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Enderami A, Rashedi V, Malakouti SK, Shariati B, Birgani NF, Gharaeipour M, Kodan Z, Pourshams M. Dementia prevalence among hospitalized older patients: a multicenter study in Iran. Dement Neuropsychol 2024; 18:e20230083. [PMID: 38469122 PMCID: PMC10926988 DOI: 10.1590/1980-5764-dn-2023-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/15/2023] [Indexed: 03/13/2024] Open
Abstract
Dementia poses a significant societal and health challenge in the 21st century, with many hospitalized patients experiencing dementia without a documented diagnosis. Objective To evaluate the prevalence of dementia and its associated risk factors among older patients admitted to hospitals. Methods The study included older patients (≥ 60 years) admitted to medical departments of a general hospital in three major Iranian cities. Researchers utilized the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, the Geriatric Depression Scale (GDS), the Mini-Cog test, the 4 A's test (4AT), and the Abbreviated Mental Test Score (AMTS). Among the 420 recruited older inpatients, 228 (54.3%) were female. Results The mean age of participants was 71.39 years (standard deviation ±7.95), with 30.7% diagnosed with major neurocognitive disorder (dementia). The likelihood of dementia exhibited statistically significant correlations with gender, age, number of children, and occupation. Conclusions Screening older individuals for cognitive impairment upon hospital admission holds the potential to prevent adverse outcomes and enhance the quality of treatment for patients concurrently dealing with dementia.
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Affiliation(s)
- Athena Enderami
- Mazandaran University of Medical Sciences, Faculty of Medicine, Department of Psychiatry, Sari, Mazandaran, Iran
| | - Vahid Rashedi
- University of Social Welfare and Rehabilitation Sciences, Iranian Research Center on Aging, Department of Aging, Tehran, Iran
| | - Seyed Kazem Malakouti
- Iran University of Medical Sciences, Director School of Behavioral Sciences and Mental Health, Tehran, Iran
| | - Behnam Shariati
- Iran University of Medical Sciences, School of Medicine, Psychosocial Health Research Institute, Mental Health Research Center, Department of Psychiatry, Tehran, Iran
| | | | | | - Zeinab Kodan
- Department of Psychiatry, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences and Health Service, Sari, Mazandaran, Iran
| | - Maryam Pourshams
- Department of Psychiatry, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Sepúlveda-Ibarra C, Chaparro FH, Marcotti A, Soto G, Slachevsky A. Normalization of Rowland Universal Dementia Assessment Scale (RUDAS) in Chilean older people. Dement Neuropsychol 2023; 17:e20230033. [PMID: 38089173 PMCID: PMC10715235 DOI: 10.1590/1980-5764-dn-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/12/2023] [Indexed: 02/01/2024] Open
Abstract
Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive screening that evaluates older people with low educational levels. In Chile, there are no normative data to assess this population. Objective To obtain normative data on RUDAS in older Chilean people with up to 12 years of schooling, and to determine whether age and schooling years influence a person's performance on RUDAS and on the items that constitute it. Methods A group of cognitively healthy people 60 years old or over, with up to 12 schooling years was evaluated (n=135). Multiple regression models were applied to obtain normative data on RUDAS, according to age and schooling years, and to measure the effects of schooling on different items. Results Regression analysis showed that none of the items had schooling as a significant predictor, except for the visuoconstruction item. The variables age and schooling explained 12.6% (R^2=0.126) of the RUDAS total score variance. The item visuoconstruction was the most associated with the educational level (OR=1,147). Conclusion This study showed that RUDAS is a recommended instrument for evaluating older people with low educational levels. However, more studies are needed to prove the validity of the RUDAS on Chilean older people.
