Frailty, psychological well-being, and social isolation in older adults with cognitive impairment during the SARS-CoV-2 pandemic: data from the GeroCovid initiative

BACKGROUND

The containment measures linked to the COVID-19 pandemic negatively affected the phyco-physical well-being of the population, especially older adults with neurocognitive disorders (NCDs). This study aims to evaluate whether the frailty of NCD patients was associated with different changes in multiple health domains, in particular in relation to loneliness and social isolation, pre- and post-lockdown.

MATERIALS AND METHODS

Patients were recruited from 10 Italian Centers for Cognitive Disorders and Dementia. Data were collected in the pre-pandemic period (T0), during the pandemic lockdown (T1), and 6-9 months post-lockdown (T2). The UCLA Loneliness Scale-3, Activities of Daily Living (ADL), Instrumental ADL (IADL), Mini-Mental State Examination, and Neuropsychiatric Inventory (NPI) were administered. Caregivers' burden was also tested. Patients were categorized as non-frail, pre-frail, and frail according to the Fatigue, Resistance, Ambulation, Illness, and Loss of Weight scale.

RESULTS

The sample included 165 subjects (61.9% women, mean age 79.5 ± 4.9 years). In the whole sample, the ADL, IADL, and NPI scores significantly declined between T0 and T2. There were no significative variations in functional and cognitive domains between the frail groups. During lockdown we recorded higher Depression Anxiety Stress Scales and Perceived Stress Scale scores in frail people. In multivariable logistic regression, frailty was associated with an increase in social isolation, and a loss of IADL.

CONCLUSIONS

We observed a global deterioration in functional and neuro-psychiatric domains irrespective of the degree of frailty. Frailty was associated with the worsening of social isolation during lockdown. Frail patients and their caregivers seemed to experience more anxiety and stress disorders during SARS-CoV-2 pandemic.

Measuring global functioning in older adults with cognitive impairments using the Rasch model

Background

Cognitive and functional measures are often measured and interpreted separately during the clinical evaluation of patients with cognitive impairment. This can sometimes lead to a challenging interpretation when measures do not show concordance, especially after a clinical intervention. In this study, the development and evaluation of a new approach, using the Rasch model, that combines cognitive and functional measures in one single and more powerful measure (compared to stand-alone tests) to assess global functioning in older adults with cognitive impairment (including dementia) was presented.

Methods

Clinical data from 265 older adults’ subjects diagnosed with mild cognitive impairment, or dementia, included: The Mini-mental state examination (MMSE), the Esame Neuropsicologico Breve (ENB) – a neuropsychological battery used in Italy–, the Activities of Daily Living (ADL), and the Instrumental Activities of Daily Living (IADL) questionnaires.

Results

Patients with severe cognitive impairment showed lower global functioning score compared to patients with moderate impairment. Receiver Operating Characteristic (ROC) curve analyses were performed to determine sensitivity and specificity of the global functioning score resulting from the combined measure. Results showed that the global functioning score discriminates better between patients with severe and moderate cognitive impairment compared to the ENB, ADL, and IADL when considered separately.

Conclusions

The Rasch model was able to combine cognitive and functional measures into a single score (global functioning score). All together, these results suggest that the diverse cognitive and functional measures can be considered part of one single dimension (global functioning) and that this dimension can be measured as a single construct and score. This study offers an alternative perspective for future development of instruments that would help clinicians in measuring global functioning in older adults’ patients at different stages of cognitive impairments and different baseline level of performance.

Multidimensional Prognostic Index predicts mortality and length of stay during hospitalization in the older patients: a multicenter prospective study

BACKGROUND

The Multidimensional Prognostic Index (MPI) is a validated predictive tool for long-term mortality based on information collected in a standardized Comprehensive Geriatric Assessment. We investigated whether the MPI is an effective predictor of intrahospital mortality and length of hospital stay after admission to acute geriatric wards.

