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Resnick B, Klinedinst NJ, Yerges-Armstrong L, Magaziner J, Orwig D, Hochberg MC, Gruber-Baldini AL, Dorsey SG. Genotype, resilience and function and physical activity post hip fracture. Int J Orthop Trauma Nurs 2019; 34:36-42. [PMID: 31257007 PMCID: PMC7069656 DOI: 10.1016/j.ijotn.2019.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 12/15/2018] [Accepted: 03/07/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Individuals who are resilient are more likely to engage in functional tasks and exercise post hip fracture. There may be a genetic predisposition to being resilient. OBJECTIVES This study tested the direct and indirect association of 10 candidate genes, age, cognition, gender, comorbidities, pain and social activity on resilience, function and exercise post hip fracture. METHOD This was a descriptive study including 172 community dwelling older adults. Measures included: age, gender, cognition (Modified Mini Mental Status Exam), comorbidities, social activities (self-report), DNA (GRM1, NTRK1, NTRK2, GNB3, NPY, SLC6A15. SLC6A4, BDNF, CR1TR1, FKBP5), pain (areas of pain and Numeric Rating Scale), function (Physical and Instrumental Activities of Daily Living; Lower Extremity Gains Score; Short Physical Performance Battery; Grip Strength) and exercise (Yale Physical Activity Scale). RESULTS The majority of participants were Caucasian (93%), 50% were women and the average age was 81.09 (SD = 7.42). There were significant associations between resilience and single nucleotide polymorphisms from GRM1, NTRK1, NTRK2, GNB3, NPY and SLC6A15. Resilience, age, cognition, social activity, pain and genetic variability were directly and/or indirectly associated with exercise and/or function. DISCUSSION This study highlights the importance of resilience for engagement in exercise and function after hip fracture and provides preliminary evidence for a genetic role for resilience.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA.
| | - N Jennifer Klinedinst
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
| | - Laura Yerges-Armstrong
- Program in Personalized Medicine, Division of Endocrinology, Department of Medicine, University of Maryland School of Medicine, 685 W. Baltimore St., Baltimore, MD 21201, USA
| | - Jay Magaziner
- University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD 21201, USA
| | - Denise Orwig
- University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD 21201, USA
| | - Marc C Hochberg
- University of Maryland, School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA
| | - Ann L Gruber-Baldini
- University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD 21201, USA
| | - Susan G Dorsey
- University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD 21201, USA
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Resnick B, Klinedinst NJ, Yerges-Armstrong L, Magaziner J, Orwig D, Hochberg MC, Gruber-Baldini AL, Hicks GE, Dorsey SG. Pain, Genes, and Function in the Post-Hip Fracture Period. Pain Manag Nurs 2016; 17:181-96. [PMID: 27283266 PMCID: PMC4902874 DOI: 10.1016/j.pmn.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/18/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
Post-hip fracture generalized pain can lead to a progressive decline in function and greater disability. The purpose of this study was to explore the factors that influence pain among older adults post-hip fracture, including genetic variability, and evaluate whether pain directly or indirectly influenced upper and lower extremity function. This was a secondary data analysis using data from the first 200 participants in a Baltimore Hip Study (BHS), BHS-7. Assessments were done at 2 months post-hip fracture and included age, sex, marital status, education, cognitive status, comorbidities, body mass index (BMI), upper and lower extremity function, single nucleotide polymorphisms (SNPs) from 10 candidate genes, and total areas of pain and pain intensity. Model testing was done using the AMOS statistical program. The full sample included 172 participants with an average age of 81. Fifty percent were female and the majority was Caucasian (93%). Model testing was done on 144 individuals who completed 2 month surveys. Across all models, age, cognition, and BMI were significantly associated with total areas of pain. Thirty SNPs from five genes (BDNF, FKBP5, NTRK2, NTRK3, and OXTR) were associated with areas of pain and/or pain intensity. Together, age, cognition, BMI, and the SNP from one of the five genes explained 25% of total areas of pain and 15% of pain intensity. Only age and cognition were significantly associated with lower extremity function, and only cognition was significantly associated with upper extremity function. The full model was partially supported in this study. Our genetic findings related to pain expand prior reports related to BDNF and NTRK2.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, Maryland.
| | | | | | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Denise Orwig
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Marc C Hochberg
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | - Susan G Dorsey
- University of Maryland School of Nursing, Baltimore, Maryland
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Creavin ST, Wisniewski S, Noel‐Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev 2016; 2016:CD011145. [PMID: 26760674 PMCID: PMC8812342 DOI: 10.1002/14651858.cd011145.pub2] [Citation(s) in RCA: 320] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia. OBJECTIVES To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia. SEARCH METHODS We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall. SELECTION CRITERIA We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating. DATA COLLECTION AND ANALYSIS At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method. MAIN RESULTS We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data. AUTHORS' CONCLUSIONS The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.
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Affiliation(s)
- Sam T Creavin
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Susanna Wisniewski
- Cochrane Dementia and Cognitive Improvement Group, Oxford UniversityOxfordUK
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineRoom 4401c (4th Floor)John Radcliffe Hospital, HeadingtonOxfordUKOX3 9DU
| | - Clare M Trevelyan
- Avon and Wiltshire Mental Health Partnership NHS TrustMedical EducationWoodland View, Brentry LaneBristolUKBS10 6NB
| | - Thomas Hampton
- Frimley Health NHS Foundation TrustENTFrimley Park HospitalPortsmouth RoadFrimley, CamberleySurreyUKGU16 7UJ
| | - Dane Rayment
- Avon and Wiltshire Partnership NHS TrustOlder Adult PsychiatryJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Victoria M Thom
- Avon & Wiltshire Mental Health Partnership NHS TrustForensic PsychiatryFromeside, Blackberry Hill HospitalBristolUKBS16 1EG
| | | | - Hosam Elhamoui
- Somerset Partnership NHS TrustPsychiatry91 Comeytrowe LaneTauntonSomersetUKTA1 5QG
| | - Rowena Milligan
- Mansion House SurgeryGeneral PracticeAbbey StreetStoneStaffordshireUKST15 0WA
| | - Anish S Patel
- Avon and Wiltshire Mental Health Partnership NHS TrustNBT Acute Mental Health Liaison TeamDonal Early HouseSouthmead HospitalBristolUKBS10 5NB
| | - Demitra V Tsivos
- North Bristol NHS TrustNeuropsychologySouthmead HospitalBristolUKBS10 5NB
| | - Tracey Wing
- Taunton and Somerset NHS trustCare of Elderly/ITU/A+EBristolUKBS1 3DH
| | - Emma Phillips
- 2gether NHS Foundation TrustCharlton Lane HospitalCheltenhamGloucestershireUKGL53 9DZ
| | - Sophie M Kellman
- Avon and Wiltshire Mental Health Partnership NHS TrustJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Hannah L Shackleton
- NHS ScotlandNHS Forth ValleyFalkirk Community Hospital, Majors LoanFalkirkUK
| | | | - Bethany E Neale
- RCGP Severn FacultyGeneral PracticeDeanery HouseBristolUKBA16 1GW
| | | | - Sarah Cullum
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
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Sterniczuk R, Theou O, Rusak B, Rockwood K. Cognitive Test Performance in Relation to Health and Function in 12 European Countries: The SHARE Study. Can Geriatr J 2015; 18:144-51. [PMID: 26495048 PMCID: PMC4597814 DOI: 10.5770/cgj.18.154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Even subtle impairments on cognitive test scores can be associated with future cognitive decline and dementia. We assayed the relationships between test score impairment and adverse outcomes. Methods Secondary analyses were performed on data from non-institutionalized participants, 50+ years of age (N = 30,038), from 12 countries taking part in the Survey of Health, Ageing and Retirement in Europe (SHARE) longitudinal study on aging. At baseline, participants’ cognition was tested using verbal fluency, immediate recall, and delayed recall tasks. Results Greater levels of cognitive impairment at baseline were strongly associated with future poor health outcomes and functional impairment. Controlling for age, sex and education, those with 1 (OR = 1.58, 95% CI = 1.34–1.87) or ≥ 2 (OR = 2.59, 95% CI = 2.17–3.09) impaired tests at baseline were more likely to die after an average of 40 months compared to individuals with no impairments. After selecting for participants who reported the absence of dementia initially, those with ≥ 2 cognitive impairments at baseline (OR = 3.34, 95% CI = 2.27–4.92) were more likely to report dementia at follow-up compared to those with no impairment. Conclusions People with impaired cognitive test scores at baseline are at greater risk to die or develop dementia within four years than their less impaired or unimpaired counterparts.