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Affiliation(s)
- Consuelo Sepúlveda-Ibarra
- Universidad Bernardo O’Higgins, Facultad de Ciencias de la Salud, Escuela de Fonoaudiología, Santiago, Chile
- Universidad de Chile, Facultad de Filosofía y Humanidades, Santiago, Chile
| | - Fernando Henríquez Chaparro
- Geroscience Center for Brain Health and Metabolism, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Program Institute of Biomedical Sciences, Neuroscience and East Neuroscience Departments, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Hospital del Salvador Neurology Department, Memory and Neuropsychiatric Center, Santiago, Chile
- Pontificia Universidad Católica de Chile, Facultad de Medicina, Laboratorio de Neurociencia Cognitiva y Evolutiva, Santiago, Chile
| | - Anthony Marcotti
- Universidad San Sebastián, Facultad de Odontología y Ciencias de la Rehabilitación, Escuela de Fonoaudiología, Santiago, Chile
- Pontificia Universidad Católica de Chile, Facultad de Ciencias Sociales, Escuela de Psicología, Programa de Doctorado en Psicología, Santiago, Chile
| | - Guillermo Soto
- Universidad de Chile, Facultad de Filosofía y Humanidades, Santiago, Chile
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Program Institute of Biomedical Sciences, Neuroscience and East Neuroscience Departments, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Hospital del Salvador Neurology Department, Memory and Neuropsychiatric Center, Santiago, Chile
- Clínica Alemana-Universidad del Desarrollo, Departamento de Medicina, Servicio de Neurología, Santiago, Chile
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Koshimoto BHB, Brandão PRDP, Borges V, Ferraz HB, Schumacher-Schuh AF, Rieder CRDM, Olchik MR, Mata IF, Tumas V, Santos-Lobato BL. Floor and ceiling effects on the Montreal Cognitive Assessment in patients with Parkinson's disease in Brazil. Dement Neuropsychol 2023; 17:e20230022. [PMID: 38053643 PMCID: PMC10695441 DOI: 10.1590/1980-5764-dn-2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/10/2023] [Accepted: 07/30/2023] [Indexed: 12/07/2023] Open
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease associated with cognitive impairment. The Montreal Cognitive Assessment (MoCA) has been used as a recommended global cognition scale for patients with PD, but there are some concerns about its application, partially due to the floor and ceiling effects. Objective To explore the floor and ceiling effects on the MoCA in patients with PD in Brazil. Methods Cross-sectional study with data from patients with PD from five Brazilian Movement Disorders Clinics, excluding individuals with a possible diagnosis of dementia. We analyzed the total score of the MoCA, as well as its seven cognitive domains. The floor and ceiling effects were evaluated for the total MoCA score and domains. Multivariate analyses were performed to detect factors associated with floor and ceiling effects. Results We evaluated data from 366 patients with PD and approximately 19% of individuals had less than five years of education. For the total MoCA score, there was no floor or ceiling effect. There was a floor effect in the abstraction and delayed memory recall domains in 20% of our sample. The ceiling effect was demonstrated in all domains (80.8% more common in naming and 89% orientation), except delayed recall. Education was the main factor associated with the floor and ceiling effects, independent of region, sex, age at evaluation, and disease duration. Conclusion The floor and ceiling effects are present in specific domains of the MoCA in Brazil, with a strong impact on education. Further adaptations of the MoCA structure for underrepresented populations may reduce these negative effects.
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Affiliation(s)
| | - Pedro Renato de Paula Brandão
- Universidade de Brasília, Laboratório de Neurociências e Comportamento, Brasília DF, Brazil
- Hospital Sírio-Libanês, Instituto de Ensino e Pesquisa, Brasília DF, Brazil
| | - Vanderci Borges
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Henrique Ballalai Ferraz
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Artur Francisco Schumacher-Schuh
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal do Rio Grande do Sul, Departamento de Farmacologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
| | - Carlos Roberto de Mello Rieder
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Maira Rozenfeld Olchik
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil
- Universidade Federal do Rio Grande do Sul, Departamento de Cirurgia e Ortopedia, Porto Alegre RS, Brazil
| | - Ignacio Fernandez Mata
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Lerner Research Institute, Genomic Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Vitor Tumas
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências Comportamentais, Ribeirão Preto SP, Brazil
| | - Bruno Lopes Santos-Lobato
- Universidade Federal do Pará, Instituto de Ciências Médicas, Belém PA, Brazil
- Hospital Ophir Loyola, Serviço de Neurologia, Belém PA, Brazil
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Lima DP, Bonfadini JDC, Carneiro AHS, de Almeida SB, Viana AB, Nogueira e Silva AC, Roriz JDS, Braga P. Educational disparities in Brazil may interfere with the cognitive performance of Parkinson's disease patients. Dement Neuropsychol 2023; 17:e20220084. [PMID: 38028380 PMCID: PMC10666553 DOI: 10.1590/1980-5764-dn-2022-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/05/2023] [Accepted: 07/30/2023] [Indexed: 12/01/2023] Open
Abstract
The prevalence of cognitive impairment in Parkinson's disease (PD) is about 20% to 60%. The Mini-Mental Status Examination (MMSE) is the most used cognitive screening test. Objective To evaluate the influence of clinical and demographic characteristics, specifically the education level, on the MMSE score in PD patients of a northeast Brazilian sample. Methods We performed a cross-sectional study of 198 PD patients at a Movement Disorders outpatient clinic in Fortaleza, CE, Brazil. Participants were assessed by detailed clinical history, modified Hoehn and Yahr staging (HY), geriatric depression scale (GDS) and MMSE. Results We found that 68% of patients had MMSE scores below the Brazilian thresholds, which were based in Brucki et al. study (2003). There was a statistically significant difference in the bivariate analysis between educational level and cut-off classification for MMSE. More years of formal schooling were associated with more patients scoring below threshold. We found that 75%, 68.8%, and 79.7% of individuals with more than 11, 9 to 11, and 4 to 8 years of formal schooling, respectively, were below the suggested Brazilian Brucki's threshold. GDS and age were negatively correlated with total MMSE and all its domains. There was no correlation between disease duration and MMSE. Subjects with hallucinations had lower scores. Conclusion Most of the sample had lower performance according to Brazilian thresholds, but there was no control group and no neuropsychological test in this study. Further studies in northeast Brazil are needed to review MMSE cut-off values.
