The existing evidence base on objective assessment of attention in delirium is small. Objective testing of attention is underdeveloped but shows considerable promise in clinical practice and research. Copyright © 2014 John Wiley & Sons, Ltd.

Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson's Disease Dementia and Dementia with Lewy Bodies.

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Watermeyer, Tamlyn J; Hindle, John V; Roberts, Julie; Lawrence, Catherine L; Martyr, Anthony; Lloyd-Williams, Huw; Brand, Andrew; Gutting, Petra; Hoare, Zoe; Edwards, Rhiannon Tudor; Clare, Linda

2016-01-01

Alongside the physical symptoms associated with Parkinson's disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual's needs and abilities. Fundamental to this therapy is a person's capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson's disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants' goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015).

Symptoms of delirium: an exploratory factor analytic study among referred patients.

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Jain, Gaurav; Chakrabarti, Subho; Kulhara, Parmanand

2011-01-01

Factor analytic studies of delirium symptoms among patients referred through consultation-liaison psychiatric services are rare. We examined the factor structure of delirium symptoms in referred patients and determined whether combining items from several delirium rating scales influenced the factor structure of delirium symptoms. Eighty-six patients with delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) referred though the consultation-liaison services were assessed with structured rating scales. Nineteen symptom items extracted from the Delirium Rating Scale-Revised-98 (DRS-R-98), the Memorial Delirium Assessment Scale and the Confusional State Evaluation Scale were subjected to an exploratory (principal component) factor analysis. A second such analysis was conducted on 15 items of the DRS-R-98 for comparison. Compared with prior studies, patients were younger and the majority had hyperactive delirium. Principal components analysis identified two factors: (1) a "cognitive" factor comprising of disturbances in language, thought processes, orientation, attention, short- and long-term memory, visuospatial ability, consciousness (awareness) and perseveration accounted for 28.9% of the variance and (2) a "behavioral" factor consisting of sleep-wake cycle disturbances, delusions, perceptual disturbances, motor agitation, affect-lability, distractibility, irritability and temporal onset accounted for 18.9% of the variance. An identical factor structure was obtained with the DRS-R-98 items. Similar to previous factor analytic studies, the present study supported the existence of two principal dimensions of delirium, cognitive and behavioral. Additionally, it extended the results of earlier investigations to a wider group of patients with delirium, suggesting that these dimensions might provide important clues to the neurobiology of delirium. Copyright © 2011 Elsevier Inc. All rights reserved.

Test-Retest Reliability of a Serious Game for Delirium Screening in the Emergency Department.

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Tong, Tiffany; Chignell, Mark; Tierney, Mary C; Lee, Jacques S

2016-01-01

Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. Failure to recognize delirium can have devastating consequences including increased mortality (Kakuma et al., 2003). Given the demands on emergency staff, an automated cognitive test to screen for delirium onset could be a valuable tool to support delirium prevention and management. In earlier research we examined the concurrent validity of a serious game, and carried out an initial assessment of its potential as a delirium screening tool (Tong et al., 2016). In this paper, we examine the test-retest reliability of the game, as it is an important criterion in a cognitive test for detecting risk of delirium onset. Objective: To demonstrate the test-retest reliability of the screening tool over time in a clinical sample of older emergency patients. A secondary objective is to assess whether there are practice effects that might make game performance unstable over repeated presentations. Materials and Methods: Adults over the age of 70 were recruited from a hospital ED. Each patient played our serious game in an initial session soon after they arrived in the ED, and in follow up sessions conducted at 8-h intervals (for each participant there were up to five follow up sessions, depending on how long the person stayed in the ED). Results: A total of 114 adults (61 females, 53 males) between the ages of 70 and 104 years ( M = 81 years, SD = 7) participated in our study after screening out delirious patients. We observed a test-retest reliability of the serious game (as assessed by correlation r -values) between 0.5 and 0.8 across adjacent

Neurocognitive differential diagnosis of dementing diseases: Alzheimer's Dementia, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder.

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Braaten, Alyssa J; Parsons, Thomas D; McCue, Robert; Sellers, Alfred; Burns, William J

2006-11-01

Similarities in presentation of Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder, pose differential diagnosis challenges. The current study identifies specific neuropsychological patterns of scores for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. Neuropsychological domains directly assessed in the study included: immediate memory, delayed memory, confrontational naming, verbal fluency, attention, concentration, and executive functioning. The results reveal specific neuropsychological comparative profiles for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. The identification of these profiles will assist in the differential diagnosis of these disorders and aid in patient treatment.

Alcohol-related dementia: an update of the evidence

Science.gov (United States)

2013-01-01

The characteristics of dementia relating to excessive alcohol use have received increased research interest in recent times. In this paper, the neuropathology, nosology, epidemiology, clinical features, and neuropsychology of alcohol-related dementia (ARD) and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome, or WKS) are reviewed. Neuropathological and imaging studies suggest that excessive and prolonged use of alcohol may lead to structural and functional damage that is permanent in nature; however, there is debate about the relative contributions of the direct toxic effect of alcohol (neurotoxicity hypothesis), and the impact of thiamine deficiency, to lasting damage. Investigation of alcohol-related cognitive impairment has been further complicated by differing definitions of patterns of alcohol use and associated lifestyle factors related to the abuse of alcohol. Present diagnostic systems identify two main syndromes of alcohol-related cognitive impairment: ARD and WKS. However, 'alcohol-related brain damage' is increasingly used as an umbrella term to encompass the heterogeneity of these disorders. It is unclear what level of drinking may pose a risk for the development of brain damage or, in fact, whether lower levels of alcohol may protect against other forms of dementia. Epidemiological studies suggest that individuals with ARD typically have a younger age of onset than those with other forms of dementia, are more likely to be male, and often are socially isolated. The cognitive profile of ARD appears to involve both cortical and subcortical pathology, and deficits are most frequently observed on tasks of visuospatial function as well as memory and higher-order (executive) tasks. The WKS appears more heterogeneous in nature than originally documented, and deficits on executive tasks commonly are reported in conjunction with characteristic memory deficits. Individuals with alcohol-related disorders have the potential to at least

Cognitive impairment of dementias

OpenAIRE

Medina, L. D.; Rodríguez-Agudelo, Yaneth

2012-01-01

Dementia is a clinical syndrome characterized by a loss of cognitive and emotional abilities of sufficient severity to infer with social or occupational functioning, or both. Although the causes of dementia and characteristics are not always fully understood, it is understood that it is not a natural part of aging. Definitive diagnosis of dementia is made only through the autopsy and although the diagnosis of probable or possible dementia is complex is achieved by the intervention of several ...

Increased Sensitivity to Proactive and Retroactive Interference in Amnestic Mild Cognitive Impairment: New Insights

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Hanseeuw, Bernard J.; Seron, Xavier; Ivanoiu, Adrian

2012-01-01

Background: Increased sensitivity to proactive (PI) and retroactive (RI) interference has been observed in amnestic mild cognitive impairment (aMCI). PI and RI are often explained as being the result of a response competition mechanism. However, patients with aMCI are supposed to suffer mostly from encoding deficits. We hypothesized that in aMCI…

Level of recall, retrieval speed, and variability on the Cued-Recall Retrieval Speed Task (CRRST) in individuals with amnestic mild cognitive impairment.

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Ramratan, Wendy S; Rabin, Laura A; Wang, Cuiling; Zimmerman, Molly E; Katz, Mindy J; Lipton, Richard B; Buschke, Herman

2012-03-01

Individuals with amnestic mild cognitive impairment (aMCI) show deficits on traditional episodic memory tasks and reductions in speed of performance on reaction time tasks. We present results on a novel task, the Cued-Recall Retrieval Speed Task (CRRST), designed to simultaneously measure level and speed of retrieval. A total of 390 older adults (mean age, 80.2 years), learned 16 words based on corresponding categorical cues. In the retrieval phase, we measured accuracy (% correct) and retrieval speed/reaction time (RT; time from cue presentation to voice onset of a correct response) across 6 trials. Compared to healthy elderly adults (HEA, n = 303), those with aMCI (n = 87) exhibited poorer performance in retrieval speed (difference = -0.13; p cued-learning and processing speed variability may facilitate early detection of dementia in at-risk older adults.

Biomarkers of postoperative delirium and cognitive dysfunction

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Ganna eAndrosova

2015-06-01

Full Text Available Elderly surgical patients frequently experience postoperative delirium (POD and the subsequent development of postoperative cognitive dysfunction (POCD. Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers.

Delirium in palliative care: Detection, documentation and management in three settings.

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Hey, Jennifer; Hosker, Christian; Ward, Jason; Kite, Suzanne; Speechley, Helen

2015-12-01

Delirium is characterized by disturbances of consciousness and changes in cognition that develop rapidly and fluctuate. It is common in palliative care, affecting up to 88% of patients with advanced cancer, yet often remains insufficiently diagnosed and managed. This study sought to compare rates of screening, documentation, and management of delirium across three palliative care settings - two hospices and one hospital team - and to determine whether definitive documentation of delirium as a diagnosis is associated with improved management of the disorder. A retrospective review of patient case notes was performed in three U.K. palliative care settings for the presence of: cognitive screening tools on first assessment; the term "delirium" as a stated documented diagnosis; documented terms, descriptions, and synonyms suggestive of delirium; and management plans aimed at addressing delirium. We reviewed 319 notes. The prevalence of delirium as a documented diagnosis ranged from 0 to 8.4%, rising to 35.7-39.2% when both documented delirium and descriptions suggestive of delirium were taken into account. An abbreviated mental test score (AMTS) was determined for 19.6 (H1) and 26.8% (H2) of hospice admissions and for 0% of hospital assessments. Symptoms suggestive of delirium were managed in 56.3% of cases in hospital, compared with 66.7 (H1) and 72.2% (H2) in hospices. Use of the term "delirium" was infrequent in both hospital and hospice palliative care settings, as was the use of routine screening. Many identified cases did not receive targeted management. The definitive use of the term as a diagnosis was associated with clearer management plans in hospital patients. The authors suggest that better screening and identification remains the first step in improving delirium management.

Delirium in the elderly: A systematic review of pharmacological and non-pharmacological treatments

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Cecília Carboni Tardelli Cerveira

Full Text Available ABSTRACT Delirium is a common disorder associated with poor prognosis, especially in the elderly. The impact of different treatment approaches for delirium on morbimortality and long-term welfare is not completely understood. OBJECTIVE: To determine the efficacy of pharmacological and non-pharmacological treatments in elderly patients with delirium. METHODS: This systematic review compared pharmacological and non-pharmacological treatments in patients over 60 years old with delirium. Databases used were: MEDLINE (PubMed, EMBASE, Cochrane CENTRAL and LILACS from inception to January 6th, 2016. RESULTS: A total of ten articles were selected. The six non-pharmacological intervention studies showed no impact on duration of delirium, mortality or institutionalization, but a decrease in severity of delirium and improvement in medium-term cognitive function were observed. The most commonly used interventions were temporal-spatial orientation, orientation to self and others, early mobilization and sleep hygiene. The four studies with pharmacological interventions found that rivastigmine reduced the duration of delirium, improved cognitive function and reduced caregiver burden; olanzapine and haloperidol decreased the severity of delirium; droperidol reduced length of hospitalization and improved delirium remission rate. CONCLUSION: Although the pharmacological approach has been used in the treatment of delirium among elderly, there have been few studies assessing its efficacy, involving a small number of patients. However, the improvements in delirium duration and severity suggest these drugs are effective in treating the condition. Once delirium has developed, non-pharmacological treatment seems less effective in controlling symptoms, and there is a lack of studies describing different non-pharmacological interventions.

Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial - The PINOCCHIO trial

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Spinelli Allison

2011-07-01

Full Text Available Abstract Background Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient. We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. Methods/Design After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl. The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation. Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight and to the

A longitudinal study of delirium phenomenology indicates widespread neural dysfunction.

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Leonard, Maeve; Adamis, Dimitrios; Saunders, Jean; Trzepacz, Paula; Meagher, David

2015-04-01

Delirium affects all higher cortical functions supporting complex information processing consistent with widespread neural network impairment. We evaluated the relative prominence of delirium symptoms throughout episodes to assess whether impaired consciousness is selectively affecting certain brain functions at different timepoints. Twice-weekly assessments of 100 consecutive patients with DSM-IV delirium in a palliative care unit used the Delirium Rating Scale Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). A mixed-effects model was employed to estimate changes in severity of individual symptoms over time. Mean age = 7 0.2 ± 10.5 years, 51% were male, and 27 had a comorbid dementia. A total of 323 assessments (range 2-9 per case) were conducted, but up to 6 are reported herein. Frequency and severity of individual DRS-R98 symptoms was very consistent over time even though the majority of patients (80%) experienced fluctuation in symptom severity over the course of hours or minutes. Over time, DRS-R98 items for attention (88-100%), sleep-wake cycle disturbance (90-100%), and any motor disturbance (87-100%), and CTD attention and vigilance were most frequently and consistently impaired. Mixed-effects regression modeling identified only very small magnitudes of change in individual symptoms over time, including the three core domains. Attention is disproportionately impaired during the entire episode of delirium, consistent with thalamic dysfunction underlying both an impaired state of consciousness and well-known EEG slowing. All individual symptoms and three core domains remain relatively stable despite small fluctuations in symptom severity for a given day, which supports a consistent state of impaired higher cortical functions throughout an episode of delirium.

Bipolar Disorder and Cognitive Dysfunction: A Complex Link.

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Cipriani, Gabriele; Danti, Sabrina; Carlesi, Cecilia; Cammisuli, Davide Maria; Di Fiorino, Mario

2017-10-01

The aim of this article was to describe the current evidence regarding phenomenon of cognitive functioning and dementia in bipolar disorder (BD). Cochrane Library and PubMed searches were conducted for relevant articles, chapters, and books published before 2016. Search terms used included "bipolar disorder," "cognitive dysfunction," and "dementia." At the end of the selection process, 159 studies were included in our qualitative synthesis. As result, cognitive impairments in BD have been previously considered as infrequent and limited to the affective episodes. Nowadays, there is evidence of stable and lasting cognitive dysfunctions in all phases of BD, including remission phase, particularly in the following domains: attention, memory, and executive functions. The cause of cognitive impairment in BD raises the question if it subtends a neurodevelopmental or a neurodegenerative process. Impaired cognitive functioning associated with BD may contribute significantly to functional disability, in addition to the distorted affective component usually emphasized.

Cognitive impairment and dementia in Parkinson’s disease: clinical features, diagnosis, and management

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Joana eMeireles

2012-05-01

Full Text Available Parkinson’s disease (PD is a common, disabling, neurodegenerative disorder. In addition to classical motor symptoms, nonmotor features are now widely accepted as part of the clinical picture, and cognitive decline is a very important aspect of the disease, as it brings an additional significant burden for the patient and caregivers. The diagnosis of cognitive decline in PD, namely mild cognitive impairment and dementia, can be extremely challenging, remaining largely based on clinical and cognitive assessments. Diagnostic criteria and methods for PD dementia and mild cognitive impairment have been recently issued by expert work groups. This manuscript has synthesized relevant data in order to obtain a pragmatic and updated review regarding cognitive decline in PD, from milder stages to dementia. This text will summarize clinical features, diagnostic methodology, and therapeutic issues of clinical decline in Parkinson’s disease. Relevant clinical genetic issues, including recent advances, will also be approached.

Major Vascular Neurocognitive Disorder: A Reappraisal to Vascular Dementia

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Emre Kumral

2017-03-01

Full Text Available Major vascular neurocognitive disorder (NCD is the second leading form of dementia after Alzheimer’s disease, accounting for 17-20% of all dementias. Vascular NCD is a progressive disease caused by reduced cerebral blood flow related to multiple large volume or lacunar infarcts that induce a sudden onset and stepwise decline in cognitive abilities. Despite its prevalence and clinical importance, there is still controversy in the terminology of vascular NCD. Only after the release of Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5 (2013 did the American Psychiatric Association define vascular dementia as “major vascular NCD”. This review includes an overview of risk factors, pathophysiology, types, diagnostic and clinical features of major vascular NCD, and current treatment options of vascular NCD regarding to DSM-5 criteria

Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder.

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Baldaçara, Leonardo; Borgio, João Guilherme Fiorani; Araújo, Célia; Nery-Fernandes, Fabiana; Lacerda, Acioly Luiz Taveres; Moraes, Walter André Dos Santos; Montaño, Maria Beatriz Marcondes Macedo; Rocha, Marlos; Quarantini, Lucas C; Schoedl, Aline; Pupo, Mariana; Mello, Marcelo F; Andreoli, Sergio B; Miranda-Scippa, Angela; Ramos, Luiz Roberto; Mari, Jair J; Bressan, Rodrigo Affonseca; Jackowski, Andrea Parolin

2012-01-01

New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP) and patients with post-traumatic stress disorder (PTSD) from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia) were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.

Regional analysis of the magnetization transfer ratio of the brain in mild Alzheimer disease and amnestic mild cognitive impairment.

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Mascalchi, M; Ginestroni, A; Bessi, V; Toschi, N; Padiglioni, S; Ciulli, S; Tessa, C; Giannelli, M; Bracco, L; Diciotti, S

2013-01-01

Manually drawn VOI-based analysis shows a decrease in magnetization transfer ratio in the hippocampus of patients with Alzheimer disease. We investigated with whole-brain voxelwise analysis the regional changes of the magnetization transfer ratio in patients with mild Alzheimer disease and patients with amnestic mild cognitive impairment. Twenty patients with mild Alzheimer disease, 27 patients with amnestic mild cognitive impairment, and 30 healthy elderly control subjects were examined with high-resolution T1WI and 3-mm-thick magnetization transfer images. Whole-brain voxelwise analysis of magnetization transfer ratio maps was performed by use of Statistical Parametric Mapping 8 software and was supplemented by the analysis of the magnetization transfer ratio in FreeSurfer parcellation-derived VOIs. Voxelwise analysis showed 2 clusters of significantly decreased magnetization transfer ratio in the left hippocampus and amygdala and in the left posterior mesial temporal cortex (fusiform gyrus) of patients with Alzheimer disease as compared with control subjects but no difference between patients with amnestic mild cognitive impairment and either patients with Alzheimer disease or control subjects. VOI analysis showed that the magnetization transfer ratio in the hippocampus and amygdala was significantly lower (bilaterally) in patients with Alzheimer disease when compared with control subjects (ANOVA with Bonferroni correction, at P ratio values in the hippocampus and amygdala in patients with amnestic mild cognitive impairment were between those of healthy control subjects and those of patients with mild Alzheimer disease. Support vector machine-based classification demonstrated improved classification performance after inclusion of magnetization transfer ratio-related features, especially between patients with Alzheimer disease versus healthy subjects. Bilateral but asymmetric decrease of magnetization transfer ratio reflecting microstructural changes of the

Consequences of delirium after cardiac operations

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Hogen-Koster, S.; Hensens, A.G.; Schuurmans, M.J.; van der Palen, Jacobus Adrianus Maria

2012-01-01

Background Delirium is a transient mental syndrome characterized by disturbances in consciousness, cognition, and perception. The risk that delirium will develop is increased in patients who undergo cardiac operations, especially the elderly. Generally, delirium during hospital admission is

What do Cochrane systematic reviews say about non-pharmacological interventions for treating cognitive decline and dementia?

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Vitória Carvalho Vilela

Full Text Available ABSTRACT BACKGROUND: Dementia is a highly prevalent condition worldwide. Its chronic and progressive presentation has an impact on physical and psychosocial characteristics and on public healthcare. Our aim was to summarize evidence from Cochrane reviews on non-pharmacological treatments for cognitive disorders and dementia. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: Cochrane reviews on non-pharmacological interventions for cognitive dysfunctions and/or type of dementia were included. For this, independent assessments were made by two authors. RESULTS: Twenty-four reviews were included. These showed that carbohydrate intake and validation therapy may be beneficial for cognitive disorders. For dementia, there is a potential benefit from physical activity programs, cognitive training, psychological treatments, aromatherapy, light therapy, cognitive rehabilitation, cognitive stimulation, hyperbaric oxygen therapy in association with donepezil, functional analysis, reminiscence therapy, transcutaneous electrical stimulation, structured decision-making on feeding options, case management approaches, interventions by non-specialist healthcare workers and specialized care units. No benefits were found in relation to enteral tube feeding, acupuncture, Snoezelen stimulation, respite care, palliative care team and interventions to prevent wandering behavior. CONCLUSION: Many non-pharmacological interventions for patients with cognitive impairment and dementia have been studied and potential benefits have been shown. However, the strength of evidence derived from these studies was considered low overall, due to the methodological limitations of the primary studies.

Evaluating the Association between Diabetes, Cognitive Decline and Dementia

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Omorogieva Ojo

2015-07-01

Full Text Available The aim of this article is to review the association between diabetes mellitus, cognitive decline and dementia, including the effects of cognitive decline and dementia on self management of diabetes. This is a literature review of primary research articles. A number of contemporary research articles that met the inclusion criteria were selected for this review paper. These articles were selected using a number of search strategies and electronic databases, such as EBSCOhost Research and SwetsWise databases. The duration of diabetes, glycated haemoglobin levels and glycaemic fluctuations were associated with cognitive decline and dementia. Similarly, hypoglycaemia was significantly related to increased risk of developing cognitive decline and dementia. Furthermore, cognitive decline and dementia were associated with poorer diabetes management. There is evidence of the association between diabetes, cognitive decline and dementia including the shared pathogenesis between diabetes and Alzheimer’s disease. In addition, the self management of diabetes is affected by dementia and cognitive decline. It could be suggested that the association between diabetes and dementia is bidirectional with the potential to proceed to a vicious cycle. Further studies are needed in order to fully establish the relationship between diabetes, cognitive decline and dementia. Patients who have diabetes and dementia could benefit from structured education strategies, which should involve empowerment programmes and lifestyle changes. The detection of cognitive decline should highlight the need for education strategies.

Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson’s Disease Dementia and Dementia with Lewy Bodies

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Tamlyn J. Watermeyer

2016-01-01

Full Text Available Alongside the physical symptoms associated with Parkinson’s disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual’s needs and abilities. Fundamental to this therapy is a person’s capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson’s disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants’ goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015.

Functional neuroimaging using F-18 FDG PET/CT in amnestic mild cognitive impairment: a preliminary study

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Tripathi, Madhavi; Tripathi, Manjari; Sharma, Rajnish; Jaimini, Abhinav; D'Souza, Maria M.; Saw, Sanjiv; Mondal, Anupam; Kushwaha, Suman

2013-01-01

People with amnestic mild cognitive impairment (aMCI) are at a higher risk of developing Alzheimers Dementia (AD) than their cognitively normal peers. Decreased glucose metabolism with 18 F fluorodeoxyglucose (FDG) positron emission tomography (PET) is a downstream marker of neuronal injury and neurodegeneration. The risk of developing AD is higher in patients with aMCI who have a pattern of AD related glucose metabolic changes on FDG-PET than those who do not have these changes. We evaluated the utility of visual and 'statistical parametric mapping (SPM)-supported reading' of the FDG-PET scans of patients clinically classified as aMCI for identification of predementia patterns and for prediction of their progression to AD (PTAD). On visual analysis, four scans were classified as high likelihood of PTAD and reveled hypometabolism in AD related territories. Seven patients had hypometabolism in at least one AD related territory and were classified as intermediate likelihood for PTAD. Two patients had hypometabolism in other than AD territories, while 22 patients did not show any significant hypometabolism on their FDG-PET scans and were classified as low likelihood for PTAD. SPM analysis of these cases confirmed the areas hypometabolism in all 13 patients compared to a normal subgroup (P < 0.05). On follow-up of 24 months, all four cases with high likelihood scans had progression of cognitive deficits and were confirmed as AD in the CDM clinic while none of the others showed cognitive decline. A pattern of AD hypometabolism on the FDG-PET study is useful for predicting PTAD. A longer follow-up of patients with hypometabolism in single AD territories is needed to predict their clinical behavior

Relative power and coherence of EEG series are related to amnestic mild cognitive impairment in diabetes

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Zhijie eBian

2014-02-01

Full Text Available Objective: Diabetes is a risk factor for dementia and mild cognitive impairment. The aim of this study was to investigate whether some features of resting-state EEG (rsEEG could be applied as a biomarker to distinguish the subjects with amnestic mild cognitive impairment (aMCI from normal cognitive function in type 2 diabetes. Materials and Methods: In this study, 28 patients with type 2 diabetes (16 aMCI patients and 12 controls were investigated. Recording of the rsEEG series and neuropsychological assessments were performed. The rsEEG signal was first decomposed into delta, theta, alpha, beta, gamma frequency bands. The relative power of each given band/sum of power and the coherence of waves from different brain areas were calculated. The extracted features from rsEEG and neuropsychological assessments were analyzed as well. Results: The main findings of this study were that: 1 compared with the control group, the ratios of power in theta band (P(theta versus power in alpha band (P(alpha (P(theta/P(alpha in the frontal region and left temporal region were significantly higher for aMCI, and 2 for aMCI, the alpha coherences in posterior, fronto-right temporal, fronto-posterior, right temporo-posterior were decreased; the theta coherences in left central-right central (LC-RC and left posterior-right posterior (LP-RP regions were also decreased; but the delta coherences in left temporal-right temporal (LT-RT region were increased. Conclusion: The proposed indexes from rsEEG recordings could be employed to track cognitive function of diabetic patients and also to help in the diagnosis of those who develop aMCI.