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Affiliation(s)
- Roxanne Sterniczuk
- Department of Psychiatry, Dalhousie University, Halifax, NS; ; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS; ; Department of Medicine, Division of Geriatric Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Olga Theou
- Department of Medicine, Division of Geriatric Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Benjamin Rusak
- Department of Psychiatry, Dalhousie University, Halifax, NS; ; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS
| | - Kenneth Rockwood
- Department of Medicine, Division of Geriatric Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
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Rockwood K, Chertkow H, Feldman HH. Is Mild Cognitive Impairment a Valid Target of Therapy. Can J Neurol Sci 2014; 34 Suppl 1:S90-6. [PMID: 17469690 DOI: 10.1017/s0317167100005643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The status of Mild Cognitive Impairment (MCI) as a valid construct is controversial. The term encompasses people with heterogeneous clinical profiles, and invites sub-classifications that still require validation. Still, much evidence suggests that, properly selected, many people with MCI - especially Amnestic MCI - are at a high risk of dementia. This paper considers the validity of the construct of MCI as a high-risk state for progression and a target for treatment. We conclude that the status of MCI as an entity remains controversial. On the one hand, it can be argued that the careful section of cases at high risk of developing dementia means that it is a valid target, with the goal being the prevention of dementia. Advocates of this view see a linear progression that they are trying to arrest, but studies have yet to show that this can be done. On the other hand, it can be argued that the patients who progressed did not develop dementia: they actually had a very early form of it. By this view, people without the progressive form will be needlessly exposed to antidementia drugs, and the others should be treated anyway. Why some people progress and others do not is not clear, but the variable rates of progression - between clinic-based and population-based samples and between very similar clinical trials with slightly different inclusion criteria - suggests that MCI is a heterogeneous entity. The phenomenon of slowing or non-progression itself should be investigated, and such investigations likely should extend to people now classified as having mild dementia.
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Affiliation(s)
- Kenneth Rockwood
- Department of Medicine (Geriatric Medicine & Neurology), Dalhousie University, Halifax, NS , Canada
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Aminzadeh F, Dalziel WB, Molnar FJ, Alie J. An Examination of the Health Profile, Service Use and Care Needs of Older Adults in Residential Care Facilities. Can J Aging 2010; 23:281-96. [PMID: 15660301 DOI: 10.1353/cja.2004.0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACTPrivate, unregulated residential care facilities have become an increasingly important component of the continuum of housing and care for frail older adults in Canada. To date, this growing segment of the older population has received very little research attention. This study involved an in-depth examination of the functional/health profile, patterns of service use, and medical/care needs of a representative sample of 178 older adults in residential care facilities in the City of Ottawa. The results indicate great diversity in resident and facility profiles in this setting and confirm earlier impressions that special care units in the residential care sector have become increasingly close to being unlicensedpseudo-nursing homes. Despite the heavy burden of care, the evidence suggests that the care needs of the majority of residents are adequately met in the residential care environment. The results can inform future research, case finding, educational, and policy planning initiatives in this setting.
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Affiliation(s)
- F Aminzadeh
- Regional Geriatric Assessment Program of Ottawa, Geriatric Outreach, 39 Robertson Rd., Suite 212, Nepean, Ontario K2H 8R2.