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Affiliation(s)
- Danielle Pessoa Lima
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Geriatria, Fortaleza CE, Brazil
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Neurologia, Fortaleza CE, Brazil
- Universidade de Fortaleza, Faculdade de Medicina, Fortaleza CE, Brazil
| | - Janine de Carvalho Bonfadini
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Geriatria, Fortaleza CE, Brazil
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Neurologia, Fortaleza CE, Brazil
| | | | - Samuel Brito de Almeida
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Geriatria, Fortaleza CE, Brazil
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Neurologia, Fortaleza CE, Brazil
| | - Antonio Brazil Viana
- Universidade Federal do Ceará, Complexo Hospitalar da Fortaleza, Unidade de Pesquisa Clínica, Fortaleza CE, Brazil
| | | | - Jarbas de Sá Roriz
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Geriatria, Fortaleza CE, Brazil
| | - Pedro Braga
- Universidade Federal do Ceará, Departamento de Clínica Médica, Divisão de Neurologia, Fortaleza CE, Brazil
- Universidade Estadual do Ceará, Faculdade de Medicina, Fortaleza CE, Brazil
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Rego de Figueiredo I, Branco Ferrão J, Dias S, Drummond Borges D, Fernandes J, Bernardino V, Gruner H, Panarra A. The Prevalence of COVID-19 Fog and the Impact on Quality of Life After SARS-CoV-2 Infection (QoL-COVID): A Cross Sectional Study. ACTA MEDICA PORT 2023; 36:631-638. [PMID: 36790319 DOI: 10.20344/amp.18784] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/19/2022] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Coronavirus has an impact on both the physical and mental health of individuals. The literature regarding the patient's health status post-SARS-CoV-2 is still scarce with limited data on the prevalence of residual symptoms and quality of life (QoL) after the infection. The aim of this study was to understand the impact of SARS-CoV-2 on patient QoL, and remaining symptoms. MATERIAL AND METHODS Single center cross-sectional study of patients who had been admitted to our COVID-19 ward between March 2020 and March 2021. By applying a QoL questionnaire (EQ-5D-5L) we assessed the overall sample, at three time points and in different groups of patients: those admitted to the intensive care unit (ICU) and the elderly. RESULTS A total of 125 participants were included in our study. Most patients who were admitted had a severe course of disease (51%), with 22% of admissions to the ICU, with 8% requiring prone ventilation, 10% experiencing thrombotic complications and 18% of nosocomial infections throughout the admission. As for persistent symptoms related with COVID-19 fog, the most frequent were fatigue (57%), memory loss (52%) and insomnia (50%). Regarding QoL, the average decrease was 0.08 ± 0.2 in the index and 8.7 ± 19 in the Visual Analogue Scale (VAS). The QoL index decrease correlated with age, chronic obstructive pulmonary disease, asthma and heart failure, and all persistent symptoms, significantly. QoL VAS correlated significantly with fatigue, mood changes, difficulty concentrating and memory loss. The decrease in QoL and the persistent symptoms remained overall stable over the three time points. The ICU group showed no statistically significant difference in QoL, but the most frequently persistent symptoms were mood changes and attention disturbances. However, the elderly experienced a worsening in QoL expressed by index (0.69 ± 0.3 vs 0.8 ± 0.2, p-value = 0.01). CONCLUSION A decrease in QoL was observed following SARS-CoV-2 infection, correlating with both chronic conditions and persistent symptoms. The lack of difference through time points of both QoL and persistent symptoms suggests a long-standing effect.