Arbitrary and semantic associations in subjective memory impairment and amnestic mild cognitive impairment among Taiwanese individuals: A cross-sectional study

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Hsin-Te Chang

2018-05-01

Full Text Available Background/Purpose: Researchers have recently proposed a preclinical stage of dementia of Alzheimer's type (DAT, referred to as subjective memory impairment (SMI, with the aim of developing methods for the early detection of DAT and subsequent intervention. It has been proposed that the objective memory functions of individuals with SMI are normal; however, arbitrary and semantic associations are both used to describe the processes of memory. No previous studies have investigated these processes among individuals with SMI. Methods: Cross-sectional analysis was used to compare the memory function of individuals with SMI, amnestic mild cognitive impairment (aMCI, or DAT. One hundred and eighty-three participants were recruited from the Memory Clinic of National Taiwan University Hospital and communities in northern Taiwan, including individuals with no memory complaints (HC, n = 30 and individuals with SMI (n = 61, aMCI-single domain (n = 24, aMCI-multiple domain (n = 33, or DAT (n = 35. The Word Sequence Learning Test (WSLT was used to assess the formation of arbitrary associations and the Logical Memory subtest of the Wechsler Memory Scale-Third Edition was used to assess the formation of semantic associations. Results: Compared to the HC group, the SMI group performed poorly only on the WSLT, whereas the other groups performed poorly on both of the memory tasks. This study demonstrated that SMI individuals tend to perform poorly in the formation of arbitrary associations. Conclusion: Our findings suggest that tasks requiring arbitrary associations may provide greater sensitivity in the detection cognitive changes associated with preclinical DAT. Keywords: Alzheimer's disease, Mild cognitive impairment, Neuropsychology, Dementia

Regional white matter lesions predict falls in patients with amnestic mild cognitive impairment and Alzheimer's disease.

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Ogama, Noriko; Sakurai, Takashi; Shimizu, Atsuya; Toba, Kenji

2014-01-01

Preventive strategy for falls in demented elderly is a clinical challenge. From early-stage of Alzheimer's disease (AD), patients show impaired balance and gait. The purpose of this study is to determine whether regional white matter lesions (WMLs) can predict balance/gait disturbance and falls in elderly with amnestic mild cognitive impairment (aMCI) or AD. Cross-sectional. Hospital out-patient clinic. One hundred sixty-three patients diagnosed with aMCI or AD were classified into groups having experienced falls (n = 63) or not (n = 100) in the previous year. Cognition, depression, behavior and psychological symptoms of dementia, medication, and balance/gait function were evaluated. Regional WMLs were visually analyzed as periventricular hyperintensity in frontal caps, bands, and occipital caps, and as deep white matter hyperintensity in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalamus, and brain stem. Brain atrophy was linearly measured. The fallers had a greater volume of WMLs and their posture/gait performance tended to be worse than nonfallers. Several WMLs in particular brain regions were closely associated with balance and gait impairment. Besides polypharmacy, periventricular hyperintensity in frontal caps and occipital WMLs were strong predictors for falls, even after potential risk factors for falls were considered. Regional white matter burden, independent of cognitive decline, correlates with balance/gait disturbance and predicts falls in elderly with aMCI and AD. Careful insight into regional WMLs on brain magnetic resonance may greatly help to diagnose demented elderly with a higher risk of falls. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Cognitive Impairment Questionnaire (CIMP-QUEST): reported topographic symptoms in MCI and dementia.

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Astrand, R; Rolstad, S; Wallin, A

2010-06-01

The Cognitive Impairment Questionnaire (CIMP-QUEST) is an instrument based on information obtained by key informants to identify symptoms of dementia and dementia-like disorders. The questionnaire consists of three subscales reflecting impairment in parietal-temporal (PT), frontal (F) and subcortical (SC) brain regions. The questionnaire includes a memory scale and lists non-cognitive symptoms. The reliability and validity of the questionnaire were examined in 131 patients with mild cognitive impairment (MCI) or mild dementia at a university-based memory unit. Cronbach alpha for all subscales was calculated at r = 0.90. Factor analysis supported the tri-dimensionality of CIMP-QUEST's brain region-oriented construct. Test-retest reliability for a subgroup of cognitively stable MCI-patients (n = 25) was found to be r = 0.83 (P = 0.0005). The correlation between the score on the cognitive subscales (PT + F + M) and Informant Questionnaire on Cognitive Decline in the Elderly was r = 0.83 (P = 0.0005, n = 123). The memory subscale correlated significantly with episodic memory tests, the PT subscale with visuospatial and language-oriented tests, and the SC and F subscales with tests of attention, psychomotor tempo and executive function. CIMP-QUEST has high reliability and validity, and provides information about cognitive impairment and brain region-oriented symptomatology in patients with MCI and mild dementia.

Assessing severity of delirium by the Delirium Observation Screening Scale

NARCIS (Netherlands)

Scheffer, Alice C.; van Munster, Barbara C.; Schuurmans, Marieke J.; de Rooij, Sophia E.

Objective: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. Assessment of the severity of delirium is important for adjusting medication. The minimal dose of medication is preferable to prevent side effects. Only few nurse based severity measures are available.

Depression associated with dementia.

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Gutzmann, H; Qazi, A

2015-06-01

Depression and cognitive disorders, including dementia and mild cognitive impairment, are common disorders in old age. Depression is frequent in dementia, causing distress, reducing the quality of life, exacerbating cognitive and functional impairment and increasing caregiver stress. Even mild levels of depression can significantly add to the functional impairment of dementia patients and the severity of psychopathological and neurological impairments increases with increasing severity of depression. Depressive symptoms may be both a risk factor for, as well as a prodrome of dementia. Major depressive syndrome of Alzheimer's disease may be among the most common mood disorders of older adults. Treating depression is therefore a key clinical priority to improve the quality of life both of people with dementia as well as their carergivers. Nonpharmacological approaches and watchful waiting should be attempted first in patients who present with mild to moderate depression and dementia. In cases of severe depression or depression not able to be managed through nonpharmacological means, antidepressant therapy should be considered.

Screening for postoperative delirium in patients with acute hip fracture: Assessment of predictive factors.

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Koskderelioglu, Asli; Onder, Ozlem; Gucuyener, Melike; Altay, Taskin; Kayali, Cemil; Gedizlioglu, Muhtesem

2017-06-01

The aim of the present study was to estimate the incidence and risk factors of delirium during the early postoperative period after hip fracture surgery. Furthermore, we investigated the accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for detection and assessment of delirium in orthopedic patients. We consecutively recruited patients aged 65 years or older undergoing hip fracture surgery. The presence of delirium was determined daily by two of the authors according to the CAM-ICU criteria. A further evaluation was made with the reference standard Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria for delirium. Their cognitive function was evaluated with the Mini-Mental State Examination, and possible depressive mood with the Beck Depression Inventory. Baseline characteristics, as well as the American Society of Anesthesiologists classification and clinical outcomes, were analyzed for a correlation with accompanying delirium. Among 109 patients, 20 (18.3%) were diagnosed with delirium. The concurrent validity of CAM-ICU was good (kappa = 0.84). Specificity was 98.9%, and sensitivity was 80%. Multivariate regression analysis showed that Mini-Mental State Examination (P = 0.001; odds ratio 0.75, 95% confidence interval 0.65-0.86) and Beck Depression Inventory scores (P = 0.001; odds ratio 1.13, 95% confidence interval 1.05-1.22) correlated with the occurrence of delirium. The present results show that CAM-ICU is highly sensitive and specific to identify delirium in hip fracture patients in the postoperative period. Among all of the risk factors, cognitive impairment and depressive mood were strongly associated with postoperative delirium. We suggest that a preoperative assessment of cognition and depression might be useful for identifying patients with a higher risk of postoperative delirium. Geriatr Gerontol Int 2017; 17: 919-924. © 2016 Japan Geriatrics Society.

The association between brain volumes, delirium duration, and cognitive outcomes in intensive care unit survivors: the VISIONS cohort magnetic resonance imaging study*.

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Gunther, Max L; Morandi, Alessandro; Krauskopf, Erin; Pandharipande, Pratik; Girard, Timothy D; Jackson, James C; Thompson, Jennifer; Shintani, Ayumi K; Geevarghese, Sunil; Miller, Russell R; Canonico, Angelo; Merkle, Kristen; Cannistraci, Christopher J; Rogers, Baxter P; Gatenby, J Chris; Heckers, Stephan; Gore, John C; Hopkins, Ramona O; Ely, E Wesley

2012-07-01

Delirium duration is predictive of long-term cognitive impairment in intensive care unit survivors. Hypothesizing that a neuroanatomical basis may exist for the relationship between delirium and long-term cognitive impairment, we conducted this exploratory investigation of the associations between delirium duration, brain volumes, and long-term cognitive impairment. A prospective cohort of medical and surgical intensive care unit survivors with respiratory failure or shock. Quantitative high resolution 3-Tesla brain magnetic resonance imaging was used to calculate brain volumes at discharge and 3-month follow-up. Delirium was evaluated using the confusion assessment method for the intensive care unit; cognitive outcomes were tested at 3- and 12-month follow-up. Linear regression was used to examine associations between delirium duration and brain volumes, and between brain volumes and cognitive outcomes. A total of 47 patients completed the magnetic resonance imaging protocol. Patients with longer duration of delirium displayed greater brain atrophy as measured by a larger ventricle-to-brain ratio at hospital discharge (0.76, 95% confidence intervals [0.10, 1.41]; p = .03) and at 3-month follow-up (0.62 [0.02, 1.21], p = .05). Longer duration of delirium was associated with smaller superior frontal lobe (-2.11 cm(3) [-3.89, -0.32]; p = .03) and hippocampal volumes at discharge (-0.58 cm(3) [-0.85, -0.31], p Battery for the Assessment of Neuropsychological Status score -11.17 [-21.12, -1.22], p = .04). Smaller superior frontal lobes, thalamus, and cerebellar volumes at 3 months were associated with worse executive functioning and visual attention at 12 months. These preliminary data show that longer duration of delirium is associated with smaller brain volumes up to 3 months after discharge, and that smaller brain volumes are associated with long-term cognitive impairment up to 12 months. We cannot, however, rule out that smaller preexisting brain volumes explain

Comparison of performance on neuropsychological tests in amnestic Mild Cognitive Impairment and Alzheimer's disease patients

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Patrícia Helena Figueirêdo do Vale

Full Text Available Abstract Mild Cognitive Impairment (MCI can be an intermediate state between normality and dementia in some patients. An early diagnosis, through neuropsychological assessment, could identify individuals at risk of developing dementia. Objective: To verify differences in performance on neuropsychological tests among controls, amnestic MCI (aMCI and Alzheimer’s disease (AD patients. Methods: Sixty-eight AD patients (mean age 73.77±7.24; mean schooling 9.04±4.83; 40 women and 28 men, 34 aMCI patients (mean age 74.44±7.05; mean schooling 12.35±4.01; 20 women and 60 controls (mean age 68.90±7.48; mean schooling 10.72±4.74; 42 women were submitted to a neuropsychological assessment composed of tasks assessing executive functions, language, constructive abilities, reasoning and memory. Results: There were statistically significant differences in performance across all tests among control, aMCI and AD groups, and also between only controls and AD patients. On comparing control and aMCI groups, we found statistically significant differences in memory tasks, except for immediate recall of Visual Reproduction. There were also statistically significant differences between aMCI and AD groups on tasks of constructive and visuoperceptual abilities, attention, language and memory, except for delayed recall of Visual Reproduction. Conclusions: Neuropsychological assessment was able to discriminate aMCI from AD patients in almost all tests except for delayed recall of Visual Reproduction, visual organization (Hooper and executive functions (WCST; and discriminate controls from AD patients in all tests, and controls from aMCI patients in all memory tests except for immediate recall of Visual Reproduction.

Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder

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Leonardo Baldaçara

Full Text Available ABSTRACT. New evidence suggests that the cerebellum has structural and functional abnormalities in psychiatric disorders. Objective: In this research, the goal was to measure the volume of the cerebellum and its subregions in individuals with psychiatric disorders and to relate these findings to their symptoms. Methods: Patients with different degrees of cognitive impairment (Epidemiology of the Elderly - UNIFESP and patients with post-traumatic stress disorder (PTSD from population studies were analyzed. Also, patients with bipolar disorder from an outpatient clinic (Center for the Study of Mood and Anxiety Disorders, Universidade Federal da Bahia were recruited for this study. All subjects underwent a 1.5T structural magnetic resonance scan. Volumetric measures and symptom measurements, by psychometric scales, were performed and compared between patients and controls. Results: The cerebellum volume was reduced in patients with cognitive impairment without dementia and with dementia, in patients with PTSD, and in patients with bipolar disorder compared to controls. In dementia and PTSD, the left cerebellar hemisphere and vermis volume were reduced. In bipolar disorder, volumes of both hemispheres and the vermis were reduced. In the first two studies, these cerebellar volumetric reductions correlated with symptoms of the disease. Conclusion: The exact nature of cerebellar involvement in mental processes is still not fully understood. However, abnormalities in cerebellar structure and its functions have been reported in some of these diseases. Future studies with larger samples are needed to clarify these findings and investigate whether they are important for treatment and prognosis.

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people

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Bellelli, Giuseppe; Morandi, Alessandro; Davis, Daniel H.J.; Mazzola, Paolo; Turco, Renato; Gentile, Simona; Ryan, Tracy; Cash, Helen; Guerini, Fabio; Torpilliesi, Tiziana; Del Santo, Francesco; Trabucchi, Marco; Annoni, Giorgio; MacLullich, Alasdair M.J.

2014-01-01

Objective: to evaluate the performance of the 4 ‘A’s Test (4AT) in screening for delirium in older patients. The 4AT is a new test for rapid screening of delirium in routine clinical practice. Design: prospective study of consecutively admitted elderly patients with independent 4AT and reference standard assessments. Setting: an acute geriatrics ward and a department of rehabilitation. Participants: two hundred and thirty-six patients (aged ≥70 years) consecutively admitted over a period of 4 months. Measurements: in each centre, the 4AT was administered by a geriatrician to eligible patients within 24 h of admission. Reference standard delirium diagnosis (DSM-IV-TR criteria) was obtained within 30 min by a different geriatrician who was blind to the 4AT score. The presence of dementia was assessed using the Alzheimer's Questionnaire and the informant section of the Clinical Dementia Rating scale. The main outcome measure was the accuracy of the 4AT in diagnosing delirium. Results: patients were 83.9 ± 6.1 years old, and the majority were women (64%). Delirium was detected in 12.3% (n = 29), dementia in 31.2% (n = 74) and a combination of both in 7.2% (n = 17). The 4AT had a sensitivity of 89.7% and specificity 84.1% for delirium. The areas under the receiver operating characteristic curves for delirium diagnosis were 0.93 in the whole population, 0.92 in patients without dementia and 0.89 in patients with dementia. Conclusions: the 4AT is a sensitive and specific method of screening for delirium in hospitalised older people. Its brevity and simplicity support its use in routine clinical practice. PMID:24590568

Validation of the revised Addenbrooke's Cognitive Examination (ACE-R) for detecting mild cognitive impairment and dementia in a Japanese population.

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Yoshida, Hidenori; Terada, Seishi; Honda, Hajime; Kishimoto, Yuki; Takeda, Naoya; Oshima, Etsuko; Hirayama, Keisuke; Yokota, Osamu; Uchitomi, Yosuke

2012-01-01

Early detection of dementia will be important for implementation of disease-modifying treatments in the near future. We aimed to investigate the diagnostic validity and reliability of the Japanese version of the revised Addenbrooke's Cognitive Examination (ACE-R J) for identifying mild cognitive impairment (MCI) and dementia. We translated and adapted the original ACE-R for use with a Japanese population. Standard tests for evaluating cognitive decline and dementing disorders were applied. A total of 242 subjects (controls = 73, MCI = 39, dementia = 130) participated in this study. The optimal cut-off scores of ACE-R J for detecting MCI and dementia were 88/89 (sensitivity 0.87, specificity 0.92) and 82/83 (sensitivity 0.99, specificity 0.99) respectively. ACE-R J was superior to the Mini-Mental State Examination in the detection of MCI (area under the curve (AUC): 0.952 vs. 0.868), while the accuracy of the two instruments did not differ significantly in identifying dementia (AUC: 0.999 vs. 0.993). The inter-rater reliability (ICC = 0.999), test-retest reliability (ICC = 0.883), and internal consistency (Cronbach's α = 0.903) of ACE-R J were excellent. ACE-R J proved to be an accurate cognitive instrument for detecting MCI and mild dementia. Further neuropsychological evaluation is required for the differential diagnosis of dementia subtypes.

Bilingualism, dementia, cognitive and neural reserve.

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Perani, Daniela; Abutalebi, Jubin

2015-12-01

We discuss the role of bilingualism as a source of cognitive reserve and we propose the putative neural mechanisms through which lifelong bilingualism leads to a neural reserve that delays the onset of dementia. Recent findings highlight that the use of more than one language affects the human brain in terms of anatomo-structural changes. It is noteworthy that recent evidence from different places and cultures throughout the world points to a significant delay of dementia onset in bilingual/multilingual individuals. This delay has been reported not only for Alzheimer's dementia and its prodromal mild cognitive impairment phase, but also for other dementias such as vascular and fronto-temporal dementia, and was found to be independent of literacy, education and immigrant status. Lifelong bilingualism represents a powerful cognitive reserve delaying the onset of dementia by approximately 4 years. As to the causal mechanism, because speaking more than one language heavily relies upon executive control and attention, brain systems handling these functions are more developed in bilinguals resulting in increases of gray and white matter densities that may help protect from dementia onset. These neurocognitive benefits are even more prominent when second language proficiency and exposure are kept high throughout life.

Use of nurse-observed symptoms of delirium in long-term care: effects on prevalence and outcomes of delirium.

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McCusker, Jane; Cole, Martin G; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Belzile, Eric

2011-05-01

Previous studies have reported that nurse detection of delirium has low sensitivity compared to a research diagnosis. As yet, no study has examined the use of nurse-observed delirium symptoms combined with research-observed delirium symptoms to diagnose delirium. Our specific aims were: (1) to describe the effect of using nurse-observed symptoms on the prevalence of delirium symptoms and diagnoses in long-term care (LTC) facilities, and (2) to compare the predictive validity of delirium diagnoses based on the use of research-observed symptoms alone with those based on research-observed and nurse-observed symptoms. Residents aged 65 years and over of seven LTC facilities were recruited into a prospective study. Using the Confusion Assessment Method (CAM), research assistants (RAs) interviewed residents and nurses to assess delirium symptoms. Delirium symptoms were also abstracted independently from nursing notes. Outcomes measured at five month follow-up were: death, the Hierarchic Dementia Scale (HDS), the Barthel ADL scale, and a composite outcome measure (death, or a 10-point decline in either the HDS or the ADL score). The prevalence of delirium among 235 LTC residents increased from 14.0% (using research-observed symptoms only) to 24.7% (using research- and nurse-observed symptoms). The relative risks (and 95% confidence intervals) for prediction of the composite outcome, after adjustment for covariates, were: 1.43 (0.88, 1.96) for delirium using research-observed symptoms only; 1.77 (1.13, 2.28) for delirium using research- and nurse-observed symptoms, in comparison with no delirium. The inclusion of delirium symptoms observed by nurses not only increases the detection of delirium in LTC facilities but improves the prediction of outcomes.

Clinical characteristics with an impact on ADL functions of PD patients with cognitive impairment indicative of dementia.

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Inga Liepelt-Scarfone

Full Text Available BACKGROUND: Dementia in Parkinson's disease (PD is defined as cognitive decline severe enough to affect activities of daily living function (ADL. The aim of our exploratory study was to compare two groups of PD patients. Both groups had cognitive deficits severe enough to justify diagnosis of dementia, but they differed according to caregivers' rating on ADL dysfunction. Parameters which differed between the two groups were interpreted to affect the caregivers' perception of ADL dysfunction in PD patients with cognitive impairment indicative of Parkinson's disease dementia. METHODOLOGY/PRINCIPAL FINDINGS: Thirty of 131 Parkinson's disease patients fulfilled the Movement Disorders Society Task Force - recommended, cognitive Level-I-criteria for dementia. According to standardized caregiver ratings, volunteers were grouped into 18 patients with (ADL- and 12 without instrumental activities of daily living dysfunction (ADL+. Caregiver activities of daily living function ratings closely correlated with self-estimates of patients and those of physician (p<0.001. ADL- patients performed worse on tests assessing visual-construction (p<0.05 and attention (p=0.03 than ADL+ patients. Moreover, the postural instability and gait disorder subtype was more frequent in ADL- patients (p=0.009. ADL- patients tended to have more communication problems (p=0.05, more anxiety (p=0.05 and showed a tendency to be treated more often with neuroleptics (p=0.049 than ADL+. CONCLUSIONS/SIGNIFICANCE: Results indicate that worse attention, visual-construction abilities, the postural instability and gait disorder subtype, communication problems, medication and presence of anxiety are related to activities of daily living dysfunctions in Parkinson's disease patients with cognitive decline indicative of dementia. Our data suggests that not only cognitive factors but also non-cognitive factors seem to be linked to the diagnosis of Parkinson's disease dementia associated with

Psychosocial Practices that Enhance Cognitive Activity in Dementia

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Neslihan Lok

2014-09-01

Full Text Available The daily lives of individuals with dementia, cognitive aspects need to be strengthened in order to maintain the quality. For this reason, dementia, cognitive, psycho-social applications there is a need to increase activity. Dementia drug treatment interventions used as an aid to increase cognitive activity. These interventions, behavior, emotion, perception and stimulation-oriented approaches can be classified into four groups. Dementia cognitive enhancer activity and an older group, this intervention and dissemination practices for selecting the most appropriate method to be applied. All psychosocial practices to increase cognitive activity psychiatrist, psychiatric nurse specialists, psychologists, social workers, occupational therapists can with the condition to study the relevant therapy. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2014; 6(3.000: 210-216

Clock Drawing Test and the diagnosis of amnestic mild cognitive impairment: can more detailed scoring systems do the work?

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Rubínová, Eva; Nikolai, Tomáš; Marková, Hana; Siffelová, Kamila; Laczó, Jan; Hort, Jakub; Vyhnálek, Martin

2014-01-01

The Clock Drawing Test is a frequently used cognitive screening test with several scoring systems in elderly populations. We compare simple and complex scoring systems and evaluate the usefulness of the combination of the Clock Drawing Test with the Mini-Mental State Examination to detect patients with mild cognitive impairment. Patients with amnestic mild cognitive impairment (n = 48) and age- and education-matched controls (n = 48) underwent neuropsychological examinations, including the Clock Drawing Test and the Mini-Mental State Examination. Clock drawings were scored by three blinded raters using one simple (6-point scale) and two complex (17- and 18-point scales) systems. The sensitivity and specificity of these scoring systems used alone and in combination with the Mini-Mental State Examination were determined. Complex scoring systems, but not the simple scoring system, were significant predictors of the amnestic mild cognitive impairment diagnosis in logistic regression analysis. At equal levels of sensitivity (87.5%), the Mini-Mental State Examination showed higher specificity (31.3%, compared with 12.5% for the 17-point Clock Drawing Test scoring scale). The combination of Clock Drawing Test and Mini-Mental State Examination scores increased the area under the curve (0.72; p Drawing Test did not differentiate between healthy elderly and patients with amnestic mild cognitive impairment in our sample. Complex scoring systems were slightly more efficient, yet still were characterized by high rates of false-positive results. We found psychometric improvement using combined scores from the Mini-Mental State Examination and the Clock Drawing Test when complex scoring systems were used. The results of this study support the benefit of using combined scores from simple methods.

Did Immanuel Kant have dementia with Lewy bodies and REM behavior disorder?

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Miranda, Marcelo; Slachevsky, Andrea; Garcia-Borreguero, Diego

2010-06-01

Immanuel Kant, one of the most brilliant minds of the XVIII century and of western philosophy, suffered from dementia in his late years. Based on the analysis of testimonies of his close friends, in this report we describe his neurological disorder which, after 8years of evolution, led to his death. His cognitive decline was strongly associated with a parasomnia compatible with a severe rapid eye movement (REM) behavior disorder (RBD) and dementia with Lewy bodies. Copyright 2010 Elsevier B.V. All rights reserved.

Intensive Care Unit Delirium

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Yongsuk Kim

2015-05-01

Full Text Available Delirium is described as a manifestation of acute brain injury and recognized as one of the most common complications in intensive care unit (ICU patients. Although the causes of delirium vary widely among patients, delirium increases the risk of longer ICU and hospital length of stay, death, cost of care, and post-ICU cognitive impairment. Prevention and early detection are therefore crucial. However, the clinical approach toward delirium is not sufficiently aggressive, despite the condition’s high incidence and prevalence in the ICU setting. While the underlying pathophysiology of delirium is not fully understood, many risk factors have been suggested. As a way to improve delirium-related clinical outcome, high-risk patients can be identified. A valid and reliable bedside screening tool is also needed to detect the symptoms of delirium early. Delirium is commonly treated with medications, and haloperidol and atypical antipsychotics are commonly used as standard treatment options for ICU patients although their efficacy and safety have not been established. The approaches for the treatment of delirium should focus on identifying the underlying causes and reducing modifiable risk factors to promote early mobilization.