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General practitioners' judgment of their elderly patients' cognitive status. J Gen Intern Med 2009; 24:1314-7. [PMID: 19844763 PMCID: PMC2787937 DOI: 10.1007/s11606-009-1118-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 07/08/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND General practitioners (GP) play an important role in detecting cognitive impairment among their patients. OBJECTIVES To explore factors associated with GPs' judgment of their elderly patients' cognitive status. DESIGN Cross-sectional data from an observational cohort study (AgeCoDe study); General practice surgeries in six German metropolitan study centers; home visits by interviewers. PARTICIPANTS 138 GPs, 3,181 patients (80.13 +/- 3.61 years, 65.23% female). MEASUREMENTS General practitioner questionnaire for each patient: familiarity with the patient, patient morbidity, judgment of cognitive status. Home visits by trained interviewers: sociodemographic and clinical data, psychometric test performance. Multivariate regression analysis was used to identify independent associations with the GPs' judgment of "cognitively impaired" vs. "cognitively unimpaired." RESULTS Less familiar patients (adjusted odds ratio [aOR] 2.42, 95% CI 1.35-4.32, for poor vs. very high familiarity), less mobile patients (aOR 1.29, 95% CI 1.13-1.46), patients with impaired hearing (aOR 5.46, 95% CI 2.35-12.67 for serious vs. no problems), and patients with greater comorbidity (aOR 1.15, 95% CI 1.08-1.22) were more likely to be rated as "cognitively impaired" by their GPs. CONCLUSIONS The associations between GPs' assessments of cognitive impairment and their familiarity with their patients and patients' mobility, hearing, and morbidity provide important insights into how GPs make their judgments.
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8
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Apart from nihilism and stigma: what influences general practitioners' accuracy in identifying incident dementia? Am J Geriatr Psychiatry 2009; 17:965-75. [PMID: 20104054 DOI: 10.1097/jgp.0b013e3181b2075e] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the accuracy of the General Practitioner's (GP) judgment in the recognition of incident dementia cases and to explore factors associated with recognition. DESIGN Prospective observational cohort study, two follow-up assessments (FU 1 and FU 2) within 3 years after baseline. SETTING One hundred thirty-eight general practice surgeries in the six study centers of a prospective German study. PARTICIPANTS Participants were between 75 and 89 years of age at baseline and were recruited from the GPs' patient lists. In FU 1, 2,402 patients and in FU 2, 2,177 patients were analyzed. MEASUREMENTS GPs' judgments on their patients' cognitive status as index test; at-home patient interviews and tests, consensus diagnosis as reference; validity of the GP judgment; associations between patient factors and GPs' dementia recognition. RESULTS One hundred eleven incident dementia cases with complete data were identified in FU 1 and FU 2. Overall sensitivity of the GP judgment was 51.4%, specificity 95.9%, positive predictive value 23.6%, and negative predictive value 98.8%. GPs missed dementia more frequently in patients living alone. GPs overrated the presence of dementia more frequently in patients with problems in mobility or hearing, in patients with memory complaints, and in patients with a GP-documented depression. CONCLUSION GPs miss nearly half of incident dementia cases. They should be alert not to miss dementia in patients living alone. Without seeking additional information, a positive GP judgment seems not sufficient for case finding. GPs should be aware of their tendency to overestimate dementia in depressed and frail patients.