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Affiliation(s)
- Inês Rego de Figueiredo
- Unidade de Transplantes. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Joana Branco Ferrão
- Serviço de Medicina Intensiva. Hospital Professor Doutor Fernando da Fonseca. Amadora. Portugal
| | - Sara Dias
- Serviço de Medicina 7.2. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Diogo Drummond Borges
- Serviço de Medicina 7.2. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Jorge Fernandes
- Serviço de Medicina 7.2. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa. Portugal
| | - Vera Bernardino
- Serviço de Medicina 7.2. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Heidi Gruner
- Serviço de Medicina 7.2. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - António Panarra
- Serviço de Medicina 7.2. Hospital Curry Cabral. Centro Hospitalar Universitário Lisboa Central. Lisboa; NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Portugal
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Huang X, Alcantara LS, Tan CS, Ng YL, van Dam RM, Hilal S. Handgrip Strength and Cognitive Performance in a Multiethnic Cohort in Singapore. J Alzheimers Dis 2022; 90:1547-1555. [PMID: 36314200 DOI: 10.3233/jad-220531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Handgrip strength (HGS) is an important marker of frailty but there is limited research on lifestyle and vascular determinants of HGS and its relationship with cognitive impairment. OBJECTIVE To identify determinants of HGS and the association of HGS with cognitive impairment in a multiethnic cohort from Singapore. METHODS This study (n = 2,109, median [Q1, Q3] age: 53 [48, 60] years, 59.6% women) was based on cross-sectional data from Singapore Multi-Ethnic Cohort. HGS was collected using hand-held Electronic Dynamometer. The potential determinants of HGS included age, sex, ethnicity, smoking, physical activity, serum cholesterol and history of hypertension, diabetes, and stroke. Cognition, assessed with the Mini-Mental State Examination (MMSE), was analyzed as both continuous and binary outcome (cognitively impaired [scores < 26] and cognitively normal [scores≥26]). RESULTS In total, 239 (11.3%) participants were cognitively impaired. Older age, female sex, Malay or Indian compared with Chinese ethnicity, and diabetes history were associated with decreased HGS, whereas higher education, higher body mass index, and more physical activity were associated with higher HGS. Higher HGS was associated with higher MMSE scores (β: 0.34, 95% CI: 0.20, 0.49) and 37% lower odds of cognitive impairment (OR: 0.63, 95% CI: 0.49-0.82). These associations were significantly stronger in participants who were older (50-90 years), female, of Malay and Indian ethnicity (compared with Chinese), and less educated. CONCLUSION In this multi-ethnic Asian population, demographics, vascular risk factors, and lifestyle behaviors were associated with HGS. Additionally, higher HGS was associated with substantially better cognitive function, which association was modified by age, sex, ethnicity, and education level.
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Affiliation(s)
- Xiangyuan Huang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Leicester Shawn Alcantara
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yi Lin Ng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Departments of Exercise and Nutrition Sciences and Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.,Department of Pharmacology, National University of Singapore, Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore
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Rahmani M, Darvishpour A, Pourghane P. The Correlation and Agreement of Montreal Cognitive Assessment, Mini-Mental State Examination and Abbreviated Mental Test in Assessing the Cognitive Status of Elderly People Undergoing Hemodialysis. Iran J Nurs Midwifery Res 2022; 27:531-537. [PMID: 36712306 PMCID: PMC9881551 DOI: 10.4103/ijnmr.ijnmr_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/13/2021] [Accepted: 05/23/2022] [Indexed: 01/31/2023]
Abstract
Background Cognitive disorders are one of the most common disorders in elderly people with chronic renal failure. This study aimed to investigate the correlation and agreement of Montreal Cognitive Assessment (MoCA), Abbreviated Mental Test Score (AMTS), and Mini-Mental State Examination (MMSE) tests in assessing the cognitive status of elderly patients undergoing hemodialysis at Guilan University of Medical Sciences in north of Iran. Materials and Methods This cross-sectional study was conducted on 84 elderly people undergoing hemodialysis. Inclusion criteria was having an age of 60 years old and older, hemodialysis treatment for at least 6 months, and having reading and writing skills. The Pearson correlation test, Intraclass Correlation Coefficient (ICC) test, and Bland-Altman plot were used for data analysis. Results The majority of samples were in the age group of 60-65 years (28.57%) and the majority of them were male (66.66%). The results showed a significant positive correlation between MoCA and MMSE (r = 0.69, p = 0.001), between MMSE and AMTS (r = 0.64, p = 0.001), and between MoCA and AMTS tests (r = 0.62, p = 0.001). The results also showed a weak agreement between MoCA and MMSE tests (ICC = -0.11, p = 0.633), between MMSE and AMTS tests (ICC = -0.007, p = 0.369), and between MoCA and AMTS tests (ICC = -0.001, p = 0.780). Conclusions Based on the results, these tools seem to complement each other. The inconsistency between cognitive tests indicates a serious need to develop appropriate instruments for detecting cognitive disorders in elderly.