The 6-Item Cognitive Impairment Test as a bedside screening for dementia in general hospital patients: results of the General Hospital Study (GHoSt).

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Hessler, Johannes Baltasar; Schäufele, Martina; Hendlmeier, Ingrid; Nora Junge, Magdalena; Leonhardt, Sarah; Weber, Joshua; Bickel, Horst

2017-07-01

The objective of this study was to examine the psychometric quality of the 6-Item Cognitive Impairment Test (6CIT) as a bedside screening for the detection of dementia in general hospital patients. Participants (N = 1,440) were inpatients aged ≥65 of 33 randomly selected general hospitals in Southern Germany. The 6CIT was conducted at bedside, and dementia was diagnosed according to DSM-IV. Nursing staff was asked to rate the patients' cognitive status, and previous diagnoses of dementia were extracted from medical records. Completion rates and validity statistics were calculated. Two-hundred seventy patients had dementia. Cases with delirium but no dementia were excluded. Feasibility was 97.9% and 83.3% for patients without and with dementia, respectively, and decreased from moderate (93.8%) to severe dementia (53%). The area under the curve of the 6CIT was 0.98. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were calculated for the cutoffs 7/8 (0.96, 0.82, 0.85, 0.52, 0.99) and 10/11 (0.88, 0.95, 0.94, 0.76, 0.98). The nurse ratings and medical records information had lower validity statistics. Logistic regression analyses revealed that the 6CIT statistically significantly provided information above nurse ratings and medical records. Twenty-five and 37 additional patients were correctly classified by the 7/8 and 10/11 cutoffs, respectively. The 6CIT is a feasible and valid screening tool for the detection of dementia in older general hospital patients. The 6CIT outperformed the nurse ratings of cognitive status and dementia diagnoses from medical records, suggesting that standardized screening may have benefits with regard to case finding. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The missing link between sleep disorders and age-related dementia: recent evidence and plausible mechanisms.

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Zhang, Feng; Zhong, Rujia; Li, Song; Chang, Raymond Chuen-Chung; Le, Weidong

2017-05-01

Sleep disorders are among the most common clinical problems and possess a significant concern for the geriatric population. More importantly, while around 40% of elderly adults have sleep-related complaints, sleep disorders are more frequently associated with co-morbidities including age-related neurodegenerative diseases and mild cognitive impairment. Recently, increasing evidence has indicated that disturbed sleep may not only serve as the consequence of brain atrophy, but also contribute to the pathogenesis of dementia and, therefore, significantly increase dementia risk. Since the current therapeutic interventions lack efficacies to prevent, delay or reverse the pathological progress of dementia, a better understanding of underlying mechanisms by which sleep disorders interact with the pathogenesis of dementia will provide possible targets for the prevention and treatment of dementia. In this review, we briefly describe the physiological roles of sleep in learning/memory, and specifically update the recent research evidence demonstrating the association between sleep disorders and dementia. Plausible mechanisms are further discussed. Moreover, we also evaluate the possibility of sleep therapy as a potential intervention for dementia.

Subcortical vascular cognitive impairment, no dementia : EEG global power independently predicts vascular impairment and brain symmetry index reflects severity of cognitive decline

NARCIS (Netherlands)

Sheorajpanday, Rishi V.A.; Mariën, Peter; Nagels, Guy; Weeren, Arie J.T.M.; Saerens, Jos; Van Putten, Michel J.A.M.; de Deyn, Peter P.

2014-01-01

Background and Purpose: Vascular cognitive impairment, no dementia (vCIND) is a prevalent and potentially preventable disorder. Clinical presentation of the small-vessel subcortical subtype may be insidious, and differential difficulties can arise with mild cognitive impairment. We investigated EEG

Subcortical Vascular Cognitive Impairment, No Dementia : EEG Global Power Independently Predicts Vascular Impairment and Brain Symmetry Index Reflects Severity of Cognitive Decline

NARCIS (Netherlands)

Sheorajpanday, Rishi V. A.; Marien, Peter; Nagels, Guy; Weeren, Arie J. T. M.; Saerens, Jos; van Putten, Michel J. A. M.; De Deyn, Peter P.

2014-01-01

Background and Purpose:Vascular cognitive impairment, no dementia (vCIND) is a prevalent and potentially preventable disorder. Clinical presentation of the small-vessel subcortical subtype may be insidious, and differential difficulties can arise with mild cognitive impairment. We investigated EEG

How can we identify patients with delirium in the emergency department?: A review of available screening and diagnostic tools.

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Tamune, Hidetaka; Yasugi, Daisuke

2017-09-01

Delirium is a widespread and serious but under-recognized problem. Increasing evidence argues that emergency health care providers need to assess the mental status of the patient as the "sixth vital sign". A simple, sensitive, time-efficient, and cost-effective tool is needed to identify delirium in patients in the emergency department (ED); however, a stand-alone measurement has not yet been established despite previous studies partly because the differential diagnosis of dementia and delirium superimposed on dementia (DSD) is too difficult to achieve using a single indicator. To fill up the gap, multiple aspects of a case should be assessed including inattention and arousal. For instance, we proposed the 100 countdown test as an effective means of detecting inattention. Further dedicated studies are warranted to shed light on the pathophysiology and better management of dementia, delirium and/or "altered mental status". We reviewed herein the clinical questions and controversies concerning delirium in an ED setting. Copyright © 2017 Elsevier Inc. All rights reserved.

Dementia in affective disorder

DEFF Research Database (Denmark)

Kessing, L V; Olsen, E W; Mortensen, P B

1999-01-01

OBJECTIVE: The aim of the study was to investigate whether patients with affective disorder have increased risk of developing dementia compared to other groups of psychiatric patients and compared to the general population. METHOD: In the Danish psychiatric central register, 3363 patients...... with unipolar affective disorder, 518 patients with bipolar affective disorder, 1025 schizophrenic and 8946 neurotic patients were identified according to the diagnosis at the first ever discharge from psychiatric hospital during the period from 1970 to 1974. The rate of discharge diagnosis of dementia...... on readmission was estimated during 21 years of follow-up. In addition, the rates were compared with the rates for admission to psychiatric hospitals with a discharge diagnosis of dementia for the total Danish population. RESULTS: Patients with unipolar and with bipolar affective disorder had a greater risk...

"Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool.

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Bellelli, Giuseppe; Morandi, Alessandro; Di Santo, Simona G; Mazzone, Andrea; Cherubini, Antonio; Mossello, Enrico; Bo, Mario; Bianchetti, Angelo; Rozzini, Renzo; Zanetti, Ermellina; Musicco, Massimo; Ferrari, Alberto; Ferrara, Nicola; Trabucchi, Marco

2016-07-18

To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission

Inattentive Delirium vs. Disorganized Thinking: A New Axis to Subcategorize PACU Delirium

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Darren F. Hight

2018-05-01

Full Text Available Background: Assessment of patients for delirium in the Post Anesthesia Care Unit (PACU is confounded by the residual effects of the varied anesthetic and analgesic regimens employed during surgery and by the physiological consequences of surgery such as pain. Nevertheless, delirium diagnosed at this early stage has been associated with adverse clinical outcomes. The last decade has seen the emergence of the confusion assessment method-intensive care unit (CAM-ICU score as a quick practical method of detecting delirium in clinical situations. Nonetheless, this tool has not been specifically designed for use in this immediate postoperative setting.Methods: Patients enrolled in a larger observational study were administered the CAM-ICU delirium screening tool 15 min after the latter of return of responsiveness to command or arrival in the post-anesthesia care unit. Numerical pain rating scores were also recorded. In addition, we reviewed additional behavioral observations suggestive of disordered thinking, such as hallucinations, a non-reactive eyes-open state, or an inability to state a pain score.Results: Two-hundred and twenty-nine patients underwent CAM-ICU testing in PACU. 33 patients (14% were diagnosed with delirium according to CAM-ICU criteria; 25 of these were inattentive with low arousal, seven were inattentive with high arousal, and one was inattentive and calm and with disordered thinking. Using our extended criteria an additional eleven patients showed signs of disordered thinking. CAM-ICU delirium was associated with increased length of operation (p = 0.028, but a positive CAM-PACU designation was associated with both increased operation length and age (p = 0.003 and 0.010 respectively. Two of the CAM-ICU positive patients with inattention and high arousal reported high pain scores and were not classified as CAM-PACU positive.Conclusion: Disordered thinking is correlated with older patients and longer operations. The sensitivity of

Differences in functional brain connectivity alterations associated with cerebral amyloid deposition in amnestic mild cognitive impairment

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Dahyun eYi

2015-02-01

Full Text Available Despite potential implications for the early detection of impending AD, very little is known about the differences of large scale brain networks between amnestic MCI (aMCI with high cerebral amyloid beta protein (Aβ deposition (i.e., aMCI+ and aMCI with no or very little Aβ deposition (i.e., aMCI-. We first aimed to extend the current literature on altering intrinsic functional connectivity (FC of the default mode network (DMN and salience network (SN from CN to AD dementia. Second, we further examined the differences of the DMN and the SN between aMCI-, aMCI+, and CN. Forty-three older adult (12 CN, 10 aMCI+, 10 aMCI-, and 11 AD dementia subjects were included. All participants received clinical and neuropsychological assessment, resting state functional MRI, structural MRI, and Pittsburgh compound-B-PET scans. FC data were preprocessed using Multivariate Exploratory Linear Optimized Decomposition into Independent Components of FSL. Group comparisons were carried out using the dual-regression approach. In addition, to verify presence of grey matter (GM volume changes with intrinsic functional network alterations, Voxel Based Morphometry was performed on the acquired T1-weighted data. As expected, AD dementia participants exhibited decreased FC in the DMN compared to CN (in precuneus and cingulate gyrus. The degree of alteration in the DMN in aMCI+ compared to CN was intermediate to that of AD. In contrast, aMCI- exhibited increased FC in the DMN compared to CN (in precuneus as well as aMCI+. In terms of the SN, aMCI- exhibited decreased FC compared to both CN and aMCI+ particularly in the inferior frontal gyrus. FC within the SN in aMCI+ and AD did not differ from CN. Compared to CN, aMCI- showed atrophy in bilateral superior temporal gyri whereas aMCI+ showed atrophy in right precuneus. The results indicate that despite of the similarity in cross-sectional cognitive features aMCI- has quite different functional brain connectivity compared to

Delirium in the intensive care unit

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Suresh Arumugam

2017-01-01

Full Text Available Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

Education and dementing disorders : The role of schooling in dementia and cognitive impairment

OpenAIRE

De Ronchi, Diana

2005-01-01

This doctoral thesis aimed to investigate the complex relationship between education, dementias, and cognitive impairment. Two different databases were used: the Faenza and the AIDS Projects. The Faenza Project is a longitudinal study on ageing and dementia, targeting 7,930 inhabitants of Faenza (including the village of Granarolo), Italy, aged 61 years and older in 1991. The study population derives from an area which has been one of the wealthiest in Italy since the beginn...

Behavioral symptoms in community-dwelling elderly Nigerians with dementia, mild cognitive impairment, and normal cognition.

Science.gov (United States)

Baiyewu, Olusegun; Unverzagt, Fred W; Ogunniyi, Adesola; Smith-Gamble, Valerie; Gureje, Oye; Lane, Kathleen A; Gao, Sujuan; Hall, Kathleen S; Hendrie, Hugh C

2012-09-01

Few studies have examined the neuropsychiatric status of patients with dementia and cognitive impairment in the developing world despite the fact that current demographic trends suggest an urgent need for such studies. To assess the level of neuropsychiatric symptoms in community-dwelling individuals with dementia, cognitive impairment no dementia and normal cognition. Subjects were from the Ibadan site of Indianapolis-Ibadan Dementia Project with stable diagnoses of normal cognition, cognitive impairment, no dementia/mild cognitive impairment (CIND/MCI), and dementia. Informants of subjects made ratings on the neuropsychiatric inventory and blessed dementia scale; subjects were tested with the mini mental state examination. One hundred and eight subjects were included in the analytic sample, 21 were cognitively normal, 34 were demented, and 53 were CIND/MCI. The diagnostic groups did not differ in age, per cent female, or per cent with any formal education. The most frequent symptoms among subjects with CIND/MCI were depression (45.3%), apathy (37.7%), night time behavior (28.3%), appetite change (24.5%), irritability (22.6%), delusions (22.6%), anxiety (18.9%), and agitation (17.0%). Depression was significantly more frequent among the CIND/MCI and dementia (44.1%) groups compared with the normal cognition group (9.5%). Distress scores were highest for the dementia group, lowest for the normal cognition group, and intermediate for the CIND/MCI group. Significant neuropsychiatric symptomatology and distress are present among cognitively impaired persons in this community-based study of older adults in this sub-Saharan African country. Programs to assist family members of cognitively impaired and demented persons should be created or adapted for use in developing countries. Copyright © 2012 John Wiley & Sons, Ltd.

Personality traits and risk of cognitive impairment and dementia.

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Terracciano, Antonio; Stephan, Yannick; Luchetti, Martina; Albanese, Emiliano; Sutin, Angelina R

2017-06-01

We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N > 10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample. Copyright © 2017 Elsevier Ltd. All rights reserved.

Delirium in Pediatric Critical Care.

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Patel, Anita K; Bell, Michael J; Traube, Chani

2017-10-01

Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment. Pediatric delirium is strongly associated with poor outcomes, including increased mortality, prolonged intensive care unit length of stay, longer time on mechanical ventilation, and increased cost of care. With heightened awareness, the pediatric intensivist can detect, treat, and prevent delirium in at-risk children. Copyright © 2017 Elsevier Inc. All rights reserved.

Breaking Bad Delirium: Methamphetamine and Boric Acid Toxicity with Hallucinations and Pseudosepsis.

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Johnson, Kayla; Stollings, Joanna L; Ely, E Wesley

2017-02-01

A 30-year-old patient presented with hallucinations and profound shock. He was initially misdiagnosed as having severe sepsis; once ingestions were considered, he was diagnosed as potentially having arsenic toxicity. The clinical story reveals many instructional lessons that could aid in the evaluation and management of future patients. This man presented with large amounts of blue crystals around his nose and lips from inhaling and eating boric acid (an ant poison) so he could, as he put it, kill the ants "pouring into my mouth and nose and up into my brain." His profound pseudosepsis and sustained delirium were induced by co-ingestion of methamphetamine and a large quantity of boric acid. Delirium is a form of acute brain dysfunction that often is multifactorial in critical illness and, when seen in septic shock, is associated with prolonged mechanical ventilation, increased length of hospital stay, medical costs, higher mortality, and long-term cognitive impairment resembling dementia. Pseudosepsis is a noninfectious condition most commonly seen with ingestions such as salicylate (aspirin) toxicity. This report emphasizes the need to recognize agents that contain boric acid as an etiology of unexplained delirium and profound shock.

Poststroke delirium incidence and outcomes: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).

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Mitasova, Adela; Kostalova, Milena; Bednarik, Josef; Michalcakova, Radka; Kasparek, Tomas; Balabanova, Petra; Dusek, Ladislav; Vohanka, Stanislav; Ely, E Wesley

2012-02-01

To describe the epidemiology and time spectrum of delirium using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and to validate a tool for delirium assessment in patients in the acute poststroke period. A prospective observational cohort study. The stroke unit of a university hospital. A consecutive series of 129 patients with stroke (with infarction or intracerebral hemorrhage, 57 women and 72 men; mean age, 72.5 yrs; age range, 35-93 yrs) admitted to the stroke unit of a university hospital were evaluated for delirium incidence. None. Criterion validity and overall accuracy of the Czech version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) were determined using serial daily delirium assessments with CAM-ICU by a junior physician compared with delirium diagnosis by delirium experts using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria that began the first day after stroke onset and continued for at least 7 days. Cox regression models using time-dependent covariate analysis adjusting for age, gender, prestroke dementia, National Institutes of Stroke Health Care at admission, first-day Sequential Organ Failure Assessment, and asphasia were used to understand the relationships between delirium and clinical outcomes. An episode of delirium based on reference Diagnostic and Statistical Manual assessment was detected in 55 patients with stroke (42.6%). In 37 of these (67.3%), delirium began within the first day and in all of them within 5 days of stroke onset. A total of 1003 paired CAM-ICU/Diagnostic and Statistical Manual of Mental Disorders daily assessments were completed. Compared with the reference standard for diagnosing delirium, the CAM-ICU demonstrated a sensitivity of 76% (95% confidence interval [CI] 55% to 91%), a specificity of 98% (95% CI 93% to 100%), an overall accuracy of 94% (95% CI 88% to 97%), and high interrater reliability (κ = 0.94; 95% CI 0

A Diagnostic Model for Dementia in Clinical Practice-Case Methodology Assisting Dementia Diagnosis.

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Londos, Elisabet

2015-04-02

Dementia diagnosis is important for many different reasons. Firstly, to separate dementia, or major neurocognitive disorder, from MCI (mild cognitive impairment), mild neurocognitive disorder. Secondly, to define the specific underlying brain disorder to aid treatment, prognosis and decisions regarding care needs and assistance. The diagnostic method of dementias is a puzzle of different data pieces to be fitted together in the best possible way to reach a clinical diagnosis. Using a modified case methodology concept, risk factors affecting cognitive reserve and symptoms constituting the basis of the brain damage hypothesis, can be visualized, balanced and reflected against test results as well as structural and biochemical markers. The model's origin is the case method initially described in Harvard business school, here modified to serve dementia diagnostics.

Treatment of Alzheimer's disease in Brazil: I. Cognitive disorders

Directory of Open Access Journals (Sweden)

Francisco de Assis Carvalho do Vale

Full Text Available Abstract This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD in Brazil, with special focus on cognitive disorders. It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of cognitive disorders in AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of cognitive disorders encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine and other drugs and substances and non-pharmacological (including cognitive rehabilitation, physical activity, occupational therapy, and music therapy approaches. Recommendations for the treatment of behavioral and psychological symptoms of dementia due to Alzheimer's disease are included in a separate article of this edition.

Translational Assays for Assessment of Cognition in Rodent Models of Alzheimer's Disease and Dementia.

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Shepherd, A; Tyebji, S; Hannan, A J; Burrows, E L

2016-11-01

Cognitive dysfunction appears as a core feature of dementia, which includes its most prevalent form, Alzheimer's disease (AD), as well as vascular dementia, frontotemporal dementia, and other brain disorders. AD alone affects more than 45 million people worldwide, with growing prevalence in aging populations. There is no cure, and therapeutic options remain limited. Gene-edited and transgenic animal models, expressing disease-specific gene mutations, illuminate pathogenic mechanisms leading to cognitive decline in AD and other forms of dementia. To date, cognitive tests in AD mouse models have not been directly relevant to the clinical presentation of AD, providing challenges for translation of findings to the clinic. Touchscreen testing in mice has enabled the assessment of specific cognitive domains in mice that are directly relevant to impairments described in human AD patients. In this review, we provide context for how cognitive decline is measured in the clinic, describe traditional methods for assessing cognition in mice, and outline novel approaches, including the use of the touchscreen platform for cognitive testing. We highlight the limitations of traditional memory-testing paradigms in mice, particularly their capacity for direct translation into cognitive testing of patients. While it is not possible to expect direct translation in testing methodologies, we can aim to develop tests that engage similar neural substrates in both humans and mice. Ultimately, that would enable us to better predict efficacy across species and therefore improve the chances that a treatment that works in mice will also work in the clinic.

Self-administered Gerocognitive Examination (SAGE): a brief cognitive assessment Instrument for mild cognitive impairment (MCI) and early dementia.

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Scharre, Douglas W; Chang, Shu-Ing; Murden, Robert A; Lamb, James; Beversdorf, David Q; Kataki, Maria; Nagaraja, Haikady N; Bornstein, Robert A

2010-01-01

To develop a self-administered cognitive assessment instrument to facilitate the screening of mild cognitive impairment (MCI) and early dementia and determine its association with gold standard clinical assessments including neuropsychologic evaluation. Adults aged above 59 years with sufficient vision and English literacy were recruited from geriatric and memory disorder clinics, educational talks, independent living facilities, senior centers, and memory screens. After Self-administered Gerocognitive Examination (SAGE) screening, subjects were randomly selected to complete a clinical evaluation, neurologic examination, neuropsychologic battery, functional assessment, and mini-mental state examination (MMSE). Subjects were identified as dementia, MCI, or normal based on standard clinical criteria and neuropsychologic testing. Two hundred fifty-four participants took the SAGE screen and 63 subjects completed the extensive evaluation (21 normal, 21 MCI, and 21 dementia subjects). Spearman rank correlation between SAGE and neuropsychologic battery was 0.84 (0.76 for MMSE). SAGE receiver operating characteristics on the basis of clinical diagnosis showed 95% specificity (90% for MMSE) and 79% sensitivity (71% for MMSE) in detecting those with cognitive impairment from normal subjects. This study suggests that SAGE is a reliable instrument for detecting cognitive impairment and compares favorably with the MMSE. The self-administered feature may promote cognitive testing by busy clinicians prompting earlier diagnosis and treatment.

Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery.

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Price, Catherine C; Garvan, Cynthia; Hizel, Loren P; Lopez, Marcos G; Billings, Frederic T

2017-01-01

Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium. Our goal was to determine if certain cognitive domains from the general cognitive screener, the Mini-Mental State Exam (MMSE), predict delirium after cardiac surgery. Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery. Following surgery, delirium was assessed throughout ICU stay using the Confusion Assessment Method for ICU delirium and the Richmond Agitation and Sedation Scale. Cardiac surgery patients who developed delirium (n = 137) had lower total MMSE scores than patients who did not develop delirium (n = 457). In particular, orientation to place, working memory, delayed recall, and language domain scores were lower. Of these, only the working memory and delayed recall domains predicted delirium in a regression model adjusting for history of chronic obstructive pulmonary disease, age, sex, and duration of cardiopulmonary bypass. For each word not recalled on the three-word delayed recall assessment, the odds of delirium increased by 50%. For each item missed on the working memory index, the odds of delirium increased by 36%. Of the patients who developed delirium, 47% had a primary impairment in memory, 21% in working memory, and 33% in both domains. The area under the receiver operating characteristics curve using only the working memory and delayed recall domains was 0.75, compared to 0.76 for total MMSE score. Delirium risk is greater for individuals with reduced MMSE scores on the delayed recall and working memory domains. Research should address why patients with memory and executive vulnerabilities are more prone to postoperative delirium than those with other cognitive limitations.

Evidence for the diagnostic criteria of delirium: an update.

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Blazer, Dan G; van Nieuwenhuizen, Adrienne O

2012-05-01

Since the publication of DSM-III in 1980, the essential criteria for delirium have been reduced progressively through DSM-III-R to DSM-IV. As the field moves toward DSM-V and ICD-11, new data can shed light on the nosological changes that are needed so that diagnostic criteria can reflect empirical data. In this study, we reassess the existing or potential criteria for delirium. Phenomenological studies in recent years have informed the criteria for delirium, including the appropriateness of the term 'consciousness' as a core symptom of the diagnosis, additional symptoms of delirium that are frequent but are not currently part of the diagnostic criteria, subsyndromal delirium, motoric subtypes of delirium (hyperactive, hypoactive), and the association of delirium with dementia. Recent studies suggest that motoric subtypes should be included as a subtype for delirium but that subsyndromal delirium, although a useful research construct, should not be included in clinical diagnostic criteria given the frequent fluctuation in symptoms over short periods. In addition, though the core symptoms are probably adequate to make the diagnosis, clinicians must be aware of the frequency of other symptoms, for symptoms such as profound sleep disturbance or psychotic symptoms may dominate the clinical picture.

Delirium

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... seizure disorder. Electrocardiography (ECG), pulse oximetry (using a sensor that measures oxygen levels in the blood), and ... electrolytes given intravenously, and delirium due to stopping alcohol with benzodiazepines (as well as measures to help ...

Plants traditionally used in age-related brain disorders (dementia): an ethanopharmacological survey.

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Natarajan, Suganthy; Shunmugiah, Karutha Pandian; Kasi, Pandima Devi

2013-04-01

Epidemiological studies have shown that despite mortality due to communicable diseases, poverty and human conflicts, the incidence of dementia increases in the developing world in tandem with the ageing population. Although some FDA approved drugs are available for the treatment of dementia, the outcomes are often unsatisfactory. In traditional practices of medicine, numerous plants have been used to treat cognitive disorders, including neurodegenerative diseases such as Alzheimer's disease (AD) and other memory-related disorders. In western medicine most of the drugs used for the treatment of neurodegenerative disorders are derived from plant sources. This article reviews plants and their active constituents that have been used for their reputed cognitive-enhancing and antidementia effects. A literature survey in Science Direct, Pubmed, and Google Scholar was performed to gather information regarding drug discovery from plants sources for the treatment of congnitive disorders and dementia. More than forty herbal remedies were identified with cholinesterase inhibitory, anti-inflammatory, or antioxidant activities. Bioactive compounds include alkaloids, flavonoids, steroids, saponins, terpenoids, and essential oils. About eleven herbal plants with multipotent activity against AD are discussed. Literature surveys show that most of the research has been conducted on herbal remedies effect on cholinesterase inhibitory and antioxidant activities. Studies regarding the effect of herbal drugs on β-secretase inhibitory activity and antiaggregation property are lacking. This review provides leads for identifying potential new drugs from plant sources for the treatment of neurodegenerative disorders.