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Werner P, Goldstein D, Heinik J. The process and organizational characteristics of memory clinics in Israel in 2007. Arch Gerontol Geriatr 2008; 49:e115-e120. [PMID: 19095313 DOI: 10.1016/j.archger.2008.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/24/2008] [Accepted: 10/27/2008] [Indexed: 11/25/2022]
Abstract
We previously described the characteristics and activities of 25 memory clinics in Israel in 1998 using a mail survey. Questionnaires assessing the administrative structure of the clinics, patient characteristics, processes and methods used, and outcomes of the assessment were mailed again in 2007 to 35 memory clinics. Overall, the general operating characteristics of the clinics in 2007 were found to be similar to those reported in the previous survey conducted in 1998. The assessment process in 2007 was shorter than in 1998 (mean time=1.92 and 3.12 h, respectively), although both surveys were based on an interdisciplinary team, including a physician, a nurse and a social worker. However, in 2007 the teams were more wide-ranging. A wider variety of instruments were reported in the more recent survey. Most of the clinics in both surveys reported that family members were involved at all stages of the assessment. Medication treatment was the main outcome reported by the clinics in both surveys. There has been a development in the process and organizational characteristics of memory clinics in Israel over the years, probably as a consequence of the development of knowledge in the area of cognitive deterioration.
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Affiliation(s)
- Perla Werner
- Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Mt. Carmel, Haifa 31905, Israel.
| | - Dovrat Goldstein
- Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Mt. Carmel, Haifa 31905, Israel
| | - Jeremia Heinik
- Margoletz Psychogeriatric Center, Ichilov Hospital, 6 Weizman Street, Tel Aviv 64239, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israel
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10
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Anthropological contributions to the understanding of age-related cognitive impairment. Lancet Neurol 2005; 4:320-6. [DOI: 10.1016/s1474-4422(05)70075-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Werner P, Heinik J, Aharon J. Process and organizational characteristics of memory clinics in Israel: a national survey. Arch Gerontol Geriatr 2005; 33:191-201. [PMID: 15374034 DOI: 10.1016/s0167-4943(01)00183-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2000] [Revised: 06/11/2001] [Accepted: 06/12/2001] [Indexed: 11/19/2022]
Abstract
A survey was conducted to describe the characteristics and activities of memory clinics in Israel. A structured questionnaire was mailed to 25 memory clinics, accompanied by a cover letter and a returning envelope. The questionnaire included items regarding: (a) administrative structure of the clinic (the period and place of operation, number of staff and their professions); (b) patients' characteristics (monthly number of patients, sources of referral and eligibility criteria); (c) assessment methods used (history, cognitive screening instruments, functional status assessment, neuroimaging and laboratory tests); (d) the assessment process (length of assessment, family involvement); and (e) outcomes of the assessment process. Twelve questionnaires were returned, yielding a 52% response rate. Overall, there was agreement regarding the general operating characteristics of the clinics. The majority was based on an interdisciplinary team including a physician, a nurse and a social worker. The mean number of new monthly patients attending the clinics was 24 (range 7-70), and the main source of referral was the Sick Funds. Mostly all clinics used the Mini Mental State Examination as a screening instrument and performed psychological, physical, neurological, and laboratory examinations. Medication treatment was the main outcome reported by the clinics. In a country like Israel, where geriatric psychiatry services are still developing, there is an increasing need to expand the number and type of services provided by memory clinics.
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Affiliation(s)
- P Werner
- Department of Gerontology, Faculty of Social Welfare and Health Studies, University of Haifa, Mt. Carmel, Haifa 31905, Israel.
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Lindsay J, Sykes E, McDowell I, Verreault R, Laurin D. More than the epidemiology of Alzheimer's disease: contributions of the Canadian Study of Health and Aging. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:83-91. [PMID: 15065741 DOI: 10.1177/070674370404900202] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To highlight contributions to knowledge made by the Canadian Study of Health and Aging (CSHA). METHOD The CSHA began in 1991, with follow-ups in 1996 and 2001. It was national in scope, with 18 study centres and a coordinating centre. It included 10 263 participants; of these, 9008 were in the community, and 1255 were in institutions. In each phase, community participants were screened for cognitive impairment, and where appropriate, cognitive status was determined by a detailed clinical examination. Data on possible risk factors for dementia were collected at baseline. Data on caring for people with dementia were collected in each phase. RESULTS The prevalence of dementia was established at 8% of those aged 65 years and over; incidence (new cases each year) was about 2%. Cognitive impairment not dementia (CIND) was more than twice as common as dementia. Factors affecting the risk of institutionalization, mortality, and the health of caregivers were examined. The costs of dementia were conservatively estimated at dollar 3.9 billion in 1991. Risk factors for Alzheimer's disease (AD) and vascular dementia are presented; it is noteworthy that physical activity appeared to protect against all forms of cognitive decline, particularly for women. Clinical contributions include the development of norms for several neuropsychological tests. Other topics include the health of those with CIND, predicting dementia, medication use, frailty and healthy aging, and urinary incontinence. CONCLUSION The CSHA has contributed substantially to knowledge of the epidemiology of dementia, including AD, and to many other topics relevant to seniors' health.