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Affiliation(s)
- Maryam Rahmani
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Azar Darvishpour
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran,Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran,Address for correspondence: Dr. Azar Darvishpour, Zeynab (P.B.U.H) School of Nursing and Midwifery, Martyr Yaghoub Sheikhi St. Leyla Kooh, Langeroud, Guilan, Iran. E-mail:
| | - Parand Pourghane
- Department of Nursing, Zeynab (P.B.U.H) School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Gamage I, Dhar A, Tregaskis P, Wilson S. Frequency and Risk Factors for Cognitive Dysfunction in Peritoneal Dialysis Patients. Nephrology (Carlton) 2022; 27:945-952. [PMID: 36190395 DOI: 10.1111/nep.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/02/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is limited data on cognition in patients undergoing peritoneal dialysis (PD). We assessed prevalence and associated risk factors of neurocognitive impairment (NCI) in PD patients. DESIGN AND METHODS A cross-sectional cohort study of 149 PD patients at a single centre between 2016 and 2020 who underwent neurocognitive screening at defined intervals by Addenbrooke's Cognitive Examination - Revised (ACE-R) with incorporated Mini-Mental State Examination (MMSE). Paired-sample t-test was used to compare cognitive performance to the general population and compare cohorts for dichotomous risk factors. Residual renal function (RRF) and clearance kinetics were evaluated using local regression models. Sub-analysis was performed in patients with cerebrovascular disease (CVD). RESULTS Patients on PD performed poorly in ACE-R screening compared to population norms, with discrepancy in all cognitive domains. In patients without CVD, attention and language domains were comparable to norms. The MMSE detected cognitive impairment in 2% of studied patients, significantly fewer than when the ACE-R was applied (32%). Age, gender, diabetic status and depression were associated with lower neurocognitive screening performance (p < 0.05). Dialysis vintage beyond 12 months conferred poorer cognitive performance. RRF correlated with cognitive performance. CONCLUSIONS Patients on PD have higher prevalence of NCI than the general population, primarily with impairments in memory, fluency, and visuospatial reasoning. CVD confers poorer performance in attention and language domains. The MMSE is ineffective in detecting subtle NCI in this population compared with ACE-R. Risk factors for NCI include age, gender, diabetic status, depression, and vintage beyond 12 months. Protective factors include RRF. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Isuru Gamage
- Department of Nephrology, Alfred Hospital, Alfred Health, Melbourne, Australia
| | - Arup Dhar
- Central Clinical School, Monash University, Melbourne, Australia.,Department of Psychiatry, Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia.,Department of Psychiatry, Monash Health
| | - Peter Tregaskis
- Central Clinical School, Monash University, Melbourne, Australia
| | - Scott Wilson
- Central Clinical School, Monash University, Melbourne, Australia.,Department of Nephrology, Alfred Hospital, Alfred Health, Melbourne, Australia
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Thammachai A, Sapbamrer R, Rohitrattana J, Tongprasert S, Hongsibsong S, Wangsan K. The reliability of neurobehavioral tests in a thai adult population. Dement Neuropsychol 2022; 16:324-331. [PMID: 36619834 PMCID: PMC9762389 DOI: 10.1590/1980-5764-dn-2021-0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/22/2022] [Accepted: 04/02/2022] [Indexed: 02/01/2023] Open
Abstract
Early detection of decline in neurobehavioral (NB) performance requires reliable methods of testing. Although NB tests have been shown to be consistent and reliable in Western countries, there has been limited research in Asian populations. Objective The purpose of this study was to investigate the test-retest reliability of NB tests in a Thai adult population and examine the impact of demographic data on NB tests. The aspects of the tests chosen were memory, attention, hand-eye coordination, motor speed, and dexterity. Methods The three NB tests used were digit span, Purdue Pegboard, and visual-motor integration. All three were administered to a population of 30 Thai adults. Results The outcomes of all Pearson's correlation coefficient tests (r) were positive and greater than 0.60, and subtest-retest reliability correlation coefficients ranged from 0.63 (p<0.001) to 0.81 (p<0.001). Interestingly, the outcomes of all of these tests were not affected by demographic data, with the exception of the Purdue Pegboard test, in which performance on the preferred hand and both hands assessment was weakly associated with age (β=-0.09, p<0.001 and β=-0.08, p<0.05, respectively). Conclusions NB tests have adequate reliability and are useful for the evaluation of clinical memory, attention, hand-eye coordination, motor speed, and dexterity in Thai adults. These tests were not affected by demographic data. However, further studies to measure the validity of the digit span, Purdue Pegboard, and visual-motor integration tests are needed.