Serial position effects in patients with mild cognitive impairment and early and moderate Alzheimer's disease compared with healthy comparison subjects.

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Moser, B; Deisenhammer, E A; Marksteiner, J; Papousek, I; Fink, A; Weiss, E M

2014-01-01

This study aimed to investigate whether the serial position effects in memory can differentiate patients with different subtypes of mild cognitive impairment (MCI) from healthy controls and patients with different stages of Alzheimer's disease (AD). The serial position effects was tested with the CERAD word list task in 184 persons (39 healthy control subjects, 15 amnestic MCI single domain subjects, 23 amnestic MCI multiple domain subjects, 31 nonamnestic MCI subjects, 45 early or mild AD patients, and 31 moderate AD patients). With progression of dementia, memory deficits increased and the impairment in the primacy effect during the learning trials advanced, whereas the recall of recent items was less impaired. The serial position profile of nonamnestic MCI patients resembled that of healthy control subjects, whereas amnestic MCI patients showed poorer performance in all 3 positions but no significant difference as a function of serial word position. Analyses of the serial position effect may be a useful complement to clinical neuropsychological measures for distinguishing amnestic MCI patients from normal aging and patients with different stages of dementia. © 2013 S. Karger AG, Basel.

Amnestic mild cognitive impairment: functional MR imaging study of response in posterior cingulate cortex and adjacent precuneus during problem-solving tasks.

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Jin, Guangwei; Li, Kuncheng; Hu, Yingying; Qin, Yulin; Wang, Xiangqing; Xiang, Jie; Yang, Yanhui; Lu, Jie; Zhong, Ning

2011-11-01

To compare the blood oxygen level-dependent (BOLD) response, measured with functional magnetic resonance (MR) imaging, in the posterior cingulate cortex (PCC) and adjacent precuneus regions between healthy control subjects and patients with amnestic mild cognitive impairment (MCI) during problem-solving tasks. This study was approved by the institutional review board. Each subject provided written informed consent. Thirteen patients with amnestic MCI and 13 age- and sex-matched healthy control subjects participated in the study. The functional magnetic resonance (MR) imaging tasks were simplified 4 × 4-grid number placement puzzles that were divided into a simple task (using the row rule or the column rule to solve the puzzle) and a complex task (using both the row and column rules to solve the puzzle). Behavioral results and functional imaging results between the healthy control group and the amnestic MCI group were analyzed. The accuracy for the complex task in the healthy control group was significantly higher than that in the amnestic MCI group (P < .05). The healthy control group exhibited a deactivated BOLD signal intensity (SI) change in the bilateral PCC and adjacent precuneus regions during the complex task, whereas the amnestic MCI group showed activation. The positive linear correlations between the BOLD SI change in bilateral PCC and adjacent precuneus regions and in bilateral hippocampi in the amnestic MCI group were significant (P < .001), while in the healthy control group, they were not (P ≥ .23). These findings suggest that an altered BOLD response in amnestic MCI patients during complex tasks might be related to a decline in problem-solving ability and to memory impairment and, thus, may indicate a compensatory response to memory impairment. RSNA, 2011

Normative Values for the German Version of the Montreal Cognitive Assessment (MoCA)

Science.gov (United States)

2018-05-30

Cognitive Impairment; Cognitive Decline; Cognition Disorders; Cognitive Symptom; Cognitive Change; Cognitive Deterioration; Cognitive Abnormality; Cognitive Impairment, Mild; Cognition Disorders in Old Age; Dementia; Dementia Alzheimers; Dementia, Alzheimer Type; Dementia, Mild; Dementia of Alzheimer Type

Cognition and dementia in older patients with epilepsy

Science.gov (United States)

Sen, Arjune; Capelli, Valentina

2018-01-01

Abstract With advances in healthcare and an ageing population, the number of older adults with epilepsy is set to rise substantially across the world. In developed countries the highest incidence of epilepsy is already in people over 65 and, as life expectancy increases, individuals who developed epilepsy at a young age are also living longer. Recent findings show that older persons with epilepsy are more likely to suffer from cognitive dysfunction and that there might be an important bidirectional relationship between epilepsy and dementia. Thus some people with epilepsy may be at a higher risk of developing dementia, while individuals with some forms of dementia, particularly Alzheimer’s disease and vascular dementia, are at significantly higher risk of developing epilepsy. Consistent with this emerging view, epidemiological findings reveal that people with epilepsy and individuals with Alzheimer’s disease share common risk factors. Recent studies in Alzheimer’s disease and late-onset epilepsy also suggest common pathological links mediated by underlying vascular changes and/or tau pathology. Meanwhile electrophysiological and neuroimaging investigations in epilepsy, Alzheimer’s disease, and vascular dementia have focused interest on network level dysfunction, which might be important in mediating cognitive dysfunction across all three of these conditions. In this review we consider whether seizures promote dementia, whether dementia causes seizures, or if common underlying pathophysiological mechanisms cause both. We examine the evidence that cognitive impairment is associated with epilepsy in older people (aged over 65) and the prognosis for patients with epilepsy developing dementia, with a specific emphasis on common mechanisms that might underlie the cognitive deficits observed in epilepsy and Alzheimer’s disease. Our analyses suggest that there is considerable intersection between epilepsy, Alzheimer’s disease and cerebrovascular disease raising

Associations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit.

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Svenningsen, Helle

2013-04-01

In the intensive care units (ICUs) sedation strategies have changed in the past decade towards less sedation and daily wake-up calls. Recent studies indicate that no sedation (after intubation) is most beneficial for patients. A smaller number of these patients have been assessed for post-traumatic stress disorder (PTSD) after ICU discharge, but none of them were assessed for delirium while in the ICU. In other studies, delirium in the ICU is described as distressing for the patients and increasing morbidity, i.e. dementia after discharge and mortality. The associations between sedation, delirium, and PTSD have not previous been described. The aim of this PhD study was to investigate: 1) how sedation is associated with delirium in the ICU, 2) the consequences of delirium in relation to PTSD, anxiety, and depression, 3) the consequences of delirium for the patients' memories from ICU and the health-related quality of life after discharge. In a prospective observation study with patients admitted a minimum of 48 hours to the ICUs in Aarhus or Hillerød, we included all patients aged > 17 years. Non-Danish-speaking, patients transferred from other ICUs and patients with brain injury that made delirium-assessment impossible were excluded. Patients were interviewed face-to-face after 1 week, and at 2 months and 6 months by telephone using six different questionnaires. Among 3,066 patients admitted to the ICUs, 942 fulfilled the inclusion criteria. Primarily due to the inability to test for delirium, 302 patients were later excluded. Of the remaining 640 patients, 65% were delirious on 1 or more days. Fluctuations in sedation levels increased the risk of delirium statistically significantly with or without adjustments for age, gender, severity of illness, surgical/medical patient, or ICU site. After 2 months vs. 6 months, 297 patients vs. 248 patients were interviewed. PTSD was found in 7% vs. 5%, anxiety in 6% vs. 4%, and depression in 10% at both interviews. Delirium

Missing link or not, mobilise against delirium.

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Page, Valerie J; Casarin, Annalisa

2014-01-31

Delirium is known to be a predictor of adverse outcomes. In a prospective study Abelha and colleagues showed that postoperative delirium was an independent risk factor for deterioration in functional capacity following discharge. While evidence for causality remains elusive, there is no doubt that patients who develop delirium are left with new functional and cognitive impairment. Finding a pharmacological treatment for the prevention and treatment of delirium is a priority in delirium research and the results of ongoing trials are awaited. Early mobilisation of ICU patients has been demonstrated to decrease delirium and improve functional outcomes. Resources should be directed to appropriate, progressive mobilisation of all critically ill patients as a priority.

RBANS memory percentage retention: No evidence of incremental validity beyond RBANS scores for diagnostic classification of mild cognitive impairment and dementia and for prediction of daily function.

Science.gov (United States)

Jodouin, Kara A; O'Connell, Megan E; Morgan, Debra G

2017-01-01

RBANS percentage retention scores may be useful for diagnosis, but their incremental validity is unclear. Percentage retention versus RBANS immediate and delayed memory subtests and delayed index scores were compared for diagnostic classification and for prediction of function. Data from 173 memory clinic patients with an interdisciplinary diagnosis (no cognitive impairment, amnestic mild cognitive impairment [aMCI], and dementia due to Alzheimer's disease [AD]) and complete RBANS data were analyzed. Across diagnostic contrasts, list percentage retention classification accuracy was similar to List Learning delayed recall, but below the Delayed Memory Index (DMI). Similarly, for classifying no cognitive impairment versus aMCI or dementia due to AD, story percentage retention was similar to Story Memory subtests and below the DMI. For classifying aMCI versus AD; however, Story Memory exceeded the DMI, but was similar to Story Memory subtest scores. Similarly, for prediction of function percentage retention measures did not predict variance beyond that predicted by the RBANS subtest or index scores. In sum, there is no evidence that calculation of percentage retention for RBANS adds clinical utility beyond those provided by the standard RBANS scores.

In geriatric patients, delirium symptoms are related to the anticholinergic burden.

Science.gov (United States)

Naja, Moustafa; Zmudka, Jadwiga; Hannat, Sanaa; Liabeuf, Sophie; Serot, Jean-Marie; Jouanny, Pierre

2016-04-01

Anticholinergic drugs are widely prescribed for elderly patients and could induce several neuropsychological disorders, especially delirium. The aim of the present study was to evaluate the relationship between anticholinergic burden and delirium symptoms. A total of 102 patients aged over 75 years (86.3 ± 5.8 years, 53 women and 49 men) hospitalized in a geriatric medicine department were included in this prospective study. Anticholinergic burden was assessed by classifying drug use into three levels (low, medium or high). An overall, weighted score was established. Delirium symptoms were measured with the Confusion Assessment Method on days 1, 3, 5, 8, 15 and 21. Covariates studied were comorbidities (Charlson), health status, activities of daily living, nutrition (albumin), cognition, length of stay and mortality. A total of 51.6% of the patients were taking anticholinergic drugs at home (2.13 ± 1.34). Length of stay was 14.5 ± 9.9 days. Prevalence of delirium symptoms ranged on days between 34.8 and 60%. Anticholinergic burden was correlated with the appearance of delirium symptoms. Delirium symptoms were associated with greater mortality (16.1 and 3.7 % in patients with and without delirium symptoms; P = 0.049), a longer hospital stay (18.09 ± 11.34 vs 11.75 ± 7.80 days, P = 0.001), greater dependence on discharge (activities of daily living score: 1.57 ± 1.56 vs 3.41 ± 1.45, P delirium symptoms and mortality. Prevention of delirium symptoms requires its reduction. © 2015 Japan Geriatrics Society.

Treatment of delirium with risperidone in cancer patients.

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Kishi, Yasuhiro; Kato, Masashi; Okuyama, Toru; Thurber, Steven

2012-08-01

Antipsychotic medications have frequently been regarded as the treatment of choice for delirium. This study examined the clinical efficacy of risperidone for the treatment of delirium in cancer patients, combined with a repeated assessment of underlying medical severity levels. The study included consecutive referrals of 29 delirious cancer patients (mean age, 68.9 ± 12.5 years; male, 69%) to the psychiatric consultation service. Risperidone was given orally once per day (mean dosage, 1.4 ± 1.3 mg/day). Study participants were assessed using quantitative standardized scales of cognitive function, delirium, and physical impairment at baseline and at the end of the study (seventh day). Risperidone with routine clinical management was effective for the treatment of delirium: 48% of the patients responded and 38% achieved remission. The reduction of delirium severity occurred in 79% of the patients. Changes in delirium severity were unrelated to age, gender, general cognitive dysfunction, or to severity of attendant medical conditions. In addition to changes in agitation and perceptional disturbances, risperidone was also effective for other specific delirium symptoms. Risperidone with routine clinical management is effective in the treatment of delirium in advanced cancer patients, independent of changes in the underlying medical condition. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

[Delirium in stroke patients : Critical analysis of statistical procedures for the identification of risk factors].

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Nydahl, P; Margraf, N G; Ewers, A

2017-04-01

Delirium is a relevant complication following an acute stroke. It is a multifactor occurrence with numerous interacting risk factors that alternately influence each other. The risk factors of delirium in stroke patients are often based on limited clinical studies. The statistical procedures and clinical relevance of delirium related risk factors in adult stroke patients should therefore be questioned. This secondary analysis includes clinically relevant studies that give evidence for the clinical relevance and statistical significance of delirium-associated risk factors in stroke patients. The quality of the reporting of regression analyses was assessed using Ottenbacher's quality criteria. The delirium-associated risk factors identified were examined with regard to statistical significance using the Bonferroni method of multiple testing for forming incorrect positive hypotheses. This was followed by a literature-based discussion on clinical relevance. Nine clinical studies were included. None of the studies fulfilled all the prerequisites and assumptions given for the reporting of regression analyses according to Ottenbacher. Of the 108 delirium-associated risk factors, a total of 48 (44.4%) were significant, whereby a total of 28 (58.3%) were false positive after Bonferroni correction. Following a literature-based discussion on clinical relevance, the assumption of statistical significance and clinical relevance could be found for only four risk factors (dementia or cognitive impairment, total anterior infarct, severe infarct and infections). The statistical procedures used in the existing literature are questionable, as are their results. A post-hoc analysis and critical appraisal reduced the number of possible delirium-associated risk factors to just a few clinically relevant factors.

Caffeine, Diabetes, Cognition, and Dementia

NARCIS (Netherlands)

Biessels, Geert Jan

2010-01-01

People with diabetes mellitus are at increased risk of cognitive dysfunction. This review explores the relation between caffeine intake, diabetes, cognition and dementia, focusing on type 2 diabetes (T2DM). Epidemiological studies on caffeine/coffee intake and T2DM risk are reviewed. Next, the

Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of a susceptibility score based on factors identified externally in pooled data for use at entry to the acute care pathway.

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Pendlebury, Sarah T; Lovett, Nicola G; Smith, Sarah C; Wharton, Rose; Rothwell, Peter M

2017-03-01

recognition of prevalent delirium and prediction of incident delirium may be difficult at first assessment. We therefore aimed to validate a pragmatic delirium susceptibility (for any, prevalent and incident delirium) score for use in front-line clinical practice in a consecutive cohort of older acute medicine patients. consecutive patients aged ≥65 years over two 8-week periods (2010-12) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The delirium susceptibility score was the sum of weighted risk factors derived using pooled data from UK-NICE guidelines: age >80 = 2, cognitive impairment (cognitive score below cut-off/dementia) = 2, severe illness (systemic inflammatory response syndrome) = 1, infection = 1, visual impairment = 1. Score reliability was determined by the area under the receiver operating curve (AUC). among 308 consecutive patients aged ≥65 years (mean age/SD = 81/8 years, 164 (54%) female), AUC was 0.78 (95% CI 0.71-0.84) for any delirium; 0.71 (0.64-0.79), for prevalent delirium; 0.81 (0.70-0.92), for incident delirium; odds ratios (ORs) for risk score 5-7 versus delirium, 8.1 (2.2-29.7), P = 0.002 for prevalent delirium, and 25.0 (3.0-208.9) P = 0.003 for incident delirium, with corresponding relative risks of 5.4, 4.7 and 13. Higher risk scores were associated with frailty markers, increased care needs and poor outcomes. the externally derived delirium susceptibility score reliably identified prevalent and incident delirium using clinical data routinely available at initial patient assessment and might therefore aid recognition of vulnerability in acute medical admissions early in the acute care pathway. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

Differences in knowledge of dementia among older adults with normal cognition, mild cognitive impairment, and dementia: A representative nationwide sample of Korean elders.

Science.gov (United States)

Lee, Jun-Young; Park, Soowon; Kim, Ki Woong; Kwon, Ji Eyon; Park, Joon Hyuk; Kim, Moon Doo; Kim, Bong-Jo; Kim, Jeong Lan; Moon, Seok Woo; Bae, Jae Nam; Ryu, Seung-Ho; Yoon, Jong Chul; Lee, Nam-Jin; Lee, Dong Young; Lee, Dong Woo; Lee, Seok Bum; Lee, Jung Jae; Lee, Chang-Uk; Jhoo, Jin Hyeong; Cho, Maeng Je

2016-01-01

Lack of knowledge about a disease could impede early diagnosis and may lead to delays in seeking appropriate medical care. The aim of this study was to explore knowledge of dementia (KOD) and to find the determinants of KOD among three groups: older adults with normal cognition, mild cognitive impairment (MCI), and dementia. A representative nationwide sample of 6141 Korean elders aged 65 years or older participated in face-to-face interviews and answered 14 questions pertaining to general information, etiology, symptoms, and treatment of dementia. Stepwise multiple regressions and path analyses probed the relationships between various sociodemographic variables and KOD. The percentage of correct responses was only 62%. The item 'A person who remembers things that happened in the past does not have dementia' was answered correctly (false) by only 24.8-27% of the respondents in all groups. Older adults with normal cognition had higher KOD scores than those with MCI or dementia. In the normal-cognition group, KOD scores were higher among highly educated, younger, and literate women with no depression and a family history of dementia. In contrast with the determinants in the normal-cognition group, only the ability to read and write predicted KOD scores in the dementia group. Efforts to enhance KOD in elder adults are needed. Public education regarding the differences between dementia and healthy aging may increase KOD among normal elders and those with MCI. Among elders with dementia, educational materials that do not require literacy may be more helpful in increasing KOD with the aim of preventing treatment delay. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Physical Activity Prevents Progression for Cognitive Impairment and Vascular Dementia

DEFF Research Database (Denmark)

Verdelho, Ana; Madureira, Sofia; Ferro, José M

2012-01-01

BACKGROUND AND PURPOSE: We aimed to study if physical activity could interfere with progression for cognitive impairment and dementia in older people with white matter changes living independently. METHODS: The LADIS (Leukoaraiosis and Disability) prospective multinational European study evaluates....... Physical activity was recorded during the clinical interview. MRI was performed at entry and at the end of the study. RESULTS: Six hundred thirty-nine subjects were included (74.1±5 years old, 55% women, 9.6±3.8 years of schooling, 64% physically active). At the end of follow-up, 90 patients had dementia...... (vascular dementia, 54; Alzheimer disease with vascular component, 34; frontotemporal dementia, 2), and 147 had cognitive impairment not dementia. Using Cox regression analysis, physical activity reduced the risk of cognitive impairment (dementia and not dementia: β=-0.45, P=0.002; hazard ratio, 0.64; 95...

Delirium subtype identification and the validation of the Delirium Rating Scale--Revised-98 (Dutch version) in hospitalized elderly patients

NARCIS (Netherlands)

de Rooij, Sophia E.; van Munster, Barbara C.; Korevaar, Johanna C.; Casteelen, Gerty; Schuurmans, Marieke J.; van der Mast, Roos C.; Levi, Marcel

2006-01-01

BACKGROUND: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the

Peri-operative cognitive dysfunction and protection

DEFF Research Database (Denmark)

Steinmetz, J; Rasmussen, L S

2016-01-01

Cognition may decline after surgery. Postoperative delirium, especially when hyperactive, may be easily recognised, whereas cognitive dysfunction is subtle and can only be detected using neuropsychological tests. The causes for these two conditions are largely unknown, although they share risk...... factors, the predominant one being age. Ignorance of the causes for postoperative cognitive dysfunction contributes to the difficulty of conducting interventional studies. Postoperative cognitive disorders are associated with increased mortality and permanent disability. Peri-operative interventions can...... reduce the rate of delirium in the elderly, but in spite of promising findings in animal experiments, no intervention reduces postoperative cognitive dysfunction in humans....

Delirium assessed by Memorial Delirium Assessment Scale in advanced cancer patients admitted to an acute palliative/supportive care unit.

Science.gov (United States)

Mercadante, Sebastiano; Adile, Claudio; Ferrera, Patrizia; Cortegiani, Andrea; Casuccio, Alessandra

2017-07-01

Delirium is often unrecognized in cancer patients. The aim of this study was to investigate the prevalence of delirium assessed by the Memorial Delirium Assessment Scale (MDAS) and possible associated factors on admission to an acute palliative/supportive care unit (APSCU). The secondary outcome was to assess changes in MDAS and symptom burden at time of discharge. A consecutive sample of advanced cancer patients who were admitted to an APSCU was prospectively assessed for a period of 10 months. Patient demographics, including age, gender, primary diagnosis, Karnofsky status, stage of disease, and educational level were collected. The Edmonton Symptom Assessment Scale (ESAS) and the MDAS were measured at hospital admission and discharge. A total of 314 patients were surveyed. Of 292 patients with MDAS available at T0, 74 (25.3%) and 24 (8.2%) had a MDAS of 7-12 and ≥13, respectively. At discharge, there was a significant decrease in the number of patients with a MDAS ≥7/30. Higher values of MDAS were associated with age (p = .028), a lower Karnofsky status (p symptoms (p = .026), hospital stay (p = .038) and death (p Delirium is highly prevalent in patients admitted to APSCU, characterized by a low mortality due to early referral. Comprehensive assessment and treatment may allow a decrease in the level of cognitive disorders and symptom burden.

Clock drawing test in screening for Alzheimer's dementia and mild cognitive impairment in clinical practice.

Science.gov (United States)

Vyhnálek, Martin; Rubínová, Eva; Marková, Hana; Nikolai, Tomáš; Laczó, Jan; Andel, Ross; Hort, Jakub

2017-09-01

The clock drawing test (CDT) is a commonly used brief cognitive measure. We evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. We further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT. Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a "yes" (abnormal) versus "suspected" versus "no" (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. We also used a 17-point CDT rating system. When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI. A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The process of disclosing a diagnosis of dementia and mild cognitive impairment: A national survey of specialist physicians in Denmark.

Science.gov (United States)

Nielsen, T Rune; Svensson, Birthe Hjorth; Rohr, Gitte; Gottrup, Hanne; Vestergaard, Karsten; Høgh, Peter; Waldemar, Gunhild

2018-01-01

Background Although general recommendations for diagnostic disclosure of dementia are available, little is known about how these recommendations are implemented. The aim of the current study was to investigate the process and content of dementia diagnostic disclosure meetings, and to compare key aspects of disclosing a diagnosis of dementia and mild cognitive impairment. Method A total of 54 specialist physicians in Danish dementia diagnostic departments completed an online survey on their practices regarding diagnostic disclosure of dementia and mild cognitive impairment. The influence of respondent characteristics was assessed, and differences on key aspects of disclosing a diagnosis of dementia and mild cognitive impairment were analyzed. Results The results suggest that among Danish specialist physicians, there is a general consensus regarding the organization of diagnostic disclosure meetings. However, differences in employed terminology and information provided when disclosing a dementia diagnosis were evident. Significant differences were present on key aspects of the diagnostic disclosure of dementia and mild cognitive impairment. For instance, 91% would use the term dementia during diagnostic disclosures compared to just 72% for mild cognitive impairment. Conclusion The range of practices reflected in the present study confirms the complexity of diagnostic disclosure and highlights the importance of preparation and follow-up strategies to tailor the disclosure process to the needs of individual patients with dementia and their caregivers. Due to earlier diagnosis of neurodegenerative disorders, more research is urgently needed on this aspect of the diagnostic process, especially to develop evidence-based models for the disclosure of mild cognitive impairment.

Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

Directory of Open Access Journals (Sweden)

Yadollah Jannati

2014-09-01

Full Text Available Objective: The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Methods: This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression on SPSS software version 15. Results: We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion: Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.

Feeling Older and the Development of Cognitive Impairment and Dementia.

Science.gov (United States)

Stephan, Yannick; Sutin, Angelina R; Luchetti, Martina; Terracciano, Antonio

2017-10-01

Subjective age is a biopsychosocial marker of aging associated with a range of outcomes in old age. In the domain of cognition, feeling older than one's chronological age is related to lower cognitive performance and steeper cognitive decline among older adults. The present study examines whether an older subjective age is associated with the risk of incident cognitive impairment and dementia. Participants were 5,748 individuals aged 65 years and older drawn from the Health and Retirement Study. Measures of subjective age, cognition, and covariates were obtained at baseline, and follow-up cognition was assessed over a 2- to 4-year period. Only participants without cognitive impairment were included at baseline. At follow-up, participants were classified into one of the three categories: normal functioning, cognitive impairment without dementia (CIND), and dementia. An older subjective age at baseline was associated with higher likelihood of CIND (odds ratio [OR] = 1.18; 1.09-1.28) and dementia (OR = 1.29; 1.02-1.63) at follow-up, controlling for chronological age, other demographic factors, and baseline cognition. Physical inactivity and depressive symptoms partly accounted for these associations. An older subjective age is a marker of individuals' risk of subsequent cognitive impairment and dementia. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cognitive performance and informant reports in the diagnosis of cognitive impairment and dementia in African Americans and whites.