METHODS

Prospective study of 1,178 older patients (702 women and 476 men, 85.0±6.8 years) admitted to 20 geriatrics units. Within 48 hours from admission, the MPI, according to an earlier validated algorithm, was calculated. Subjects were divided into three groups of MPI score, low-risk (MPI-1 value ≤ 0.33), moderate-risk (MPI-2 value 0.34-0.66), and severe-risk of mortality (MPI-3 value ≥ 0.67), on the basis of earlier established cut-offs. Associations with in-hospital mortality and length of stay were examined using multivariable Cox regression models and adjusted Poisson linear mixed-effects models, respectively.

RESULTS

At admission, 23.6% subjects had a MPI-1 score, 33.8% had a MPI-2 score, and 42.6% had a MPI-3 score. Subjects with higher MPI score at admission were older (p < .001), more frequently women (p < .001) and had higher prevalence of common chronic conditions. After adjustment for age, gender, and diseases, patients included in the MPI-2 and MPI-3 groups had a significantly higher risk for intrahospital mortality (hazard ratio: 3.48, 95% confidence intervals: 1.02-11.88, p = .047; hazard ratio: 8.31, 95% confidence intervals: 2.54-27.19, p < .001) than patients included in the MPI-1 group, respectively. In multivariable model, length of stay significantly increased across the three MPI groups (11.29 [0.5], 13.73 [1.3], and 15.30 [1.4] days, respectively [p < .0001]).

CONCLUSIONS

In older acute care inpatients, MPI score assessed at hospital admission is an independent predictor of in-hospital mortality and the length of hospital stay.

Development and validation of a Multidimensional Prognostic Index for mortality based on a standardized Multidimensional Assessment Schedule (MPI-SVaMA) in community-dwelling older subjects

OBJECTIVES

To develop and validate a Multidimensional Prognostic Index (MPI) for mortality based on information collected by the Multidimensional Assessment Schedule (SVaMA), the recommended standard tool for multidimensional assessment of community-dwelling older subjects in seven Italian regions.

DESIGN

Prospective cohort study.

PARTICIPANTS

Community-dwelling subjects older than 65 years who underwent an SVaMA evaluation from 2004 to 2010 in Padova Health District, Veneto, Italy.

MEASUREMENTS

The MPI-SVaMA was calculated as a weighted (weights were derived from multivariate Cox regressions) linear combination of the following nine domains: age, sex, main diagnosis, and six scores, ie, the Short Portable Mental Status Questionnaire, the Barthel index (contains two domains: activities of daily living and mobility), the Exton-Smith scale, the Nursing Care Needs, and the Social Network Support by a structured interview. Subjects were followed for a median of 2 years; those who had not died were followed for at least 1 year. The MPI-SVaMA score ranged from 0 to 1 and 3 grades of severity of the MPI-SVaMA were calculated on the basis of estimated cutoffs. Discriminatory power and calibration were further assessed.

RESULTS

A total of 12,020 subjects (mean age 81.84 ± 7.97 years) were included. Two random cohorts were selected: (1) a development cohort, ie, 7876 subjects (mean age 81.79 ± 8.05, %females: 63.1) and (2) a validation cohort, ie, 4144 subjects (mean age: 81.95 ± 7.83, %females: 63.7). The discriminatory power for mortality of MPI-SVaMA was 0.828 (95% CI 0.817-0.838) and 0.832 (95% CI 0.818-0.845) at 1 month and 0.791 (95% CI 0.784-0.798) and 0.792 (95% CI 0.783-0.802) at 1 year in development and validation cohorts, respectively. MPI-SVaMA results were well calibrated showing lower than 10% differences between predicted and observed mortality, both in development and validation cohorts.

CONCLUSIONS

The MPI-SVaMA is an accurate and well-calibrated prognostic tool for mortality in community-dwelling older subjects, and can be used in clinical decision making.