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Affiliation(s)
- Ajchamon Thammachai
- Chiang Mai University, Faculty of Medicine, Department of
Community Medicine, Chiang Mai, Thailand
| | - Ratana Sapbamrer
- Chiang Mai University, Faculty of Medicine, Department of
Community Medicine, Chiang Mai, Thailand
| | | | - Siam Tongprasert
- Chiang Mai University, Faculty of Medicine, Department of
Rehabilitation Medicine, Chiang Mai, Thailand
| | - Surat Hongsibsong
- Chiang Mai University, Research Institute for Health Sciences,
School of Health Sciences Research, Chiang Mai, Thailand
| | - Kampanat Wangsan
- Chiang Mai University, Faculty of Medicine, Department of
Community Medicine, Chiang Mai, Thailand
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10
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Lopes KF, Bahia VS, Natividade JC, Bastos RVS, Shiguti WA, da Silva KER, de Souza WC. Changes in personality traits in patients with Alzheimer's Disease. Dement Neuropsychol 2022; 16:187-193. [PMID: 35720659 PMCID: PMC9173796 DOI: 10.1590/1980-5764-dn-2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/30/2021] [Indexed: 05/31/2023] Open
Abstract
Changes in personality traits in patients with Alzheimer's disease (AD) are extremely common throughout the course of the pathology, and these behavioral changes present themselves as challenges in clinical management and as a significant cause of caregivers’ burden.
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Affiliation(s)
- Kaoue Fonseca Lopes
- Universidade de Brasília, Instituto de Psicologia, Departamento de Processos Psicológicos Básicos, Brasília DF, Brazil.,Clínica de Neurologia Neurob, Brasília DF, Brazil
| | - Valéria Santoro Bahia
- Universidade Cidade de São Paulo, Departamento de Medicina Interna, São Paulo SP, Brazil
| | - Jean Carlos Natividade
- Pontifícia Universidade Católica do Rio de Janeiro, Instituto de Psicologia, Departamento de Psicologia Social, Rio de Janeiro RJ, Brazil
| | - Rafael Valdece Sousa Bastos
- Universidade São Francisco, Instituto de Psicologia, Departamento de Psicologia Social, São Paulo SP, Brazil
| | | | | | - Wânia Cristina de Souza
- Universidade de Brasília, Instituto de Psicologia, Departamento de Processos Psicológicos Básicos, Brasília DF, Brazil
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11
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Parker K, Vincent B, Rhee Y, Choi BJ, Robinson-Lane SG, Hamm JM, Klawitter L, Jurivich DA, McGrath R. The estimated prevalence of no reported dementia-related diagnosis in older Americans living with possible dementia by healthcare utilization. Aging Clin Exp Res 2022; 34:359-365. [PMID: 34524654 PMCID: PMC8925882 DOI: 10.1007/s40520-021-01980-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis. AIMS This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization. METHODS The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years. RESULTS The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%-93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1-90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1-91.4%). DISCUSSION Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless. CONCLUSIONS We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.