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Potter, Guy G; Plassman, Brenda L; Burke, James R; Kabeto, Mohammed U; Langa, Kenneth M; Llewellyn, David J; Rogers, Mary A M; Steffens, David C

2009-11-01

The diagnosis of cognitive impairment and dementia must reflect an increasingly diverse and aging United States population. This study compared direct testing and informant reports of cognition with clinical diagnoses of cognitive impairment and dementia between African Americans and whites. Participants in the Aging, Demographics, and Memory Study completed in-person dementia evaluations, and were assigned clinical diagnoses (by a consensus panel of dementia experts) of normal; cognitive impairment, not demented (CIND); and dementia. The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) total score and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were used to assess cognitive performance and reported cognitive decline. A higher CERAD total score was associated with lower odds of CIND and dementia, at comparable ratios between African Americans and whites. Higher IQCODE scores were associated with increased odds of dementia in both African Americans and whites. Higher IQCODE scores were associated with increased odds of CIND among whites, but not among African Americans. Cultural differences may influence informant reports of prevalent CIND and dementia. Our findings also highlight the need for more comparative research to establish the cultural validity of measures used to diagnose these conditions.

Analysis of the Substantia Innominata Volume in Patients with Parkinson’s Disease with Dementia, Dementia with Lewy Bodies, and Alzheimer’s Disease

Science.gov (United States)

Kim, Hee Jin; Lee, Ji Eun; Shin, Soo Jeong; Sohn, Young Ho; Lee, Phil Hyu

2011-01-01

Background and Purpose The substantia innominata (SI) contains the nucleus basalis of Meynert, which is the major source of cholinergic input to the cerebral cortex. We hypothesized that degeneration of the SI and its relationship to general cognitive performance differs in amyloidopathy and synucleinopathy. Methods We used magnetic resonance imaging (MRI)-based volumetric analysis to evaluate the SI volume in patients with amnestic mild cognitive impairment (aMCI), Alzheimer’s disease (AD), Parkinson’s disease-mild cognitive impairment (PD-MCI), PD with dementia (PDD), dementia with Lewy bodies (DLB), and healthy elderly controls. The correlation between SI volume and general cognitive performance, measured using the Korean version of the Mini-Mental State Examination (K-MMSE), was examined. Results Compared to control subjects, the mean normalized SI volume was significantly decreased in all of the other groups. The normalized SI volume did not differ between the subjects with PDD and DLB, whereas it was significantly smaller in subjects with PDD (p = 0.029) and DLB (p = 0.011) compared with AD. In subjects with PD-related cognitive impairment (PD-MCI, PDD, or DLB), there was a significant positive correlation between the SI volume and K-MMSE score (r = 0.366, p < 0.001), whereas no correlation was seen in subjects with AD-related cognitive impairment (aMCI or AD). Conclusions Our data suggest that the SI loss is greater in synucleinopathy-related dementia (PDD or DLB) than in AD and that the contribution of the SI to cognitive performance is greater in synucleinopathy than in amyloidopathy. PMID:24868398

Analysis of the Substantia Innominata Volume in Patients with Parkinson’s Disease with Dementia, Dementia with Lewy Bodies, and Alzheimer’s Disease

Directory of Open Access Journals (Sweden)

Hee Jin Kim

2011-10-01

Full Text Available Background and Purpose The substantia innominata (SI contains the nucleus basalis of Meynert, which is the major source of cholinergic input to the cerebral cortex. We hypothesized that degeneration of the SI and its relationship to general cognitive performance differs in amyloidopathy and synucleinopathy. Methods We used magnetic resonance imaging (MRI-based volumetric analysis to evaluate the SI volume in patients with amnestic mild cognitive impairment (aMCI, Alzheimer’s disease (AD, Parkinson’s disease-mild cognitive impairment (PD-MCI, PD with dementia (PDD, dementia with Lewy bodies (DLB, and healthy elderly controls. The correlation between SI volume and general cognitive performance, measured using the Korean version of the Mini-Mental State Examination (K-MMSE, was examined. Results Compared to control subjects, the mean normalized SI volume was significantly decreased in all of the other groups. The normalized SI volume did not differ between the subjects with PDD and DLB, whereas it was significantly smaller in subjects with PDD (p = 0.029 and DLB (p = 0.011 compared with AD. In subjects with PD-related cognitive impairment (PD-MCI, PDD, or DLB, there was a significant positive correlation between the SI volume and K-MMSE score (r = 0.366, p < 0.001, whereas no correlation was seen in subjects with AD-related cognitive impairment (aMCI or AD. Conclusions Our data suggest that the SI loss is greater in synucleinopathy-related dementia (PDD or DLB than in AD and that the contribution of the SI to cognitive performance is greater in synucleinopathy than in amyloidopathy.

The neuroimaging approach to the assessment of mild cognitive impairment

International Nuclear Information System (INIS)

Lucignani, Giovanni

2006-01-01

Imaging techniques, including emission tomography and magnetic resonance imaging, are progressively being exploited for the classification and prognostic evaluation (indispensable for possible treatments) of mild cognitive impairment (MCI). The main traits of MCI and unsolved issues in its assessment are discussed in two review articles by Feldman and Jacova from the Division of Neurology, Dept. of Medicine, Clinic for Alzheimer Disease and Related Disorders, University of British Columbia, in Vancouver, Canada [1] and Chong and Sahadevan from the Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore [2]. Because MCI has different presentations in terms of the type and degree of cognitive deficits observed, several clinical subtypes of MCI besides the amnestic form have now been recognised and characterised on the basis of deficits in different cognitive domains, either in isolation or in combination with amnesia. The different subtypes of MCI suggest that MCI has a heterogeneous nature, with several possible causes that lead to the same symptoms. This is a field in evolution, and a uniform diagnostic classification of MCI has not yet been accomplished. Lopez et al. from the Departments of Neurology and Psychiatry, University of Pittsburgh, School of Medicine,Pittsburgh, Pennsylvania, USA [3] point out that the classification of MCI subtypes is useful to improve prediction of the subsequent risk of dementia and the type of dementia, and that the manner in which MCI subjects are classified into subgroups has implications for the cognitive profile of the group and thus for our inferences about the aetiology and possible clinical course of the disorder

The neuroimaging approach to the assessment of mild cognitive impairment

Energy Technology Data Exchange (ETDEWEB)

Lucignani, Giovanni [University of Milan and Unit of Molecular Imaging, Division of Radiation Therapy, European Institute of Oncology, Institute of Radiological Sciences, Milan (Italy)

2006-06-15

Imaging techniques, including emission tomography and magnetic resonance imaging, are progressively being exploited for the classification and prognostic evaluation (indispensable for possible treatments) of mild cognitive impairment (MCI). The main traits of MCI and unsolved issues in its assessment are discussed in two review articles by Feldman and Jacova from the Division of Neurology, Dept. of Medicine, Clinic for Alzheimer Disease and Related Disorders, University of British Columbia, in Vancouver, Canada [1] and Chong and Sahadevan from the Department of Geriatric Medicine, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore [2]. Because MCI has different presentations in terms of the type and degree of cognitive deficits observed, several clinical subtypes of MCI besides the amnestic form have now been recognised and characterised on the basis of deficits in different cognitive domains, either in isolation or in combination with amnesia. The different subtypes of MCI suggest that MCI has a heterogeneous nature, with several possible causes that lead to the same symptoms. This is a field in evolution, and a uniform diagnostic classification of MCI has not yet been accomplished. Lopez et al. from the Departments of Neurology and Psychiatry, University of Pittsburgh, School of Medicine,Pittsburgh, Pennsylvania, USA [3] point out that the classification of MCI subtypes is useful to improve prediction of the subsequent risk of dementia and the type of dementia, and that the manner in which MCI subjects are classified into subgroups has implications for the cognitive profile of the group and thus for our inferences about the aetiology and possible clinical course of the disorder.

Predicting Delirium Duration in Elderly Hip-Surgery Patients: Does Early Symptom Profile Matter?

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Chantal J. Slor

2013-01-01

Full Text Available Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology during the course of delirium are associated with delirium duration. Methods. This study was conducted in prospectively identified cases of incident delirium. We compared patients experiencing delirium of short duration (1 or 2 days with patients who had more prolonged delirium (≥3 days with regard to DRS-R-98 (Delirium Rating Scale Revised-98 symptoms on the first delirious day. Delirium symptom profile was evaluated daily during the delirium course. Results. In a homogenous population of 51 elderly hip-surgery patients, we found that the severity of individual delirium symptoms on the first day of delirium was not associated with duration of delirium. Preexisting cognitive decline was associated with prolonged delirium. Longitudinal analysis using the generalised estimating equations method (GEE identified that more severe impairment of long-term memory across the whole delirium episode was associated with longer duration of delirium. Conclusion. Preexisting cognitive decline rather than severity of individual delirium symptoms at onset is strongly associated with delirium duration.

The process of disclosing a diagnosis of dementia and mild cognitive impairment

DEFF Research Database (Denmark)

Nielsen, T Rune; Svensson, Birthe Hjorth; Rohr, Gitte

2018-01-01

aspects of disclosing a diagnosis of dementia and mild cognitive impairment. Method A total of 54 specialist physicians in Danish dementia diagnostic departments completed an online survey on their practices regarding diagnostic disclosure of dementia and mild cognitive impairment. The influence...... of respondent characteristics was assessed, and differences on key aspects of disclosing a diagnosis of dementia and mild cognitive impairment were analyzed. Results The results suggest that among Danish specialist physicians, there is a general consensus regarding the organization of diagnostic disclosure...... meetings. However, differences in employed terminology and information provided when disclosing a dementia diagnosis were evident. Significant differences were present on key aspects of the diagnostic disclosure of dementia and mild cognitive impairment. For instance, 91% would use the term dementia during...

123I-IMP SPECT study on patients with amnestic syndrome

International Nuclear Information System (INIS)

Hanyu, Haruo; Abe, Shinei; Arai, Hisayuki; Takasaki, Masaru; Suzuki, Takanari; Abe, Kimihiko; Amino, Saburo

1992-01-01

Regional cerebral blood flow was studied using single photon emission CT (SPECT) with 123 I-IMP to elucidate the pathophysiology of amnesia. Four patients with amnestic syndrome diagnosed by DSM-III-R criteria were investigated. SPECT images demonstrated definite hypoperfusion of the temporoparietal lobe and relative sparing of motorsensory and occipital cortices in two out of four patients. Since these abnormalities of regional cerebral blood flow have been considered to be characteristic findings in dementia of the Alzheimer type, two patients with temporoparietal hypoperfusion are suggested to manifest the early stage of dementia of the Alzheimer type. Our observations suggest that 123 I-IMP SPECT is an useful madality in the diagnosis of the early stage of dementia of the Alzheimer type, especially in patients with only memory impairment. (author)

Transitions to mild cognitive impairments, dementia, and death: findings from the Nun Study.

Science.gov (United States)

Tyas, Suzanne L; Salazar, Juan Carlos; Snowdon, David A; Desrosiers, Mark F; Riley, Kathryn P; Mendiondo, Marta S; Kryscio, Richard J

2007-06-01

The potential of early interventions for dementia has increased interest in cognitive impairments less severe than dementia. However, predictors of the trajectory from intact cognition to dementia have not yet been clearly identified. The purpose of this study was to determine whether known risk factors for dementia increased the risk of mild cognitive impairments or progression from mild cognitive impairments to dementia. A polytomous logistic regression model was used, with parameters governing transitions within transient states (intact cognition, mild cognitive impairments, global impairment) estimated separately from parameters governing the transition from transient to absorbing state (dementia or death). Analyses were based on seven annual examinations (1991-2002) of 470 Nun Study participants aged > or = 75 years at baseline and living in the United States. Odds of developing dementia increased with age primarily for those with low educational levels. In these women, presence of an apolipoprotein E gene *E4 allele increased the odds more than fourfold by age 95 years. Age, education, and the apolipoprotein E gene were all significantly associated with mild cognitive impairments. Only age, however, was associated with progression to dementia. Thus, risk factors for dementia may operate primarily by predisposing individuals to develop mild cognitive impairments; subsequent progression to dementia then depends on only time and competing mortality.

Increased Diagnostic Accuracy of Digital vs. Conventional Clock Drawing Test for Discrimination of Patients in the Early Course of Alzheimer’s Disease from Cognitively Healthy Individuals

OpenAIRE

Müller, Stephan; Preische, Oliver; Heymann, Petra; Elbing, Ulrich; Laske, Christoph

2017-01-01

The conventional Clock Drawing Test (cCDT) is a rapid and inexpensive screening tool for detection of moderate and severe dementia. However, its usage is limited due to poor diagnostic accuracy especially in patients with mild cognitive impairment (MCI). The diagnostic value of a newly developed digital Clock Drawing Test (dCDT) was evaluated and compared with the cCDT in 20 patients with early dementia due to AD (eDAT), 30 patients with amnestic MCI (aMCI) and 20 cognitively healthy controls...

Role of cognitive reserve in progression from mild cognitive impairment to dementia

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Ricardo F. Allegri

Full Text Available Abstract Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. Objectives: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI to degenerative dementia. Methods: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years was assessed and followed for five years (2001 to 2006. Results: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer's dementia. Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion. Conclusions: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation, particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.

Factors predicting perioperative delirium and acute exacerbation of behavioral and psychological symptoms of dementia based on admission data in elderly patients with proximal femoral fracture: A retrospective study.

Science.gov (United States)

Tanaka, Tomohiro

2016-07-01

To examine factors predicting the onset of perioperative delirium and acute exacerbation of behavioral and psychological symptoms of dementia (BPSD), based on patient background, operative background and laboratory data obtained on admission, in elderly patients with proximal femoral fracture. The participants were 152 patients (aged >70 years) who underwent surgery between 1 November 2012 and 31 March 2014. The participants were classified into group B (with onset of perioperative delirium or acute exacerbation of BPSD, n = 52), or group N, (without onset, n = 100), and risk factors were retrospectively examined. Onset was judged based on the presence or absence of common items; that is, "hallucination and delusion," "disturbing speech," "excitatory behavior" and "altered sleep-wake cycle." The participants were observed for 1 week after admission. The incidence of perioperative delirium or acute exacerbation of BPSD was 34.2% in total. In univariate analysis, the incidence was significantly higher (P delirium and acute exacerbation of BPSD. Geriatr Gerontol Int 2016; 16: 821-828. © 2015 Japan Geriatrics Society.

Benefits of music therapy on behaviour disorders in subjects diagnosed with dementia: a systematic review.

Science.gov (United States)

Gómez-Romero, M; Jiménez-Palomares, M; Rodríguez-Mansilla, J; Flores-Nieto, A; Garrido-Ardila, E M; González López-Arza, M V

2017-05-01

Dementia is characterised by cognitive deterioration and the manifestation of psychological and behavioural symptoms, especially changes in perception, thought content, mood, and conduct. In addition to drug therapy, non-pharmacological treatments are used to manage these symptoms, and one of these latter treatments is music therapy. Since this novel technique in non-verbal, it can be used to treat patients with dementia at any stage, even when cognitive deterioration is very severe. Patients' responses to music are conserved even in the most advanced stages of the disease DEVELOPMENT: A literature research was carried out using the following databases: Academic Search Complete, PubMed, Science Direct y Dialnet. The period of publication was 2003 to 2013 and the search keywords were 'Music Therapy, Dementia, Behaviour, Behaviour Disorders y Behavioural Disturbances'. Out of the 2188 studies that were identified, 11 studies met inclusion criteria for the systematic review. Music therapy is beneficial and improves behavior disorders, anxiety and agitation in subjects diagnosed with dementia. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

Yes/No Versus Forced-Choice Recognition Memory in Mild Cognitive Impairment and Alzheimer’s Disease: Patterns of Impairment and Associations with Dementia Severity

Science.gov (United States)

Clark, Lindsay R.; Stricker, Nikki H.; Libon, David J.; Delano-Wood, Lisa; Salmon, David P.; Delis, Dean C.; Bondi, Mark W.

2012-01-01

Memory tests are sensitive to early identification of Alzheimer’s disease (AD) but less useful as the disease advances. However, assessing particular types of recognition memory may better characterize dementia severity in later stages of AD. We sought to examine patterns of recognition memory deficits in individuals with AD and mild cognitive impairment (MCI). Memory performance and global cognition data were collected from participants with AD (n=37), MCI (n=37), and cognitively intact older adults (normal controls, NC; n=35). One-way analyses of variance (ANOVAs) examined differences between groups on yes/no and forced-choice recognition measures. Individuals with amnestic MCI performed worse than NC and nonamnestic MCI participants on yes/no recognition, but were comparable on forced-choice recognition. AD patients were more impaired across yes/no and forced-choice recognition tasks. Individuals with mild AD (≥120 Dementia Rating Scale, DRS) performed better than those with moderate-to-severe AD (recognition, but were equally impaired on yes/no recognition. There were differences in the relationships between learning, recall, and recognition performance across groups. Although yes/no recognition testing may be sensitive to MCI, forced-choice procedures may provide utility in assessing severity of anterograde amnesia in later stages of AD. Implications for assessment of insufficient effort and malingering are also discussed. PMID:23030301

Comparison of diagnostic classification systems for delirium with new research criteria that incorporate the three core domains.

Science.gov (United States)

Trzepacz, Paula T; Meagher, David J; Franco, José G

2016-05-01

Diagnostic classification systems do not incorporate phenomenological research findings about the three core symptom domains of delirium (Attentional/Cognitive, Circadian, Higher Level Thinking). We evaluated classification performances of novel Trzepacz, Meagher, and Franco research diagnostic criteria (TMF) that incorporate those domains and ICD-10, DSM-III-R, DSM-IV, and DSM-5. Primary data analysis of 641 patients with mixed neuropsychiatric profiles. Delirium (n=429) and nondelirium (n=212) reference standard groups were identified using cluster analysis of symptoms assessed using the Delirium Rating Scale-Revised-98. Accuracy, sensitivity, specificity, positive and negative predictive values (PPV, NPV), and likelihood ratios (LR+, LR-) are reported. TMF criteria had high sensitivity and specificity (87.4% and 89.2%), more balanced than DSM-III-R (100% and 31.6%), DSM-IV (97.7% and 74.1%), DSM-5 (97.7% and 72.6%), and ICD-10 (66.2% and 100%). PPV of DSM-III-R, DSM-IV, and DSM-5 were 90%. ICD-10 had the lowest NPV (59.4%). TMF had the highest LR+ (8.06) and DSM-III-R the lowest LR- (0.0). Overall, values for DSM-IV and DSM-5 were similar, whereas for ICD-10 and DSM-III-R were inverse of each other. In the pre-existing cognitive impairment/dementia subsample (n=128), TMF retained its highest LR+ though specificity (58.3%) became less well balanced with sensitivity (87.9%), which still exceeded that of DSM. TMF research diagnostic criteria performed well, with more balanced sensitivity and specificity and the highest likelihood ratio for delirium identification. Reflecting the three core domains of delirium, TMF criteria may have advantages in biological research where delineation of this syndrome is important. Copyright © 2016. Published by Elsevier Inc.

Caring for a patient with delirium in an acute hospital: The lived experience of cardiology, elderly care, renal, and respiratory nurses.

Science.gov (United States)

Brooke, Joanne; Manneh, Claire

2018-03-12

To explore the lived experience of caring for a patient during an acute episode of delirium by nurses working in cardiology, elderly care, renal, or respiratory specialities. A missed or delayed diagnosis of delirium in an acute hospital setting adversely impacts on patient outcomes. Nurses are the best placed health care professionals to identify a change in patient's cognitive status but struggle to do so. Inductive interpretative phenomenology. Semi-structured interviews with nurses working in an acute hospital in England between November 2016 and March 2017 (n = 23). Interviews were transcribed verbatim and analysed using thematic analysis. Three themes were identified: (i) "sometimes delirium is confusing", difficultly in differentiating between delirium and dementia; (ii) "everyone in the ward was looking after him", a need for collaborative working to provide harm free care; and (iii) "he was aggressive with us, but after treatment he was a gentleman", acceptance and tolerance of aggression. The need for education across specialities, with a combination of classroom and simulation teaching. Alongside, the development of structures to support the development of nursing teamwork and reporting of near miss incidents that occur with patients during an episode of delirium. © 2018 John Wiley & Sons Australia, Ltd.

Major depressive disorder with psychotic features may lead to misdiagnosis of dementia: a case report and review of the literature.

Science.gov (United States)

Wagner, Gerhardt S; McClintock, Shawn M; Rosenquist, Peter B; McCall, W Vaughn; Kahn, David A

2011-11-01

Major depressive disorder (MDD) with psychotic features is relatively frequent in patients with greater depressive symptom severity and is associated with a poorer course of illness and greater functional impairment than MDD without psychotic features. Multiple studies have found that patients with psychotic mood disorders demonstrate significantly poorer cognitive performance in a variety of areas than those with nonpsychotic mood disorders. The Mini Mental State Examination (MMSE) and the Dementia Rating Scale, Second Edition (DRS-2) are widely used to measure cognitive functions in research on MDD with psychotic features. Established total raw score cut-offs of 24 on the MMSE and 137 on the DRS-2 in published manuals suggest possible global cognitive impairment and dementia, respectively. Limited research is available on these suggested cut-offs for patients with MDD with psychotic features. We document the therapeutic benefit of electroconvulsive therapy (ECT), which is usually associated with short-term cognitive impairment, in a 68-year-old woman with psychotic depression whose MMSE and DRS-2 scores initially suggested possible global cognitive impairment and dementia. Over the course of four ECT treatments, the patient's MMSE scores progressively increased. After the second ECT treatment, the patient no longer met criteria for global cognitive impairment. With each treatment, depression severity, measured by the 24-item Hamilton Rating Scale for Depression, improved sequentially. Thus, the suggested cut-off scores for the MMSE and the DRS-2 in patients with MDD with psychotic features may in some cases produce false-positive indications of dementia.

Emergence Delirium With Post-traumatic Stress Disorder Among Military Veterans

OpenAIRE

Nguyen, Son; Pak, Mila; Paoli, Daniel; Neff, Donna F

2016-01-01

The clinical characteristics of emergence delirium (ED) associated with post-traumatic stress disorder (PTSD) among military veterans encompass transient agitation, restlessness, disorientation, and violent verbal and physical behaviors?due to?re-experiencing of PTSD-related incidents. Two cases of?ED after general anesthesia associated with PTSD are presented. Different?anesthesia methods were applied for the?two cases.?A traditional medical approach appeared not to prevent the incidence of ...

Hematoma Locations Predicting Delirium Symptoms After Intracerebral Hemorrhage.

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Naidech, Andrew M; Polnaszek, Kelly L; Berman, Michael D; Voss, Joel L

2016-06-01

Delirium symptoms are associated with later worse functional outcomes and long-term cognitive impairments, but the neuroanatomical basis for delirium symptoms in patients with acute brain injury is currently uncertain. We tested the hypothesis that hematoma location is predictive of delirium symptoms in patients with intracerebral hemorrhage, a model disease where patients are typically not sedated or bacteremic. We prospectively identified 90 patients with intracerebral hemorrhage who underwent routine twice-daily screening for delirium symptoms with a validated examination. Voxel-based lesion-symptom mapping with acute computed tomography was used to identify hematoma locations associated with delirium symptoms (N = 89). Acute delirium symptoms were predicted by hematoma of right-hemisphere subcortical white matter (superior longitudinal fasciculus) and parahippocampal gyrus. Hematoma including these locations had an odds ratio for delirium of 13 (95 % CI 3.9-43.3, P delirium symptoms. Higher odds ratio for delirium was increased due to hematoma location. The location of neurological injury could be of high prognostic value for predicting delirium symptoms.

Argentinian/Chilean validation of the Spanish-language version of Addenbrooke's Cognitive Examination III for diagnosing dementia.

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Bruno, D; Slachevsky, A; Fiorentino, N; Rueda, D S; Bruno, G; Tagle, A R; Olavarria, L; Flores, P; Lillo, P; Roca, M; Torralva, T

2017-08-30

The Addenbrooke's Cognitive Examination III (ACE-III), an adaptation of the ACE cognitive screening test, has been demonstrated to have high sensitivity and specificity in detecting cognitive impairment in patients with dementia and other neurological and psychiatric disorders. Although the Spanish-language version of the ACE-III has already been validated in Spain, it is yet to be validated in Latin America. The aim of this study was to validate the ACE-III test in an Argentinean and Chilean population. ACE-III was administered to 70 patients with Alzheimer disease, 31 patients with behavioural variant frontotemporal dementia, and a control group of 139 healthy volunteers. Participants were recruited at centres in both countries. The Spanish-language version of ACE-III was found to have good internal consistency (Cronbach's alpha=0.87). We found significant differences in total ACE-III scores between patients with Alzheimer disease and controls (pcognitive dysfunction in patients with dementia. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Propositional Density in Spoken and Written Language of Czech-Speaking Patients with Mild Cognitive Impairment

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Smolík, Filip; Stepankova, Hana; Vyhnálek, Martin; Nikolai, Tomáš; Horáková, Karolína; Matejka, Štepán

2016-01-01

Purpose Propositional density (PD) is a measure of content richness in language production that declines in normal aging and more profoundly in dementia. The present study aimed to develop a PD scoring system for Czech and use it to compare PD in language productions of older people with amnestic mild cognitive impairment (aMCI) and control…

The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening.