Comparison of event related potentials (ERPs) distributions obtained with three reference systems: linked binaural, mean reference, extracephalic

Event related potentials (ERPs) to auditory and visual oddball paradigms were recorded from 19 scalp derivations in 10 controls. Three different reference systems were used: the linked earlobes (LE), the computer calculated mean reference (MR), and a calibrated sterno-vertebral extracephalic reference (EC). The distribution of ERPs was represented on single plane maps (quadratic interpolation, 4-NN method). With LE reference N2, P3a-P3b had no polarity reverted counterparts on the scalp. With EC reference a negativity was recorded on T3-T4 (and partly T5-T5) derivations with the same latency as P3a-P3b vertex component. With MR the N2, P3a-P3b components at vertex were paralleled by polarity reverted counterparts on anterior frontal, temporal and occipital derivations.

P3 recordings in patients with bilateral temporal lobe lesions

We recorded event-related potentials to an acoustic "oddball" paradigm from 19 scalp derivations in five patients (three women and two men; age range, 44 to 56) who had global amnesia following encephalitis. CT and MRI showed severe bilateral lesions of anterior and midtemporal lobes. A P3 component, with a peak latency within the normal limits for age-matched controls, was recorded to "target" stimuli in four patients from all leads except Fp1, Fp2, F7, F8, T3, and T4. In the fifth patient, the P3 peak was delayed.

Delayed P3 event-related potentials (ERPs) in thalamic hemorrhage

Delayed P3 ERPs were recorded with an acoustic oddball paradigm in 5 patients affected by unilateral thalamic hemorrhage. P3 latencies in these 5 patients were above the normal mean latency of age-matched controls +2/+3 S.D.s. The P3 delay was persistent in serial follow-ups at 6 months from stroke. Normal P3 latencies were instead recorded in 4 patients with paramedian hemorrhage not involving or only partially involving the thalamus.

Evoked potentials (EPs) in experimental allergic encephalomyelitis: a study of EP modifications during the course of a controlled disease

24 juvenile strain 13 guinea pigs were sensitized with homologous spinal cord homogenate in complete Freund's adjuvant in order to obtain Experimental Allergic Encephalomyelitis (EAE) in the Chronic Relapsing (CR-EAE), Chronic Progressive (CP-EAE) and Acute (A-EAE) forms. Visual, Brain-Stem Acoustic, Somatosensory Evoked Potentials were recorded in these animals, prior to the sensitizing injection and during the course of the disease. The aim of our study was to observe modifications of Evoked Potentials during progression of a demyelinating disease. Latency delays of Evoked Potentials appeared 15 days after the sensitizing injection, preceding or simultaneously with clinical alterations and when demyelinated plaques were not detected in anatomical specimens.

Persistence of a P3 component in severe amnestic syndrome

Event-related potentials (ERPs) to an odd-ball paradigm were recorded from 19 scalp derivations in a patient (47 years old, housewife) affected by complete amnestic syndrome following limbic encephalitis. CT scans and magnetic resonance imaging showed severe bilateral lesions of anterior, mid-temporal lobes and frontal lobes. A P3 component, with a peak latency inside normal limits for age-matched controls, was recorded to 'target' stimuli from all leads except Fp1, Fp2, F7, F8, T3 and T4.

Reduction of P3 latency during outcome from post-traumatic amnesia

We studied 10 patients with post-traumatic amnesia (PTA) and normal CTscans. P3 with an oddball paradigm, several neuropsychological tests and EEG were performed the day after the trauma and several times later until full recovery. In all patients, P3 latencies at admission were above normal limits (mean + 2 SDs) and decreased progressively during recovery from PTA. The latency reductions correlated significantly with improvement of neuropsychological tests.