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Affiliation(s)
- Joan Lindsay
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada.
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Mitnitski A, Mogilner A, MacKnight C, Rockwood K. Data integration and knowledge discovery in biomedical databases. Reliable information from unreliable sources. DATA SCIENCE JOURNAL 2003. [DOI: 10.2481/dsj.2.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ashley RV, Gladsjo A, Olson R, Judd LL, Sewell DD, Rockwell E, Jeste DV. Changes in psychiatric diagnoses from admission to discharge: review of the charts of 159 patients consecutively admitted to a geriatric psychiatry inpatient unit. Gen Hosp Psychiatry 2001; 23:3-7. [PMID: 11226550 DOI: 10.1016/s0163-8343(00)00118-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The diagnosis of psychopathology among geriatric acute inpatients requires comprehensive evaluation. To our knowledge, no recently published papers in the geriatric psychiatry literature have systematically examined diagnostic changes during single admissions. We reviewed the charts of 159 patients consecutively admitted to an acute geriatric psychiatry unit over 18 months. We recorded admission diagnoses from initial treatment plans, and discharge diagnoses from discharge summaries. Mean patient age was 80 years and average length of stay was 17 days. The most common primary diagnoses were psychotic and depressive disorders. The most common secondary diagnoses were dementias and depressive disorders. Primary diagnoses changed from admission to discharge in 31 patients (20%), and secondary diagnoses changed in 76 patients (48%). There was a significant change involving the diagnosis of dementia, but not that of depressive or psychotic disorders. A large proportion of inpatients had their diagnoses altered, especially those involving dementias, during hospitalization. Inpatient admission may be valuable for clarifying the diagnoses of elderly psychiatric patients.
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Affiliation(s)
- R V Ashley
- Department of Psychiatry, University of California-San Diego, San Diego, CA, USA
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Sramek JJ, Veroff AE, Cutler NR. Mild cognitive impairment: emerging therapeutics. Ann Pharmacother 2000; 34:1179-88. [PMID: 11054988 DOI: 10.1345/aph.19394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To present a general overview of the etiology, definition, and prevalence of mild cognitive impairment (MCI), as well as outline possible treatment strategies. DATA SOURCES A MEDLINE search was conducted for relevant references generated from 1990 to 2000 concerning MCI, mild to moderate Alzheimer disease (AD), and therapeutic strategies. Several books were also used in the compilation of data for this review, as well as the authors' experience in designing and conducting MCI trials. DATA EXTRACTION All of the references listed were assessed, and all relevant information was included in this review. DATA SYNTHESIS Forgetful individuals most likely to develop AD have a condition known as MCI previous to their development of dementia. This condition is hallmarked by memory impairment that is abnormal for the individual's age and educational level. While not all individuals with MCI develop AD, it is apparent that the condition can serve as a potential marker for early onset of AD. CONCLUSIONS As many clinicians can attest, occasional forgetfulness is a common aspect of the aging process. Eventually, however, a large portion of forgetful individuals, especially those with MCI, will be diagnosed with AD or some other form of dementia. Indeed, many researchers have suggested that MCI should be regarded as incipient AD and that these individuals would benefit from drug therapy. Thus, MCI screening may be beneficial in terms of both early AD intervention and perhaps even AD prevention.
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Affiliation(s)
- J J Sramek
- California Clinical Trials, Beverly Hills, USA.
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