Science.gov (United States)

Mioshi, Eneida; Dawson, Kate; Mitchell, Joanna; Arnold, Robert; Hodges, John R

2006-11-01

There is a clear need for brief, but sensitive and specific, cognitive screening instruments as evidenced by the popularity of the Addenbrooke's Cognitive Examination (ACE). We aimed to validate an improved revision (the ACE-R) which incorporates five sub-domain scores (orientation/attention, memory, verbal fluency, language and visuo-spatial). Standard tests for evaluating dementia screening tests were applied. A total of 241 subjects participated in this study (Alzheimer's disease=67, frontotemporal dementia=55, dementia of Lewy Bodies=20; mild cognitive impairment-MCI=36; controls=63). Reliability of the ACE-R was very good (alpha coefficient=0.8). Correlation with the Clinical Dementia Scale was significant (r=-0.321, pcognitive dysfunction. Copyright (c) 2006 John Wiley & Sons, Ltd.

Phenomenological and neuropsychological profile across motor variants of delirium in a palliative care unit

LENUS (Irish Health Repository)

Leonard, Maeve

2011-01-01

Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS-R-98 sleep-wake cycle disturbance, hallucinations, delusions, and language abnormalities. Neither the total Cognitive Test for Delirium nor its five neuropsychological domains differed across Hyperactive, Mixed, and Hypoactive motor groups. Most patients (70%) with no motor alteration had DRS-R-98 scores in the mild or subsyndromal range even though they met DSM-IV criteria. Motor variants in delirium have similar cognitive profiles, but mixed cases differ in expression of several noncognitive features.

sup 123 I-IMP SPECT study on patients with amnestic syndrome

Energy Technology Data Exchange (ETDEWEB)

Hanyu, Haruo; Abe, Shinei; Arai, Hisayuki; Takasaki, Masaru; Suzuki, Takanari; Abe, Kimihiko; Amino, Saburo [Tokyo Medical Coll. (Japan)

1992-06-01

Regional cerebral blood flow was studied using single photon emission CT (SPECT) with {sup 123}I-IMP to elucidate the pathophysiology of amnesia. Four patients with amnestic syndrome diagnosed by DSM-III-R criteria were investigated. SPECT images demonstrated definite hypoperfusion of the temporoparietal lobe and relative sparing of motorsensory and occipital cortices in two out of four patients. Since these abnormalities of regional cerebral blood flow have been considered to be characteristic findings in dementia of the Alzheimer type, two patients with temporoparietal hypoperfusion are suggested to manifest the early stage of dementia of the Alzheimer type. Our observations suggest that {sup 123}I-IMP SPECT is an useful madality in the diagnosis of the early stage of dementia of the Alzheimer type, especially in patients with only memory impairment. (author).

Informal caregivers and detection of delirium in postacute care: a correlational study of the confusion assessment method (CAM), confusion assessment method-family assessment method (CAM-FAM) and DSM-IV criteria.

Science.gov (United States)

Flanagan, Nina M; Spencer, Gale

2016-09-01

Delirium is a common, serious and potentially life-threatening syndrome affecting older adults. This syndrome continues to be under-recognised and under treated by healthcare professionals across all care settings. Older adults who develop delirium have poorer outcomes, higher mortality and higher care costs. The purposes of this study were to correlate the confusion assessment method-family assessment method and confusion assessment method in the detection of delirium in postacute care, to correlate the confusion assessment method-family assessment method and diagnostic and statistical manual of mental disorders text revision criteria in detection of delirium in postacute care, to determine the prevalence of delirium in postacute care elders and to describe the relationship of level of cognitive impairment and delirium in the postacute care setting. Implications for Practice Delirium is disturbing for patients and caregivers. Frequently . family members want to provide information about their loved one. The use of the CAM-FAM and CAM can give a more definitive determination of baseline status. Frequent observations using both instruments may lead to better recognition of delirium and implementation of interventions to prevent lasting sequelae. Descriptive studies determined the strengths of relationship between the confusion assessment method, confusion assessment method-family assessment method, Mini-Cog and diagnostic and statistical manual of mental disorders text revision criteria in detection of delirium in the postacute care setting. Prevalence of delirium in this study was 35%. The confusion assessment method-family assessment method highly correlates with the confusion assessment method and diagnostic and statistical manual of mental disorders text revision criteria for detecting delirium in older adults in the postacute care setting. Persons with cognitive impairment are more likely to develop delirium. Family members recognise symptoms of delirium when

Computer-Based Training Programs for Older People with Mild Cognitive Impairment and/or Dementia

Directory of Open Access Journals (Sweden)

Blanka Klimova

2017-05-01

Full Text Available Currently, due to the demographic trends, the number of aging population groups is dramatically rising, especially in developed countries. This trend causes serious economic and social issues, but also an increase of aging disorders such as mild cognitive impairment (MCI or dementia in older population groups. MCI and dementia are connected with deterioration of cognitive functions. The aim of this mini review article is therefore to explore whether computer-based training programs might be an effective intervention tool for older people with MCI and/or dementia or not. The methods include a literature search in the world’s acknowledged databases: Web of Science, Scopus, Science Direct, MEDLINE and Springer, and consequently, evaluation of the findings of the relevant studies. The findings from the selected studies are quite neutral with respect to the efficacy of the computer assisted intervention programs on the improvement of basic cognitive functions. On the one hand, they suggest that the computer-based training interventions might generate some positive effects on patients with MCI and/or dementia, such as the improvement of learning and short-term memory, as well as behavioral symptoms. On the other hand, these training interventions seem to be short-term, with small sample sizes and their efficacy was proved only in the half of the detected studies. Therefore more longitudinal randomized controlled trials (RCTs are needed to prove the efficacy of the computer-based training programs among older individuals with MCI and/or dementia.

Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial.

Science.gov (United States)

Amjad, Halima; Wong, Stephanie K; Roth, David L; Huang, Jin; Willink, Amber; Black, Betty S; Johnston, Deirdre; Rabins, Peter V; Gitlin, Laura N; Lyketsos, Constantine G; Samus, Quincy M

2018-02-01

To investigate effects of a novel dementia care coordination program on health services utilization. A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011). Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team. Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months. From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use. © Health Research and Educational Trust.

Delirium and Catatonia in Critically Ill Patients: The Delirium and Catatonia Prospective Cohort Investigation.

Science.gov (United States)

Wilson, Jo E; Carlson, Richard; Duggan, Maria C; Pandharipande, Pratik; Girard, Timothy D; Wang, Li; Thompson, Jennifer L; Chandrasekhar, Rameela; Francis, Andrew; Nicolson, Stephen E; Dittus, Robert S; Heckers, Stephan; Ely, E Wesley

2017-11-01

Catatonia, a condition characterized by motor, behavioral, and emotional changes, can occur during critical illness and appear as clinically similar to delirium, yet its management differs from delirium. Traditional criteria for medical catatonia preclude its diagnosis in delirium. Our objective in this investigation was to understand the overlap and relationship between delirium and catatonia in ICU patients and determine diagnostic thresholds for catatonia. Convenience cohort, nested within two ongoing randomized trials. Single academic medical center in Nashville, TN. We enrolled 136 critically ill patients on mechanical ventilation and/or vasopressors, randomized to two usual care sedation regimens. Patients were assessed for delirium and catatonia by independent and masked personnel using Confusion Assessment Method for the ICU and the Bush Francis Catatonia Rating Scale mapped to Diagnostic Statistical Manual 5 criterion A for catatonia. Of 136 patients, 58 patients (43%) had only delirium, four (3%) had only catatonia, 42 (31%) had both, and 32 (24%) had neither. In a logistic regression model, more catatonia signs were associated with greater odds of having delirium. For example, patient assessments with greater than or equal to three Diagnostic Statistical Manual 5 symptoms (75th percentile) had, on average, 27.8 times the odds (interquartile range, 12.7-60.6) of having delirium compared with patient assessments with zero Diagnostic Statistical Manual 5 criteria (25th percentile) present (p delirium, these data prompt reconsideration of Diagnostic Statistical Manual 5 criteria for "Catatonic Disorder Due to Another Medical Condition" that preclude diagnosing catatonia in the presence of delirium.

Variable lung protective mechanical ventilation decreases incidence of postoperative delirium and cognitive dysfunction during open abdominal surgery.

Science.gov (United States)

Wang, Ruichun; Chen, Junping; Wu, Guorong

2015-01-01

Postoperative cognitive dysfunction (POCD) is a subtle impairment of cognitive abilities and can manifest on different neuropsychological features in the early postoperative period. It has been proved that the use of mechanical ventilation (MV) increased the development of delirium and POCD. However, the impact of variable and conventional lung protective mechanical ventilation on the incidence of POCD still remains unknown, which was the aim of this study. 162 patients scheduled to undergo elective gastrointestinal tumor resection via laparotomy in Ningbo No. 2 hospital with expected duration >2 h from June, 2013 to June, 2015 were enrolled in this study. Patients included were divided into two groups according to the scheme of lung protective MV, variable ventilation group (VV group, n=79) and conventional ventilation group (CV group, n=83) by randomization performed by random block randomization. The plasma levels of inflammatory cytokines, characteristics of the surgical procedure, incidence of delirium and POCD were collected and compared. Postoperative delirium was detected in 36 of 162 patients (22.2%) and 12 patients of these (16.5%) belonged to the VV group while 24 patients (28.9%) were in the CV group (P=0.036). POCD on the seventh postoperative day in CV group (26/83, 31.3%) was increased in comparison with the VV group (14/79, 17.7%) with significant statistical difference (P=0.045). The levels of inflammatory cytokines were all significantly higher in CV group than those in VV group on the 1st postoperative day (Pprotective MV decreased the incidence of postoperative delirium and POCD by reducing the systemic proinflammatory response.

Circulating metabolites and general cognitive ability and dementia: Evidence from 11 cohort studies.

Science.gov (United States)

van der Lee, Sven J; Teunissen, Charlotte E; Pool, René; Shipley, Martin J; Teumer, Alexander; Chouraki, Vincent; Melo van Lent, Debora; Tynkkynen, Juho; Fischer, Krista; Hernesniemi, Jussi; Haller, Toomas; Singh-Manoux, Archana; Verhoeven, Aswin; Willemsen, Gonneke; de Leeuw, Francisca A; Wagner, Holger; van Dongen, Jenny; Hertel, Johannes; Budde, Kathrin; Willems van Dijk, Ko; Weinhold, Leonie; Ikram, M Arfan; Pietzner, Maik; Perola, Markus; Wagner, Michael; Friedrich, Nele; Slagboom, P Eline; Scheltens, Philip; Yang, Qiong; Gertzen, Robert E; Egert, Sarah; Li, Shuo; Hankemeier, Thomas; van Beijsterveldt, Catharina E M; Vasan, Ramachandran S; Maier, Wolfgang; Peeters, Carel F W; Jörgen Grabe, Hans; Ramirez, Alfredo; Seshadri, Sudha; Metspalu, Andres; Kivimäki, Mika; Salomaa, Veikko; Demirkan, Ayşe; Boomsma, Dorret I; van der Flier, Wiesje M; Amin, Najaf; van Duijn, Cornelia M

2018-01-06

Identifying circulating metabolites that are associated with cognition and dementia may improve our understanding of the pathogenesis of dementia and provide crucial readouts for preventive and therapeutic interventions. We studied 299 metabolites in relation to cognition (general cognitive ability) in two discovery cohorts (N total = 5658). Metabolites significantly associated with cognition after adjusting for multiple testing were replicated in four independent cohorts (N total = 6652), and the associations with dementia and Alzheimer's disease (N = 25,872) and lifestyle factors (N = 5168) were examined. We discovered and replicated 15 metabolites associated with cognition including subfractions of high-density lipoprotein, docosahexaenoic acid, ornithine, glutamine, and glycoprotein acetyls. These associations were independent of classical risk factors including high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, and apolipoprotein E (APOE) genotypes. Six of the cognition-associated metabolites were related to the risk of dementia and lifestyle factors. Circulating metabolites were consistently associated with cognition, dementia, and lifestyle factors, opening new avenues for prevention of cognitive decline and dementia. Copyright © 2018 the Alzheimer's Association. All rights reserved.

Epidemiology of Delirium in the Intensive Care Unit

NARCIS (Netherlands)

Zaal, I.J.

2014-01-01

Delirium is a common neuropsychiatric syndrome in critically ill patients, characterized by a disturbance in attention and cognition. Delirium is not an inevitable consequence of critical illness itself, however, it is associated with poor patient outcomes such as an increased ICU length of stay and

Which part of the Quick mild cognitive impairment screen (Qmci) discriminates between normal cognition, mild cognitive impairment and dementia?

LENUS (Irish Health Repository)

O'Caoimh, Rónán

2013-05-01

the Qmci is a sensitive and specific test to differentiate between normal cognition (NC), mild cognitive impairment (MCI) and dementia. We compared the sensitivity and specificity of the subtests of the Qmci to determine which best discriminated NC, MCI and dementia.

Trajectories of cognitive decline in different types of dementia

NARCIS (Netherlands)

Smits, L.L.; van Harten, A.C.; Pijnenburg, Y.A.L.; Koedam, E.L.G.E.; Bouwman, F.H.; Sistermans, N.; Reuling, I.E.W.; Prins, N.D.; Lemstra, A.W.; Scheltens, P.; van der Flier, W.M.

2015-01-01

Background. To investigate trajectories of cognitive decline in patients with different types of dementia compared to controls in a longitudinal study. Method. In 199 patients with Alzheimer's disease (AD), 10 with vascular dementia (VaD), 26 with dementia with Lewy bodies (DLB), 20 with behavioural

Nursing and Patients with Delirium: a Literature Review

Directory of Open Access Journals (Sweden)

Ángela María Henao-Castaño

2014-04-01

Full Text Available Objective. This work sought to analyze the scientific production regarding delirium in patients in Intensive Care Units (ICU. Synthesis. Delirium (cognitive alteration occurs in acute and fluctuating manner in patients in ICU. It is a risk factor for mortality and prolonged stay in ICU. Its diagnosis is derived from an objective assessment with widely disseminated validated instruments, available in Spanish and other languages. Strategies to prevent delirium in ICU are documented. Conclusion. Implementation of these strategies to prevent, monitor, and control delirium in patients hospitalized in ICU must be a priority of nursing research in our setting.

Long-Term Mental Health Problems After Delirium in the ICU.

Science.gov (United States)

Wolters, Annemiek E; Peelen, Linda M; Welling, Maartje C; Kok, Lotte; de Lange, Dylan W; Cremer, Olaf L; van Dijk, Diederik; Slooter, Arjen J C; Veldhuijzen, Dieuwke S

2016-10-01

To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. Prospective cohort study. Survey study, 1 year after discharge from a medical-surgical ICU in the Netherlands. One-year ICU survivors of an ICU admission lasting more than 48 hours, without a neurologic disorder or other condition that would impede delirium assessment during ICU stay. None. One year after discharge, ICU survivors received a survey containing the Hospital Anxiety and Depression Scale with a subscale for symptoms of depression and a subscale for symptoms of anxiety, and the Impact of Event Scale 15 item measuring symptoms of posttraumatic stress disorder. Participants were classified as having experienced no delirium (n = 270; 48%), a single day of delirium (n = 86; 15%), or multiple days of delirium (n = 211; 37%) during ICU stay. Log-binomial regression was used to assess the association between delirium and symptoms of anxiety, depression, and posttraumatic stress disorder. The study population consisted of 567 subjects; of whom 246 subjects (43%) reported symptoms of anxiety (Hospital Anxiety and Depression Scale with a subscale for anxiety, ≥ 8), and 254 (45%) symptoms of depression (Hospital Anxiety and Depression Scale with a subscale for depression, ≥ 8). In 220 patients (39%), the Impact of Event Scale 15 item was greater than or equal to 35, indicating a high probability of posttraumatic stress disorder. There was substantial overlap between these mental health problems-63% of the subjects who scored positive for the presence of any three of the mental health problems, scored positive for all three. No association was observed between either a single day or multiple days of delirium and symptoms of anxiety, depression, or posttraumatic stress disorder. Although symptoms of anxiety, depression, and posttraumatic stress disorder were found to be common 1 year after

Delirium diagnosis methodology used in research: a survey-based study.

Science.gov (United States)

Neufeld, Karin J; Nelliot, Archana; Inouye, Sharon K; Ely, E Wesley; Bienvenu, O Joseph; Lee, Hochang Benjamin; Needham, Dale M

2014-12-01

To describe methodology used to diagnose delirium in research studies evaluating delirium detection tools. The authors used a survey to address reference rater methodology for delirium diagnosis, including rater characteristics, sources of patient information, and diagnostic process, completed via web or telephone interview according to respondent preference. Participants were authors of 39 studies included in three recent systematic reviews of delirium detection instruments in hospitalized patients. Authors from 85% (N = 33) of the 39 eligible studies responded to the survey. The median number of raters per study was 2.5 (interquartile range: 2-3); 79% were physicians. The raters' median duration of clinical experience with delirium diagnosis was 7 years (interquartile range: 4-10), with 5% having no prior clinical experience. Inter-rater reliability was evaluated in 70% of studies. Cognitive tests and delirium detection tools were used in the delirium reference rating process in 61% (N = 21) and 45% (N = 15) of studies, respectively, with 33% (N = 11) using both and 27% (N = 9) using neither. When patients were too drowsy or declined to participate in delirium evaluation, 70% of studies (N = 23) used all available information for delirium diagnosis, whereas 15% excluded such patients. Significant variability exists in reference standard methods for delirium diagnosis in published research. Increasing standardization by documenting inter-rater reliability, using standardized cognitive and delirium detection tools, incorporating diagnostic expert consensus panels, and using all available information in patients declining or unable to participate with formal testing may help advance delirium research by increasing consistency of case detection and improving generalizability of research results. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Assessment of delirium in ICU patients : A literature review

NARCIS (Netherlands)

Lisette Schoonhoven; Peter Pickkers; Mark van den Boogaard

2010-01-01

A psycho-organic disorder such as delirium is a frequently occurring and serious disorder especially on Intensive Care units. Nowadays, more attention is paid to this problem by physicians, nurses and by researchers, but assessment of delirium in all ICU patients is still not common practice. If

Debating the Role of Arousal in Delirium Diagnosis: Should Delirium Diagnosis Be Inclusive or Restrictive?

Science.gov (United States)

Oldham, Mark A; Flaherty, Joseph H; Rudolph, James L

2017-07-01

Delirium is common in acute, postacute, and long-term care settings, and it can be difficult to recognize, especially without deliberate mental status evaluation. Because delirium typically presents with altered arousal and arousal can be assessed within a matter of seconds, routine assessment of arousal offers an efficient means of delirium screening. Nevertheless, impaired arousal often precludes formal assessment of attention and awareness, the cardinal features of delirium per the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Here we debate the relative merits of "ruling in" as delirious noncomatose patients with impaired arousal (inclusive approach) vs reserving delirium diagnosis to patients in whom diagnostic criteria can be elicited (restrictive approach). Inclusivism provides efficiency and may prevent missing or delaying delirium diagnosis. The restrictive approach challenges the utility of ruling such patients in as delirious and advocates for identifying mental states that directly inform clinical care. Both positions, however, firmly emphasize the value of routine clinical assessment of arousal. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

The effects of cognitive reserve and lifestyle on cognition and dementia in Parkinson's disease--a longitudinal cohort study.

Science.gov (United States)

Hindle, John V; Hurt, Catherine S; Burn, David J; Brown, Richard G; Samuel, Mike; Wilson, Kenneth C; Clare, Linda

2016-01-01

Cognitive reserve theory seeks to explain the observed mismatch between the degree of brain pathology and clinical manifestations. Early-life education, midlife social and occupational activities and later-life cognitive and social interactions are associated with a more favourable cognitive trajectory in older people. Previous studies of Parkinson's disease (PD) have suggested a possible role for the effects of cognitive reserve, but further research into different proxies for cognitive reserve and longitudinal studies is required. This study examined the effects of cognitive lifestyle on cross-sectional and longitudinal measures of cognition and dementia severity in people with PD. Baseline assessments of cognition, and of clinical, social and demographic information, were completed by 525 participants with PD. Cognitive assessments were completed by 323 participants at 4-year follow-up. Cognition was assessed using the measures of global cognition dementia severity. Cross-sectional and longitudinal serial analyses of covariance for cognition and binomial regression for dementia were performed. Higher educational level, socio-economic status and recent social engagement were associated with better cross-sectional global cognition. In those with normal cognition at baseline, higher educational level was associated with better global cognition after 4 years. Increasing age and low levels of a measure of recent social engagement were associated with an increased risk of dementia. Higher cognitive reserve has a beneficial effect on performance on cognitive tests and a limited effect on cognitive decline and dementia risk in PD. Copyright © 2015 John Wiley & Sons, Ltd.

Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches.

Science.gov (United States)

Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

2015-08-01

Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The intent is to inform educational processes in the work-place beyond traditional approaches such as training. Adopting grounded theory as a research method and working within a social constructionist paradigm we explored the practice gaps of 15 healthcare professionals by interview and conducted five focus groups with patients, carers and Liaison mental health professionals. Data were thematically analysed by constant comparison and theoretical sampling was undertaken until saturation reached. Categories were identified and pragmatic concepts developed grounded within the data. Findings were then further analysed using cultural historical activity theory as a deductive lens. Practice gaps in relation to managing the confused older patient are determined by factors operating at individual (knowledge and skill gaps, personal philosophy, task based practice), team (leadership, time and ward environmental factors) and organisational (power relationships, dominance of medical model, fragmentation of care services) levels. Conceptually, practice appeared to be influenced by socio-cultural ward factors and compounded by a failure to join up existing "patient" knowledge amongst professionals. Applying cultural historical activity theory to further illuminate the findings, the central object is defined as learning about the patient and the mediating artifacts are the care relationships. The overarching medical dominance emerges as an important cultural historical factor at play and staff rules and divisions of labour are exposed. Lastly key contradictions and tensions in the system that work against learning about the patient are

Vascular Contributions to Cognitive Impairment and Dementia

Science.gov (United States)

Gorelick, Philip B.; Scuteri, Angelo; Black, Sandra E.; DeCarli, Charles; Greenberg, Steven M.; Iadecola, Costantino; Launer, Lenore J.; Laurent, Stephane; Lopez, Oscar L.; Nyenhuis, David; Petersen, Ronald C.; Schneider, Julie A.; Tzourio, Christophe; Arnett, Donna K.; Bennett, David A.; Chui, Helena C.; Higashida, Randall T.; Lindquist, Ruth; Nilsson, Peter M.; Roman, Gustavo C.; Sellke, Frank W.; Seshadri, Sudha

2013-01-01

Background and Purpose This scientific statement provides an overview of the evidence on vascular contributions to cognitive impairment and dementia. Vascular contributions to cognitive impairment and dementia of later life are common. Definitions of vascular cognitive impairment (VCI), neuropathology, basic science and pathophysiological aspects, role of neuroimaging and vascular and other associated risk factors, and potential opportunities for prevention and treatment are reviewed. This statement serves as an overall guide for practitioners to gain a better understanding of VCI and dementia, prevention, and treatment. Methods Writing group members were nominated by the writing group co-chairs on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council Scientific Statement Oversight Committee, the Council on Epidemiology and Prevention, and the Manuscript Oversight Committee. The writing group used systematic literature reviews (primarily covering publications from 1990 to May 1, 2010), previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and, when appropriate, formulate recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. After peer review by the American Heart Association, as well as review by the Stroke Council leadership, Council on Epidemiology and Prevention Council, and Scientific Statements Oversight Committee, the statement was approved by the American Heart Association Science Advisory and Coordinating Committee. Results The construct of VCI has been introduced to capture the entire spectrum of cognitive disorders associated with all forms of cerebral vascular brain injury—not solely stroke—ranging from mild cognitive impairment through fully developed

Influence of Different Cut-Off Values on the Diagnosis of Mild Cognitive Impairment in Parkinson's Disease

Directory of Open Access Journals (Sweden)

Inga Liepelt-Scarfone

2011-01-01

Full Text Available Comparable to Alzheimer's disease, mild cognitive impairment in Parkinson's disease (PD-MCI is associated with an increased risk for dementia. However different definitions of PD-MCI may have varying predictive accuracy for dementia. In a cohort of 101 nondemented Parkinson patients who underwent neuropsychological testing, the frequency of PD-MCI subjects and PD-MCI subtypes (i.e., amnestic/nonamnestic was determined by use of varying healthy population-based cut-off values. We also investigated the association between defined PD-MCI groups and ADL scales. Varying cut-off values for the definition of PD-MCI were found to affect frequency of PD-MCI subjects (9.9%–92.1% and, maybe more important, lead to a “shift” of proportion of detected PD-MCI subtypes especially within the amnestic single-domain subtype. Models using a strict cut-off value were significantly associated with lower ADL scores. Thus, the use of defined cut-off values for the definition of PD-MCI is highly relevant for comparison purposes. Strict cut-off values may have a higher predictive value for dementia.

Everyday episodic memory in amnestic mild cognitive impairment: a preliminary investigation.