Mapped distribution of pattern reversal VEPs to central field and lateral half-field stimuli of different spatial frequencies

Visual evoked potentials (VEPs) to pattern reversal vertical bar stimuli of 3 different sizes (1, 2, 4 c/deg) were recorded from 19 scalp derivations in 50 controls. The stimuli were presented on a full-field (FF) screen of 24 degrees visual angle, and on left and right half-fields (HF) of 12 degrees radius. In 15 controls partial HF stimuli were presented on the central 3 and 6 degrees and as hemiannular stimuli of 12 degrees with occlusion of the central 3 and 6 degrees. An antero-posterior polarity reversal of the N1-P1-N2 sequence was observed for FF VEPs. A tangential polarity reversal was observed for HF VEPs. Also with central or hemiannular stimuli polarity reversals of all VEP components were observed within the scalp. Variants of VEP distribution, absence or prominence of some of the ipsi- or contralateral VEP components were observed in 8-40% of controls. The FF and HF VEP distribution, and the variant VEP asymmetries were partly dependent on the pattern spatial frequency.

Mapping of event-related potentials to auditory and visual odd-ball paradigms in controls

The paper reports the results of recordings and maps of event-related potentials (ERPs) obtained in normal subjects. ERPs were recorded from 19 scalp electrode derivations using both visual and acoustic paradigms. In normal subjects, topographical distribution of all ERP components is described in detail. Our findings in normals suggest that the early modulation of stimulus-related potentials could be located in primary associative areas, and that N2, P3a, P3b, and SW have different distributions.

Mapping of event-related potentials to auditory and visual odd-ball paradigms in patients affected by different forms of dementia

The paper reports the results of recordings and maps of event-related potentials (ERPs) in patients with Alzheimer's disease (AD), progressive supranuclear palsy (PSP) and in subjects affected by dementia in multiple sclerosis (MS). ERPs were recorded from 19 scalp electrode derivations using both visual and acoustic paradigms. In 43% of AD patients, ERPs were normal; in 20%, although present, ERP components were delayed, while in the other 37% none of the N2 and P3 peaks could be recorded, because of abnormal topography of potentials on the scalp. In patients with PSP, the normal ERP sequence was not identified. In patients with MS delayed ERPs (50%), abnormal topography of ERPs (30%) and absence of ERPs (20%) were observed. The follow-up of AD patients showed a progressive alteration of ERPs. ERP topography alterations were observed in AD, PSP and MS patients with poorest cognitive performances.

Maps of somatosensory evoked potentials (SEPs) to mechanical (tapping) stimuli: comparison with P14, N20, P22, N30 of electrically elicited SEPs

Bit mapped color imaging of SEPs was recorded from 19 derivations in 11 healthy volunteers after electrical stimulation of the median nerve at the wrist, index finger digital nerve stimulation, and mechanical stimulation of the index fingertips by an electromechanically driven vibrating thin metallic plate. The latencies of SEP components increased for the various stimulation modalities, being shortest after median nerve stimulation at the wrist and longest after mechanical stimulation of the index fingertips. The scalp distribution of SEPs to mechanical stimuli was, however, the same as other SEPs, independently of the stimulation employed, and components corresponding to N20 and P22 were recorded only contralaterally to the stimulated side.

Mapping of event-related potentials to auditory and visual odd-ball paradigms

This paper reports the results of recordings and maps of event-related potentials (ERPs) obtained in normal subjects, patients with Alzheimer's disease (AD), progressive supranuclear palsy, confusional states, and in subjects with homonymous hemianopsia. ERPs were recorded from 19 scalp electrode derivations using both visual and acoustic paradigms. In normal subjects, the topographical distribution of all ERP components is described in detail. In 45% of AD patients, ERPs were normal; in 35%, although present, ERP components were delayed, while in the other 20% the N2 and P3 peaks could not be recorded. In patients with progressive supranuclear palsy, the normal ERP sequence was not identified. Our findings in normals and in hemianopic patients suggest that the early modulation of stimulus-related potentials could be located in primary associative areas, and that N2, P3a, P3b, SW should have different origins.