Science.gov (United States)

Irish, Muireann; Lawlor, Brian A; Coen, Robert F; O'Mara, Shane M

2011-08-04

Decline in episodic memory is one of the hallmark features of Alzheimer's disease (AD) and is also a defining feature of amnestic Mild Cognitive Impairment (MCI), which is posited as a potential prodrome of AD. While deficits in episodic memory are well documented in MCI, the nature of this impairment remains relatively under-researched, particularly for those domains with direct relevance and meaning for the patient's daily life. In order to fully explore the impact of disruption to the episodic memory system on everyday memory in MCI, we examined participants' episodic memory capacity using a battery of experimental tasks with real-world relevance. We investigated episodic acquisition and delayed recall (story-memory), associative memory (face-name pairings), spatial memory (route learning and recall), and memory for everyday mundane events in 16 amnestic MCI and 18 control participants. Furthermore, we followed MCI participants longitudinally to gain preliminary evidence regarding the possible predictive efficacy of these real-world episodic memory tasks for subsequent conversion to AD. The most discriminating tests at baseline were measures of acquisition, delayed recall, and associative memory, followed by everyday memory, and spatial memory tasks, with MCI patients scoring significantly lower than controls. At follow-up (mean time elapsed: 22.4 months), 6 MCI cases had progressed to clinically probable AD. Exploratory logistic regression analyses revealed that delayed associative memory performance at baseline was a potential predictor of subsequent conversion to AD. As a preliminary study, our findings suggest that simple associative memory paradigms with real-world relevance represent an important line of enquiry in future longitudinal studies charting MCI progression over time.

Everyday episodic memory in amnestic mild cognitive impairment: a preliminary investigation

Directory of Open Access Journals (Sweden)

Lawlor Brian A

2011-08-01

Full Text Available Abstract Background Decline in episodic memory is one of the hallmark features of Alzheimer's disease (AD and is also a defining feature of amnestic Mild Cognitive Impairment (MCI, which is posited as a potential prodrome of AD. While deficits in episodic memory are well documented in MCI, the nature of this impairment remains relatively under-researched, particularly for those domains with direct relevance and meaning for the patient's daily life. In order to fully explore the impact of disruption to the episodic memory system on everyday memory in MCI, we examined participants' episodic memory capacity using a battery of experimental tasks with real-world relevance. We investigated episodic acquisition and delayed recall (story-memory, associative memory (face-name pairings, spatial memory (route learning and recall, and memory for everyday mundane events in 16 amnestic MCI and 18 control participants. Furthermore, we followed MCI participants longitudinally to gain preliminary evidence regarding the possible predictive efficacy of these real-world episodic memory tasks for subsequent conversion to AD. Results The most discriminating tests at baseline were measures of acquisition, delayed recall, and associative memory, followed by everyday memory, and spatial memory tasks, with MCI patients scoring significantly lower than controls. At follow-up (mean time elapsed: 22.4 months, 6 MCI cases had progressed to clinically probable AD. Exploratory logistic regression analyses revealed that delayed associative memory performance at baseline was a potential predictor of subsequent conversion to AD. Conclusions As a preliminary study, our findings suggest that simple associative memory paradigms with real-world relevance represent an important line of enquiry in future longitudinal studies charting MCI progression over time.

Everyday episodic memory in amnestic Mild Cognitive Impairment: a preliminary investigation

LENUS (Irish Health Repository)

Irish, Muireann

2011-08-04

Abstract Background Decline in episodic memory is one of the hallmark features of Alzheimer\\'s disease (AD) and is also a defining feature of amnestic Mild Cognitive Impairment (MCI), which is posited as a potential prodrome of AD. While deficits in episodic memory are well documented in MCI, the nature of this impairment remains relatively under-researched, particularly for those domains with direct relevance and meaning for the patient\\'s daily life. In order to fully explore the impact of disruption to the episodic memory system on everyday memory in MCI, we examined participants\\' episodic memory capacity using a battery of experimental tasks with real-world relevance. We investigated episodic acquisition and delayed recall (story-memory), associative memory (face-name pairings), spatial memory (route learning and recall), and memory for everyday mundane events in 16 amnestic MCI and 18 control participants. Furthermore, we followed MCI participants longitudinally to gain preliminary evidence regarding the possible predictive efficacy of these real-world episodic memory tasks for subsequent conversion to AD. Results The most discriminating tests at baseline were measures of acquisition, delayed recall, and associative memory, followed by everyday memory, and spatial memory tasks, with MCI patients scoring significantly lower than controls. At follow-up (mean time elapsed: 22.4 months), 6 MCI cases had progressed to clinically probable AD. Exploratory logistic regression analyses revealed that delayed associative memory performance at baseline was a potential predictor of subsequent conversion to AD. Conclusions As a preliminary study, our findings suggest that simple associative memory paradigms with real-world relevance represent an important line of enquiry in future longitudinal studies charting MCI progression over time.

Brief review: delirium

Directory of Open Access Journals (Sweden)

Schmitz ED

2014-12-01

Full Text Available No abstract available. Article truncated after 150 words. A significant number of patients develop a decline in cognitive function while hospitalized. Delirium in the intensive care increases mortality and healthcare costs and should be recognized and treated promptly (1,2. This is a brief review of delirium and important treatment options such as early percutaneous tracheostomy, neuroleptics, propofol, daily awakenings and reorientation by all team members. We recommend neither neuroimaging nor neurology consultation unless physical exam suggests an acute cerebral vascular accident or status epilepticus as the majority of these patients require no neurologic intervention and may be harmed by transportation to obtain additional testing. The DSM-5 defines delirium as a disturbance in attention (reduced ability to direct, focus, sustain, and shift attention and awareness (reduced orientation to the environment. The disturbance develops over a short period of time (usually hours to a few days, represents a change from baseline attention and awareness, and tends to fluctuate in severity ...

Effectiveness of multi-component non-pharmacologic delirium interventions: A Meta-analysis

Science.gov (United States)

Hshieh, Tammy T.; Yue, Jirong; Oh, Esther; Puelle, Margaret; Dowal, Sarah; Travison, Thomas; Inouye, Sharon K.

2015-01-01

Importance Delirium, an acute disorder with high morbidity and mortality, is often preventable through multi-component non-pharmacologic strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies. Objective Evaluate available evidence on multi-component non-pharmacologic delirium interventions in reducing incident delirium and preventing poor outcomes associated with delirium. Data Sources PubMed, Google Scholar, ScienceDirect and Cochrane Database of Systematic Reviews from January 1, 1999–December 31, 2013. Study Selection Studies examining the following outcomes were included: delirium incidence, falls, length of stay, rate of discharge to a long-term care institution, change in functional or cognitive status. Data Extraction and Synthesis Two experienced physician reviewers independently and blindly abstracted data on outcome measures using a standardized approach. The reviewers conducted quality ratings based on the Cochrane Risk of Bias criteria for each study. Main Outcomes and Measures We identified 14 interventional studies. Results for outcomes of delirium, falls, length of stay and institutionalization data were pooled for meta-analysis but heterogeneity limited meta-analysis of results for outcomes of functional and cognitive decline. Overall, eleven studies demonstrated significant reductions in delirium incidence (Odds Ratio 0.47, 95% Confidence Interval 0.38–0.58). The four randomized or matched (RMT) studies reduced delirium incidence by 44% (95% CI 0.42–0.76). Rate of falls decreased significantly among intervention patients in four studies (OR 0.38, 95% CI 0.25–0.60); in the two RMTs, the fall rate was reduced by 64% (95% CI 0.22–0.61). Lengths of stay and institutionalization rates also trended towards decreases in the intervention groups, mean difference −0.16 days shorter (95% CI −0.97–0.64) and odds of institutionalization 5% lower (OR 0.95, 95% CI 0.71–1

Depressive symptoms and incidence of mild cognitive impairment and probable dementia in elderly women: the Women's Health Initiative Memory Study.

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Goveas, Joseph S; Espeland, Mark A; Woods, Nancy F; Wassertheil-Smoller, Sylvia; Kotchen, Jane M

2011-01-01

To examine whether significant depressive symptoms in postmenopausal women increases the risk of subsequent mild cognitive impairment (MCI) and dementia. Prospective cohort study. Thirty nine of the 40 Women's Health Initiative (WHI) clinical centers that participated in a randomized clinical trial of hormone therapy. Six thousand three hundred seventy-six postmenopausal women without cognitive impairment aged 65 to 79 at baseline. Depressive disorders were assessed using an eight-item Burnam algorithm and followed annually for a mean period of 5.4 years. A central adjudication committee classified the presence of MCI and probable dementia based on an extensive neuropsychiatric examination. Eight percent of postmenopausal women in this sample reported depressive symptoms above a 0.06 cut point on the Burnam algorithm. Depressive disorder at baseline was associated with greater risk of incident MCI (hazard ratio (HR)=1.98, 95% confidence interval (CI)=1.33-2.94), probable dementia (HR=2.03, 95% CI=1.15-3.60), and MCI or probable dementia (HR=1.92, 95% CI=1.35-2.73) after controlling for sociodemographic characteristics, lifestyle and vascular risk factors, cardiovascular and cerebrovascular disease, antidepressant use, and current and past hormone therapy status. Assignment to hormone therapy and baseline cognitive function did not affect these relationships. Women without depression who endorsed a remote history of depression had a higher risk of developing dementia. Clinically significant depressive symptoms in women aged 65 and older are independently associated with greater incidence of MCI and probable dementia. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Assessment of delirium in the intensive care unit | Kallenbach ...

African Journals Online (AJOL)

Delirium poses a significant burden on our healthcare, with patients in the intensive care unit (ICU) at an increased risk for developing this disorder. In addition, the ICU environment poses unique challenges in the assessment of delirium. It is paramount that the healthcare provider has an understanding of delirium in ICU, ...

Environmental and Clinical Risk Factors for Delirium in a Neurosurgical Center: A Prospective Study.

Science.gov (United States)

Matano, Fumihiro; Mizunari, Takayuki; Yamada, Keiko; Kobayashi, Shiro; Murai, Yasuo; Morita, Akio

2017-07-01

Few reports of delirium-related risk factors have focused on environmental risk factors and clinical risk factors, such as white matter signal abnormalities on magnetic resonance imaging fluid attenuated inversion recovery images. We prospectively enrolled 253 patients admitted to our neurosurgical center between December 2014 and June 2015 and analyzed 220 patients (100 male patients; mean age, 64.1 years; age range, 17-92 years). An Intensive Care Delirium Screening Checklist score ≥4 points indicated delirium. We evaluated patient factors consisting of baseline characteristics and related factors, such as white matter lesions (WMLs), as well as the surrounding environment. Delirium occurred in 29/220 cases (13.2%). Regarding baseline characteristics, there were significant statistical correlations between delirium and age (P = 0.0187), Hasegawa Dementia Scale-Revised score (P = 0.0022) on admission, and WMLs (P delirium and stay in a neurosurgical care unit (P = 0.0245). Multivariate logistic regression analyses showed statistically significant correlations of delirium with WMLs (P delirium (P = 0.026). WMLs in patients and the surrounding environment are risk factors for delirium in a neurosurgical center. To prevent delirium, clinicians must recognize risk factors, such as high-grade WMLs, and manage environmental factors. Copyright © 2017 Elsevier Inc. All rights reserved.

Do continued antidepressants protect against dementia in patients with severe depressive disorder?

DEFF Research Database (Denmark)

Kessing, Lars Vedel; Forman, Julie Lyng; Andersen, Per Kragh

2011-01-01

may decrease the risk of developing dementia in patients with depression. We investigated whether continued treatment with antidepressants is associated with a decreased rate of dementia in a population of patients discharged from psychiatric healthcare service with a diagnosis of depression. We used...... register data on all prescribed antidepressants in all patients discharged from psychiatric healthcare service with a diagnosis of depression and with subsequent diagnoses of dementia in Denmark from 1995 to 2005. A total of 37 658 patients with a diagnosis of depression at their first psychiatric contact......Studies on humans show that depressive disorder is associated with an increased risk of developing cognitive dysfunction, and animal studies suggest that antidepressants may have neuroprotective abilities. On the basis of these observations, it was hypothesized that treatment with antidepressants...

Cardiovascular risk factors and dementia.

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Fillit, Howard; Nash, David T; Rundek, Tatjana; Zuckerman, Andrea

2008-06-01

Dementias, such as Alzheimer's disease (AD) and vascular dementia, are disorders of aging populations and represent a significant economic burden. Evidence is accumulating to suggest that cardiovascular disease (CVD) risk factors may be instrumental in the development of dementia. The goal of this review was to discuss the relationship between specific CVD risk factors and dementia and how current treatment strategies for dementia should focus on reducing CVD risks. We conducted a review of the literature for the simultaneous presence of 2 major topics, cardiovascular risk factors and dementia (eg, AD). Special emphasis was placed on clinical outcome studies examining the effects of treatments of pharmacologically modifiable CVD risk factors on dementia and cognitive impairment. Lifestyle risk factors for CVD, such as obesity, lack of exercise, smoking, and certain psychosocial factors, have been associated with an increased risk of cognitive decline and dementia. Some evidence suggests that effectively managing these factors may prevent cognitive decline/dementia. Randomized, placebo-controlled trials of antihypertensive medications have found that such therapy may reduce the risk of cognitive decline, and limited data suggest a benefit for patients with AD. Some small open-label and randomized clinical trials of statins have observed positive effects on cognitive function; larger studies of statins in patients with AD are ongoing. Although more research is needed, current evidence indicates an association between CVD risk factors--such as hypertension, dyslipidemia, and diabetes mellitus--and cognitive decline/dementia. From a clinical perspective, these data further support the rationale for physicians to provide effective management of CVD risk factors and for patients to be compliant with such recommendations to possibly prevent cognitive decline/dementia.

Commentary: The Diagnosis of Delirium in Pediatric Patients

Science.gov (United States)

Martini, D. Richard

2005-01-01

Pediatric patients seem to be especially vulnerable to toxic, metabolic, or traumatic CNS insults and are at greater risk of delirium with fever regardless of the etiology. Developmental limitations, in the areas of communication and cognition, prevent a thorough evaluation of the young patient for delirium. Only the most severe cases are…

The protocol of the Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo-controlled trial.

Science.gov (United States)

Neerland, Bjørn Erik; Hov, Karen Roksund; Bruun Wyller, Vegard; Qvigstad, Eirik; Skovlund, Eva; MacLullich, Alasdair M J; Bruun Wyller, Torgeir

2015-02-10

Delirium affects 15% of hospitalised patients and is linked with poor outcomes, yet few pharmacological treatment options exist. One hypothesis is that delirium may in part result from exaggerated and/or prolonged stress responses. Dexmedetomidine, a parenterally-administered alpha2-adrenergic receptor agonist which attenuates sympathetic nervous system activity, shows promise as treatment in ICU delirium. Clonidine exhibits similar pharmacodynamic properties and can be administered orally. We therefore wish to explore possible effects of clonidine upon the duration and severity of delirium in general medical inpatients. The Oslo Study of Clonidine in Elderly Patients with Delirium (LUCID) is a randomised, placebo-controlled, double-blinded, parallel group study with 4-month prospective follow-up. We will recruit 100 older medical inpatients with delirium or subsyndromal delirium in the acute geriatric ward. Participants will be randomised to oral clonidine or placebo until delirium free for 2 days (Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria), or after a maximum of 7 days treatment. Assessment of haemodynamics (blood pressure, heart rate and electrocardiogram) and delirium will be performed daily until discharge or a maximum of 7 days after end of treatment. The primary endpoint is the trajectory of delirium over time (measured by Memorial Delirium Assessment Scale). Secondary endpoints include the duration of delirium, use of rescue medication for delirium, pharmacokinetics and pharmacodynamics of clonidine, cognitive function after 4 months, length of hospital stay and need for institutionalisation. LUCID will explore the efficacy and safety of clonidine for delirium in older medical inpatients. ClinicalTrials.gov NCT01956604. EudraCT Number: 2013-000815-26.

Memory complaints in subjective cognitive impairment, amnestic mild cognitive impairment and mild Alzheimer's disease.

Science.gov (United States)

Ryu, Seon Young; Lee, Sang Bong; Kim, Tae Woo; Lee, Taek Jun

2016-12-01

Memory complaints are a frequent phenomenon in elderly individuals and can lead to opportunistic help-seeking behavior. The aim of this study was to compare different aspects of memory complaints (i.e., prospective versus retrospective complaints) in individuals with subjective cognitive impairment (SCI), amnestic mild cognitive impairment (aMCI), and mild Alzheimer's disease (AD). The study included a total of 115 participants (mean age: 68.82 ± 8.83 years) with SCI (n = 34), aMCI (n = 46), and mild AD (n = 35). Memory complaints were assessed using the Prospective and Retrospective Memory Questionnaire (PRMQ), which consists of 16 items that describe everyday memory failure of both prospective memory (PM) and retrospective memory (RM). For aMCI and AD subjects, informants also completed an informant-rating of the PRMQ. All participants completed detailed neuropsychological tests. Results show that PM complaints were equivalent among the three groups. However, RM complaints differed. Specifically, RM complaints in aMCI were higher than SCI, but similar to AD. Informant-reported memory complaints were higher for AD than aMCI. Our study suggests that RM complaints of memory complaints may be helpful in discriminating between SCI and aMCI, but both PM and RM complaints are of limited value in differentiating aMCI from AD.

Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study.

Science.gov (United States)

Wu, Yu-Tzu; Prina, A Matthew; Jones, Andrew P; Barnes, Linda E; Matthews, Fiona E; Brayne, Carol

2015-11-01

Few studies have investigated the impact of the community environment, as distinct from area deprivation, on cognition in later life. This study explores cross-sectional associations between cognitive impairment and dementia and environmental features at the community level in older people. The postcodes of the 2,424 participants in the year-10 interview of the Cognitive Function and Ageing Study in England were mapped into small area level geographical units (Lower-layer Super Output Areas) and linked to environmental data in government statistics. Multilevel logistic regression was conducted to investigate associations between cognitive impairment (defined as MMSE ≤ 25), dementia (organicity level ≥3 in GMS-AGECAT) and community level measurements including area deprivation, natural environment, land use mix and crime. Sensitivity analyses tested the impact of people moving residence within the last two years. Higher levels of area deprivation and crime were not significantly associated with cognitive impairment and dementia after accounting for individual level factors. Living in areas with high land use mix was significantly associated with a nearly 60% reduced odds of dementia (OR: 0.4; 95% CI: 0.2, 0.8) after adjusting for individual level factors and area deprivation, but there was no linear trend for cognitive impairment. Increased odds of dementia (OR: 2.2, 95% CI: 1.2, 4.2) and cognitive impairment (OR: 1.4, 95% CI: 1.0, 2.0) were found in the highest quartile of natural environment availability. Findings were robust to exclusion of the recently relocated. Features of land use have complex associations with cognitive impairment and dementia. Further investigations should focus on environmental influences on cognition to inform health and social policies. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society.

Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure.

Science.gov (United States)

Maldonado, José R

2017-12-26

Delirium is the most common neuropsychiatric syndrome encountered by clinicians dealing with older adults and the medically ill and is best characterized by 5 core domains: cognitive deficits, attentional deficits, circadian rhythm dysregulation, emotional dysregulation, and alteration in psychomotor functioning. An extensive literature review and consolidation of published data into a novel interpretation of known pathophysiological causes of delirium. Available data suggest that numerous pathological factors may serve as precipitants for delirium, each having differential effects depending on patient-specific patient physiological characteristics (substrate). On the basis of an extensive literature search, a newly proposed theory, the systems integration failure hypothesis, was developed to bring together the most salient previously described theories, by describing the various contributions from each into a complex web of pathways-highlighting areas of intersection and commonalities and explaining how the variable contribution of these may lead to the development of various cognitive and behavioral dysfunctions characteristic of delirium. The specific cognitive and behavioral manifestations of the specific delirium picture result from a combination of neurotransmitter function and availability, variability in integration and processing of sensory information, motor responses to both external and internal cues, and the degree of breakdown in neuronal network connectivity, hence the term acute brain failure. The systems integration failure hypothesis attempts to explain how the various proposed delirium pathophysiologic theories interact with each other, causing various clinically observed delirium phenotypes. A better understanding of the underlying pathophysiology of delirium may eventually assist in designing better prevention and management approaches. Copyright © 2017 John Wiley & Sons, Ltd.

Autobiographical memory for the differential diagnosis of cognitive pathology in aging.

Science.gov (United States)

Meléndez, Juan C; Redondo, Rita; Torres, Marta; Mayordomo, Teresa; Sales, Alicia

2016-11-01

The present study distinguishes three memory stages across the lifespan, and aims to compare episodic and semantic autobiographical memory in healthy older adults, with amnesic mild cognitive impairment, and with Alzheimer's disease. This information can offer evidence about the way semantic and episodic autobiographical memory work, and how the disease affects them. The sample was composed of 56 people, all aged over 60 years; 15 with amnestic mild cognitive impairment, 12 with Alzheimer's disease and 29 healthy older people. Participants were evaluated with the Autobiographical Memory Interview. A mixed anova showed significant main effects of memory and time-period, and significant interactions of memory × group, time-period × group and memory × time × group. Assessment of autobiographical memory provides information to differentiate amnestic mild cognitive impairment patients from Alzheimer's disease patients. Although the decline in episodic memory starts with the onset of the disease, semantic memory is maintained until moderate stages of dementia. Geriatr Gerontol Int 2016; 16:1220-1225. © 2015 Japan Geriatrics Society.

Neurodegenerative Dementia

International Nuclear Information System (INIS)

Allard, Michelle

2006-01-01

Full text: With increasing life expectancy across the world, the number of elderly people at risk of developing dementia is growing rapidly. Thus, progressive neurodegenerative disorders such as dementia represent a growing public health concern. These diseases are characterized by a progressive loss in most of the cognitive functions. The promise, possibly in a near future, of disease-modifying therapies has made the characterization of the early stages of dementia a topic of major interest. The assessment of these early stages is a challenge for neuroimaging studies. In order to conceive prevention trials; it is of major outcome to fully understand the mechanisms of the cognitive system impairment and its evolution, with a particular reference to the symptomatic pre-dementia stage, when subjects just begin to depart from normality. In this article we review recent progress in neuroimaging, and their potentiality for increasing a diagnostic accuracy. (author)

Brain metabolic correlates of decision making in amnestic mild cognitive impairment.

Science.gov (United States)

Griffith, H Randall; Okonkwo, Ozioma C; den Hollander, Jan A; Belue, Katherine; Copeland, Jacqueline; Harrell, Lindy E; Brockington, John C; Clark, David G; Marson, Daniel C

2010-01-01

Persons with amnestic mild cognitive impairment (MCI) have subtle impairments in medical decision-making capacity (MDC). We examined the relationship between proton magnetic resonance spectroscopy (MRS) and MDC in MCI. Twenty-nine MCI patients and 42 controls underwent MRS to obtain ratios of N-acetylaspartate (NAA)/Creatine (Cr), Choline (Cho)/Cr, and myo-Inositol (mI)/Cr of the posterior cingulate. They also completed the Capacity to Consent to Treatment Instrument (CCTI), a vignette-based instrument measuring decisional standards of expressing choice, appreciating consequences of choice, providing rational reasons for choice, and understanding treatment choices. Patients showed abnormal MRS ratios of mI/Cr and Cho/Cr compared to controls, and impairments on the CCTI understanding and reasoning Standards. Performance on the reasoning standard of the CCTI was correlated with NAA/Cr (r = .46, p decision-making suggests a role for posterior cortical neuronal functioning in performance of complex IADLs in MCI.

Hypertension is associated with cognitive decline in elderly people at high risk for dementia.

Science.gov (United States)

Wysocki, Michael; Luo, Xiaodong; Schmeidler, James; Dahlman, Karen; Lesser, Gerson T; Grossman, Hillel; Haroutunian, Vahram; Beeri, Michal Schnaider

2012-02-01

Cardiovascular risk factors including hypertension (HTN) have been shown to increase the risk of Alzheimer disease. The current study investigated whether individuals with HTN are more susceptible to increased cognitive decline and whether the influence of HTN on cognitive decline varied as a function of dementia severity. A total of 224 nursing home and assisted living residents, with a mean age of 84.9 (±7.6) years, were assessed longitudinally with Mini Mental State Exams (MMSEs) and Clinical Dementia Ratings (CDR). Baseline dementia status was defined by the CDR score. As described in , MMSE scores in persons with HTN and questionable dementia (CDR = 0.5) declined significantly faster than nonhypertensive questionably demented persons. Hypertensive participants did not decline significantly faster than nonhypertensive participants in persons with intact cognition (CDR = 0) or frank dementia (CDR ≥ 1). These results suggest an increased risk of subsequent cognitive decline in hypertensive individuals who are especially vulnerable to developing dementia and raises the possibility that avoiding or controlling HTN might reduce the rate of cognitive decline in cognitively vulnerable individuals, potentially delaying their conversion to full-fledged dementia.

A Clinical Update on Delirium: From Early Recognition to Effective Management

Directory of Open Access Journals (Sweden)

Joaquim Cerejeira

2011-01-01

Full Text Available Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role.

Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients.

Science.gov (United States)

Culley, Deborah J; Flaherty, Devon; Fahey, Margaret C; Rudolph, James L; Javedan, Houman; Huang, Chuan-Chin; Wright, John; Bader, Angela M; Hyman, Bradley T; Blacker, Deborah; Crosby, Gregory

2017-11-01

The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.

Symptoms of depression and delirium assessed serially in palliative-care inpatients.

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Leonard, Maeve; Spiller, Juliet; Keen, Jeremy; MacLullich, Alasdair; Kamholtz, Barbara; Meagher, David

2009-01-01

Delirium occurs in approximately 1 in 5 general hospital admissions and up to 85% of patients with terminal illness, but can be difficult to differentiation from other disorders, such as depression. The authors assessed and compared mood states as they relate to onset of delirium. Symptoms of depression and delirium were assessed in 100 consecutive palliative-care admissions immediately after admission and 1 week later. Overall, 51% experienced either major depression or delirium. Most patients with syndromal delirium also met criteria for major depressive illness, and 50% of those with depression had delirium or subsyndromal delirium (SSD). Delirium symptoms were less common in patients with major depression than depressive symptoms in patients with delirium or SSD. Delirium should be considered in patients with altered mood states, and screening for depression should initially rule out delirium. Sustained alterations in mood may be more frequent in delirium than previously recognized.

Visual selective attention in amnestic mild cognitive impairment.

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McLaughlin, Paula M; Anderson, Nicole D; Rich, Jill B; Chertkow, Howard; Murtha, Susan J E

2014-11-01

Subtle deficits in visual selective attention have been found in amnestic mild cognitive impairment (aMCI). However, few studies have explored performance on visual search paradigms or the Simon task, which are known to be sensitive to disease severity in Alzheimer's patients. Furthermore, there is limited research investigating how deficiencies can be ameliorated with exogenous support (auditory cues). Sixteen individuals with aMCI and 14 control participants completed 3 experimental tasks that varied in demand and cue availability: visual search-alerting, visual search-orienting, and Simon task. Visual selective attention was influenced by aMCI, auditory cues, and task characteristics. Visual search abilities were relatively consistent across groups. The aMCI participants were impaired on the Simon task when working memory was required, but conflict resolution was similar to controls. Spatially informative orienting cues improved response times, whereas spatially neutral alerting cues did not influence performance. Finally, spatially informative auditory cues benefited the aMCI group more than controls in the visual search task, specifically at the largest array size where orienting demands were greatest. These findings suggest that individuals with aMCI have working memory deficits and subtle deficiencies in orienting attention and rely on exogenous information to guide attention. © The Author 2013. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Old people with femoral neck fracture : delirium, malnutrition and surgical methods - an intervention program

OpenAIRE

Olofsson, Birgitta

2007-01-01

Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associate...

Does the Order of Item Difficulty of the Addenbrooke's Cognitive Examination Add Anything to Subdomain Scores in the Clinical Assessment of Dementia?

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McGrory, Sarah; Starr, John M; Shenkin, Susan D; Austin, Elizabeth J; Hodges, John R

2015-01-01

The Addenbrooke's Cognitive Examination (ACE) is used to measure cognition across a range of domains in dementia. Identifying the order in which cognitive decline occurs across items, and whether this varies between dementia aetiologies could add more information to subdomain scores. ACE-Revised data from 350 patients were split into three groups: Alzheimer's type (n = 131), predominantly frontal (n = 119) and other frontotemporal lobe degenerative disorders (n = 100). Results of factor analysis and Mokken scaling analysis were compared. Principal component analysis revealed one factor for each group. Confirmatory factor analysis found that the one-factor model fit two samples poorly. Mokken analyses revealed different item ordering in terms of difficulty for each group. The different patterns for each diagnostic group could aid in the separation of these different types of dementia.

Dementia: role of MRI

International Nuclear Information System (INIS)

Georgieva-Kozarova, G.

2012-01-01

Full text: This presentation will focus on the role of MRI in the diagnosis of dementia and related diseases. We will discuss the following subjects: 1. Systematic assessment of MR in dementia 2. MR protocol for dementia 3. Typical findings in the most common dementia syndrome Alzheimer's disease (AD), Vascular Dementia (VaD), Frontotemporal lobe dementia (FTLD) 4. Short overview of neurodegenerative disorders which may be associated with dementia. The role of neuroimaging in dementia nowadays extends to support the diagnosis of specific neurodegenerative disorders. It is a challenge to the early diagnosis of neurodegenerative diseases such as Alzheimer's disease. Early diagnosis includes recognition of predementia conditions, such as mild cognitive impairment (MCI). Neuroimaging may also be used to assess disease progression and is adopted in current trials investigating MCI and AD. An MR-study of a patient suspected of having dementia must be assessed in a standardized way. First of all, treatable diseases like subdural hematomas, tumors and hydrocephalus need to be excluded. Next we should look for signs of specific dementias such as: Alzheimer's disease (AD): medial temporal lobe atrophy (MTA) and parietal atrophy. Frontotemporal Lobar Degeneration (FTLD): (asymmetric) frontal lobe atrophy and atrophy of the temporal pole. Vascular Dementia (VaD): global atrophy, diffuse white matter lesions, lacunas and 'strategic infarcts' (infarcts in regions that are involved in cognitive function). Dementia with Lewy bodies (DLB): in contrast to other forms of dementia usually no specific abnormalities. So when we study the MR images we should score in a systematic way for global atrophy, focal atrophy and for vascular disease (i.e. infarcts, white matter lesions, lacunas)

Cognitive and imaging markers in non-demented subjects attending a memory clinic: study design and baseline findings of the MEMENTO cohort.

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Dufouil, Carole; Dubois, Bruno; Vellas, Bruno; Pasquier, Florence; Blanc, Frédéric; Hugon, Jacques; Hanon, Olivier; Dartigues, Jean-François; Harston, Sandrine; Gabelle, Audrey; Ceccaldi, Mathieu; Beauchet, Olivier; Krolak-Salmon, Pierre; David, Renaud; Rouaud, Olivier; Godefroy, Olivier; Belin, Catherine; Rouch, Isabelle; Auguste, Nicolas; Wallon, David; Benetos, Athanase; Pariente, Jérémie; Paccalin, Marc; Moreaud, Olivier; Hommet, Caroline; Sellal, François; Boutoleau-Bretonniére, Claire; Jalenques, Isabelle; Gentric, Armelle; Vandel, Pierre; Azouani, Chabha; Fillon, Ludovic; Fischer, Clara; Savarieau, Helen; Operto, Gregory; Bertin, Hugo; Chupin, Marie; Bouteloup, Vincent; Habert, Marie-Odile; Mangin, Jean-François; Chêne, Geneviève

2017-08-29

The natural history and disease mechanisms of Alzheimer's disease and related disorders (ADRD) are still poorly understood. Very few resources are available to scrutinise patients as early as needed and to use integrative approaches combining standardised, repeated clinical investigations and cutting-edge biomarker measurements. In the nationwide French MEMENTO cohort study, participants were recruited in memory clinics and screened for either isolated subjective cognitive complaints (SCCs) or mild cognitive impairment (MCI; defined as test performance 1.5 SD below age, sex and education-level norms) while not demented (Clinical Dementia Rating [CDR] <1). Baseline data collection included neurological and physical examinations as well as extensive neuropsychological testing. To be included in the MEMENTO cohort, participants had to agree to undergo both brain magnetic resonance imaging (MRI) and blood sampling. Cerebral 18 F-fluorodeoxyglucose positon emission tomography and lumbar puncture were optional. Automated analyses of cerebral MRI included assessments of volumes of whole-brain, hippocampal and white matter lesions. The 2323 participants, recruited from April 2011 to June 2014, were aged 71 years, on average (SD 8.7), and 62% were women. CDR was 0 in 40% of participants, and 30% carried at least one apolipoprotein E ε4 allele. We observed that more than half (52%) of participants had amnestic mild cognitive impairment (17% single-domain aMCI), 32% had non-amnestic mild cognitive impairment (16.9% single-domain naMCI) and 16% had isolated SCCs. Multivariable analyses of neuroimaging markers associations with cognitive categories showed that participants with aMCI had worse levels of imaging biomarkers than the others, whereas participants with naMCI had markers at intermediate levels between SCC and aMCI. The burden of white matter lesions tended to be larger in participants with aMCI. Independently of CDR, all neuroimaging and neuropsychological markers

Depressive symptoms predict slow cognitive decline in mild dementia.

NARCIS (Netherlands)

Janzing, J.G.E.; Naarding, P.; Eling, P.A.T.M.

2005-01-01

Depression may be a prognostic marker of subsequent cognitive decline in patients with dementia. Earlier investigations did not find support for this hypothesis, but these considered mainly syndromal depression. In this prospective study, 32 subjects with mild dementia were followed up for 12

Motor Disturbances in Elderly Medical Inpatients and Their Relationship to Delirium.

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Adamis, Dimitrios; McCarthy, Geraldine; O'Mahony, Edmond; Meagher, David

2017-07-01

Motor disturbances in delirious patients are common, but their relationship to cognition and severity of illness has not been studied. We examined motor subtypes in an older age inpatient population, their relationship to clinical variables including delirium, and their association with 1-year mortality in a prospective study, using the Confusion Assessment Method, Acute Physiology and Chronic Health Evaluation II, Montreal Cognitive Assessment (MoCA), Barthel Index, and Delirium Rating Scale-Revised 98 (DRS-R98). Motor subtypes were evaluated using 2 items of DRS-R98. Mortality rates were investigated 1 year later. Two hundred participated (mean age 81.1 [6.5]; 50% female). Thirty-four (17%) were identified with delirium. Motor subtypes were none: 119 (59.5%), hypoactive: 37 (18.5%), hyperactive: 29 (14.5%), and mixed: 15 (7.5%). Hypoactive and mixed subtypes were significantly more frequent in delirious patients. Regression analysis showed that hypoactive subtype was significantly associated with lower MoCA. No relationship between motor subtypes and mortality was found. Motor disturbances are not unique to delirium, with hypoactivity particularly associated with impaired cognition.

Addenbrooke's Cognitive Examination-Revised is accurate for detecting dementia in Parkinson's disease patients with low educational level.

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Rocha, Maria Sheila Guimarães; Bassetti, Elida Maria; Oliveira, Maira Okada; Kuark, Roberta Gomes Borges; Estevam, Nathercia Marinho; Brucki, Sonia Maria Dozzi

2014-01-01

Diagnosis of Parkinson's disease dementia is a challenge in clinical settings. A comprehensive neuropsychological evaluation is time-consuming and expensive; brief instruments for cognitive evaluation must be easier to administer and provide a reliable classification. To study the validity of the Brazilian version of Addenbrooke's Cognitive Examination-Revised (ACE-R) for the cognitive assessment of Parkinson's disease (PD) patients with heterogeneous educational level. Patients were evaluated according to the diagnostic procedures recommended by the Movement Disorder Society (MDS) as the gold standard for the diagnosis of dementia in PD. We studied 70 idiopathic PD patients, with a mean (SD) age of 64.1 (9.3) years and mean disease duration of 7.7 (5.3) years and educational level of 5.9 years, matched for education and age to controls. Twenty-seven patients fulfilled MDS clinical criteria for PD dementia. Mean scores on the ACE-R were 54.7 (12.8) points for patients with PD dementia, 76 (9.9) for PD patients without dementia and 79.7 (1.8) points for healthy controls. The area under the receiver operating curve, taking the MDS diagnostic procedures as a reference, was 0.93 [95% CI, 0.87-0.98; p<0.001] for ACE-R. The optimal cut-off value for ACE-R was ≤72 points [sensitivity 90%; specificity 85%; Kappa concordance (K) 0.79]. ACE-R appears to be a valid tool for dementia evaluation in PD patients with heterogeneous educational level, displaying good correlation with clinical criteria and diagnostic procedures of the MDS.

Addenbrooke's Cognitive Examination-Revised is accurate for detecting dementia in Parkinson's disease patients with low educational level

Directory of Open Access Journals (Sweden)

Maria Sheila Guimarães Rocha

Full Text Available ABSTRACT Diagnosis of Parkinson's disease dementia is a challenge in clinical settings. A comprehensive neuropsychological evaluation is time-consuming and expensive; brief instruments for cognitive evaluation must be easier to administer and provide a reliable classification. Objective: To study the validity of the Brazilian version of Addenbrooke's Cognitive Examination-Revised (ACE-R for the cognitive assessment of Parkinson's disease (PD patients with heterogeneous educational level. Methods: Patients were evaluated according to the diagnostic procedures recommended by the Movement Disorder Society (MDS as the gold standard for the diagnosis of dementia in PD. Results: We studied 70 idiopathic PD patients, with a mean (SD age of 64.1 (9.3 years and mean disease duration of 7.7 (5.3 years and educational level of 5.9 years, matched for education and age to controls. Twenty-seven patients fulfilled MDS clinical criteria for PD dementia. Mean scores on the ACE-R were 54.7 (12.8 points for patients with PD dementia, 76 (9.9 for PD patients without dementia and 79.7 (1.8 points for healthy controls. The area under the receiver operating curve, taking the MDS diagnostic procedures as a reference, was 0.93 [95% CI, 0.87-0.98; p<0.001] for ACE-R. The optimal cut-off value for ACE-R was ≤72 points [sensitivity 90%; specificity 85%; Kappa concordance (K 0.79]. Conclusion: ACE-R appears to be a valid tool for dementia evaluation in PD patients with heterogeneous educational level, displaying good correlation with clinical criteria and diagnostic procedures of the MDS.

Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia.

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Capotosto, Emanuela; Belacchi, Carmen; Gardini, Simona; Faggian, Silvia; Piras, Federica; Mantoan, Vanessa; Salvalaio, Elisa; Pradelli, Samantha; Borella, Erika

2017-03-01

Cognitive stimulation therapy (CST) has been shown to have significant benefits in enhancing cognitive functioning and improving the quality of life of people with mild to moderate dementia. The present study examines the efficacy of the Italian version of the therapy (CST-IT). Older adults with mild to moderate dementia (n = 39) were randomly assigned to two programs: one group participated in the CST-IT, consisting of 14 sessions (twice a week for 7 weeks) and the active control group took part in alternative general activities. The outcome measures were cognitive functioning (measured by the Mini-Mental State Examination-MMSE-, the Alzheimer's Disease Assessment scale-cognitive subscale, the backward digit span test, and a narrative language test); quality of life (Quality of life--Alzheimer's Disease scale); mood (Cornell scale for depression in dementia and the social and emotional loneliness scale); functional activities in daily living (Disability Assessment for Dementia); and behavior (neuropsychiatric inventory). After the intervention, only the CST-IT group maintained its MMSE score, while the control group displayed deterioration. The CST-IT group also performed better in some of the cognitive measures (Alzheimer's Disease Assessment Scale-Cognitive subscale and narrative language), mood measures (Cornell scale, social and emotional loneliness scale with a decrease in reported loneliness), and the Quality of life--Alzheimer's Disease scale. No other treatment effect was observed. The findings confirm the efficacy, at least in the short term, of the CST in sustaining cognitive functions and perceived quality of life in older adults with dementia in the Italian care setting as well. Copyright © 2016 John Wiley & Sons, Ltd.

Psychiatric symptomatology after delirium: a systematic review.

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Langan, Clare; Sarode, Deep P; Russ, Tom C; Shenkin, Susan D; Carson, Alan; Maclullich, Alasdair M J

2017-09-01

Delirium is an acute and usually transient severe neuropsychiatric syndrome associated with significant long-term physical morbidity. However, its chronic psychiatric sequelae remain poorly characterized. To investigate the prevalence of psychiatric symptoms, namely anxiety, depressive, and post-traumatic stress disorder (PTSD) symptoms after delirium, a systematic literature search of MEDLINE, EMBASE and PsycINFO databases was performed independently by two authors in March 2016. Bibliographies were hand-searched, and a forward- and backward-citation search using Web of Science was performed for all included studies. Of 6411 titles, we included eight prospective cohort studies, including 370 patients with delirium and 1073 without delirium. Studies were heterogeneous and mostly included older people from a range of clinical groups. Consideration of confounders was variable. The prevalence of depressive symptoms was almost three times higher in patients with delirium than in patients without delirium (22.2% vs 8.0%, risk ratio = 2.79; 95% confidence interval = 1.36-5.73). There was no statistically significant difference between the prevalence of anxiety symptoms between patients with and without delirium. The prevalence of PTSD symptoms after delirium was inconclusive: only one study investigated this and no association between PTSD symptoms after delirium was reported. There is limited published evidence of the prevalence of psychiatric symptoms after non-ICU delirium and the strongest evidence is for depressive symptoms. Further longitudinal studies are warranted to investigate the prevalence of anxiety and PTSD symptoms. © 2017 Japanese Psychogeriatric Society.

Detection of delirium and its symptoms by nurses working in a long term care facility.

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Voyer, Philippe; Richard, Sylvie; McCusker, Jane; Cole, Martin G; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Belzile, Eric

2012-03-01

To investigate the ability of nurses to recognize delirium and its symptoms and to investigate the factors associated with undetected delirium. A prospective, observational study with repeated measurements over a 6-month period. Seven long term care settings in Montreal and Quebec City, Canada. Residents aged 65 and older, with or without dementia, admitted to long term care (not respite care) and able to communicate in English or French. Delirium and its symptoms were assessed using the Confusion Assessment Method. Ratings of delirium by nurses based on their observations during routine care were compared with delirium ratings by trained research assistants based on a one-time formal structured evaluation (Confusion Assessment Method and Mini Mental State Examination). This procedure was repeated for 10 delirium symptoms. Sensitivity, specificity, and positive and negative predictive values were calculated. The method of generalized estimating equations was used to identify factors associated with undetected delirium. Research assistants identified delirium in 43 (21.3%) of the 202 residents. Nurses identified delirium in 51% of the cases identified by the research assistants. However, for cases without delirium according to the research assistants, nurses identified 90% of them correctly. Detection rates for delirium symptoms ranged from 25% to 66.7%. Undetected delirium was associated with lower number of depressive symptoms manifested by the resident. Detection of delirium is a major issue for nurses. Strategies to improve nurse recognition of delirium could well reduce adverse outcomes for this vulnerable population. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Delirium and high fever are associated with subacute motor deterioration in Parkinson disease: a nested case-control study.

Directory of Open Access Journals (Sweden)

Atsushi Umemura

Full Text Available BACKGROUND: In Parkinson disease (PD, systemic inflammation caused by respiratory infections such as pneumonia frequently occurs, often resulting in delirium in the advanced stages of this disease. Delirium can lead to cognitive and functional decline, institutionalization, and mortality, especially in the elderly. Inflammation causes rapid worsening of PD motor symptoms and signs, sometimes irreversibly in some, but not all, patients. PURPOSE: To identify factors associated with subacute motor deterioration in PD patients with systemic inflammation. METHODS: The association of clinical factors with subacute motor deterioration was analyzed by a case-control study. Subacute motor deterioration was defined as sustained worsening by one or more modified Hoehn and Yahr (H-Y stages. Using multivariable logistic regression incorporating baseline characteristics (age, sex, PD duration, modified H-Y stage, dementia, and psychosis history and statistically selected possible predictors (peak body temperature, duration of leukocytosis, and presence of delirium, the odds ratios for these factors were estimated as relative risks. RESULTS: Of 80 PD patients with systemic inflammation, 26 with associated subacute motor deterioration were designated as cases and the remainder as controls. In the 26 cases, 6 months after its onset the motor deterioration had persisted in 19 patients and resolved in four (three were lost for follow-up. Multivariable logistic regression analysis showed that delirium and body temperature are significantly associated with motor deterioration after systemic inflammation (P = 0.001 for delirium and P = 0.026 for body temperature, the adjusted odds ratios being 15.89 (95% confidence interval [CI]: 3.23-78.14 and 2.78 (95% CI: 1.13-6.83, respectively. CONCLUSIONS: In patients with PD and systemic inflammation, delirium and high body temperature are strong risk factors for subsequent subacute motor deterioration and such deterioration

Hippocampal subfield volumetry in mild cognitive impairment, Alzheimer's disease and semantic dementia.

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La Joie, Renaud; Perrotin, Audrey; de La Sayette, Vincent; Egret, Stéphanie; Doeuvre, Loïc; Belliard, Serge; Eustache, Francis; Desgranges, Béatrice; Chételat, Gaël

2013-01-01

Hippocampal atrophy is a well-known feature of Alzheimer's disease (AD), but sensitivity and specificity of hippocampal volumetry are limited. Neuropathological studies have shown that hippocampal subfields are differentially vulnerable to AD; hippocampal subfield volumetry may thus prove to be more accurate than global hippocampal volumetry to detect AD. CA1, subiculum and other subfields were manually delineated from 40 healthy controls, 18 AD, 17 amnestic Mild Cognitive Impairment (aMCI), and 8 semantic dementia (SD) patients using a previously developed high resolution MRI procedure. Non-parametric group comparisons and receiver operating characteristic (ROC) analyses were conducted. Complementary analyses were conducted to evaluate differences of hemispheric asymmetry and anterior-predominance between AD and SD patients and to distinguish aMCI patients with or without β-amyloid deposition as assessed by Florbetapir-TEP. Global hippocampi were atrophied in all three patient groups and volume decreases were maximal in the CA1 subfield (22% loss in aMCI, 27% in both AD and SD; all p volumetry was more accurate than global hippocampal measurement to distinguish patients from controls (areas under the ROC curve = 0.88 and 0.76, respectively; p = 0.05) and preliminary analyses suggest that it was independent from the presence of β-amyloid deposition. In patients with SD, whereas the degree of CA1 and subiculum atrophy was similar to that found in AD patients, hemispheric and anterior-posterior asymmetry were significantly more marked than in AD with greater involvement of the left and anterior hippocampal subfields. The findings suggest that CA1 measurement is more sensitive than global hippocampal volumetry to detect structural changes at the pre-dementia stage, although the predominance of CA1 atrophy does not appear to be specific to AD pathophysiological processes.

Disorders of "taste cognition" are associated with insular involvement in patients with Alzheimer's disease and vascular dementia: "memory of food is impaired in dementia and responsible for poor diet".

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Suto, Teiko; Meguro, Kenichi; Nakatsuka, Masahiro; Kato, Yuriko; Tezuka, Kimihiro; Yamaguchi, Satoshi; Tashiro, Manabu

2014-07-01

In dementia patients, dietary intake problems may occur despite the absence of swallowing problems. We investigated cognitive functions on food and taste in Alzheimer's disease (AD) and vascular dementia (VaD) patients. Participants included 15 healthy controls (HC), 30 AD and 20 VaD patients. Food Cognition Test: Replicas of three popular foods in Japan with no odors were presented visually to each participant, with the instruction to respond with the name of each food. Replicas of food materials were subsequently presented to ask whether they were included in these foods. Taste Cognition Test: Replicas of 12 kinds of foods were presented to describe their expected tastes. The AD/VaD groups exhibited significantly lower scores on Food/Taste Cognition Tests compared with the HC group. These scores correlated inversely with Mini-Mental State Examination (MMSE) scores in the AD group. Decreased dietary intake was observed in 12 of the 50 patients; 8 of the 12 exhibited decreased Taste Cognition Test scores, higher than that of the normal-intake patients. There was no difference in the filter paper taste disc test between HC/AD/VaD groups. To test the hypothesis that the insula is associated with taste cognition, two MMSE-matched AD subgroups (n = 10 vs. 10) underwent positron emission tomography. Glucose metabolism in the right insula was lower in the low taste cognition subgroup. The VaD patients with insular lesions exhibited impaired Taste Cognition Test findings. It is important to consider the cognitive aspect of dietary intake when we care for dementia patients.

Driving with Mild Cognitive Impairment or Dementia: Cognitive Test Performance and Proxy Report of Daily Life Function in Older Women.

Science.gov (United States)

Vaughan, Leslie; Hogan, Patricia E; Rapp, Stephen R; Dugan, Elizabeth; Marottoli, Richard A; Snively, Beverly M; Shumaker, Sally A; Sink, Kaycee M

2015-09-01

To investigate associations between proxy report of cognitive and functional limitations and cognitive performance and current or former driving status in older women with mild cognitive impairment (MCI) and all-cause dementia. Cross-sectional data analysis of retrospectively identified older women with adjudicated MCI and all-cause dementia in the Women's Health Initiative Memory Study-Epidemiology of Cognitive Health Outcomes (WHIMS-ECHO). Academic medical center. Women (mean age ± standard deviation 83.7 ± 3.5) adjudicated with MCI or dementia during Year 1, 2, 3, or 4 of the WHIMS-ECHO follow-up period (N = 385). The telephone-administered cognitive battery included tests of attention, verbal learning and memory, verbal fluency, executive function, working memory, and global cognitive function plus self-report measures of depressive symptomatology. The Dementia Questionnaire (DQ) was administered to a knowledgeable proxy (family member, friend). Sixty percent of women with MCI and 40% of those with dementia are current drivers. Proxy reports of functional limitations in instrumental activities of daily living (IADLs) are associated with current driving status in women with MCI, whereas performance-based cognitive tests are not. In women with dementia, proxy reports of functional limitations in IADLs and performance-based cognitive tests are associated with current driving status, as expected. These findings have clinical implications for the importance of evaluating driving concurrently with other instrumental functional abilities in MCI and dementia. Additional work is needed to determine whether proxy report of cognitive and functional impairments should help guide referrals for driving assessment and rehabilitation or counseling for driving transition. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Dementia and depression: two frequent disorders of the aged in primary health care in Greece.