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Affiliation(s)
- Kelly Parker
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA
| | - Brenda Vincent
- Department of Statistics, North Dakota State University, Fargo, ND, USA
| | - Yeong Rhee
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA,Department of Statistics, North Dakota State University, Fargo, ND, USA,Department of Public Health, North Dakota State University, Fargo, ND, USA
| | - Bong-Jin Choi
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA,Department of Statistics, North Dakota State University, Fargo, ND, USA,Department of Public Health, North Dakota State University, Fargo, ND, USA
| | | | - Jeremy M. Hamm
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - Lukus Klawitter
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND 58108, USA
| | - Donald A. Jurivich
- Department of Geriatrics, University of North Dakota, Grand Forks, ND, USA
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, NDSU Dept 2620, PO Box 6050, Fargo, ND, 58108, USA. .,Fargo VA Healthcare System, Fargo, ND, USA.
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12
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Grandi F, Martínez-Pernía D, Parra M, Olavarria L, Huepe D, Alegria P, Aliaga Á, Lillo P, Delgado C, Tenorio M, Rosas R, López O, Becker J, Slachevsky A. Standardization and diagnostic utility of the Frontal Assessment Battery for healthy people and patients with dementia in the Chilean population. Dement Neuropsychol 2022; 16:69-78. [PMID: 35719260 PMCID: PMC9170265 DOI: 10.1590/1980-5764-dn-2021-0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/06/2021] [Accepted: 09/17/2021] [Indexed: 11/22/2022] Open
Abstract
The Frontal Assessment Battery (FAB) is a screening test that measures executive functions. Although this instrument has been validated in several countries, its diagnostic utility in a Chilean population has not been studied yet. Objectives This study aimed to (1) adapt FAB in a Chilean population; (2) study the psychometric properties of the FAB in a Chilean population; (3) assess the sociodemographic influence in the performance of the FAB in a sample of healthy controls (HC); and (4) develop normative data for this healthy group. Methods A HC (n=344) and a group of patients with dementia (n=156) were assessed with the Chilean version of FAB. Results FAB showed good internal consistency (Cronbach's alpha=0.79) and acceptable validity based on the relationship with other variables. Factor analysis showed the unidimensionality of the instrument. Significant differences were found in the total FAB value between the HC and dementia groups. With the matched sample, the established cutoff point was 13.5, showing a sensitivity of 80.8% and a specificity of 90.4%. Regression analysis showed that education and age significantly predicted FAB performance in the healthy group. Finally, normative data are provided. Conclusions This study shows that FAB is a useful tool to discriminate between healthy people and people with dementia. However, further studies are needed to explore the capacity of the instrument to characterize the dysexecutive syndrome in people with dementia in the Chilean population.
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Affiliation(s)
- Fabrissio Grandi
- Gerosciences Center for Brain Health and Metabolism, Santiago, Chile.,Universidad de Chile, Faculty of Medicine, Hospital del Salvador, Memory and Neuropsychiatric Clinic, Neurology Department, Santiago, Chile.,Universidad de Chile, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Department, Neuroscience and East Neuroscience Departments, Santiago, Chile.,Universidad de los Andes, School of Psychology, Santiago, Chile
| | - David Martínez-Pernía
- Gerosciences Center for Brain Health and Metabolism, Santiago, Chile.,Universidad de Chile, Faculty of Medicine, Hospital del Salvador, Memory and Neuropsychiatric Clinic, Neurology Department, Santiago, Chile.,Universidad Adolfo Ibañez, School of Psychology, Center for Social and Cognitive Neuroscience, Santiago, Chile
| | - Mario Parra
- University of Strathclyde, School of Psychological Sciences and Health, Glasgow, Scotland
| | - Loreto Olavarria
- Universidad de Chile, Faculty of Medicine, Hospital del Salvador, Memory and Neuropsychiatric Clinic, Neurology Department, Santiago, Chile.,Universidad de Chile, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Department, Neuroscience and East Neuroscience Departments, Santiago, Chile
| | - David Huepe
- Universidad Adolfo Ibañez, School of Psychology, Center for Social and Cognitive Neuroscience, Santiago, Chile
| | - Patricia Alegria
- Clínica Alemana, Physical Medicine and Rehabilitation Service, Santiago, Chile
| | - Álvaro Aliaga
- Diego Portales Universidad, School of Psychology, Santiago, Chile
| | - Patricia Lillo
- Gerosciences Center for Brain Health and Metabolism, Santiago, Chile.,Universidad de Chile, Faculty of Medicine, South Neuroscience Department, Santiago, Chile.,Complejo Hospitalario San José, Neurology Unit, Santiago, Chile
| | - Carolina Delgado
- Universidad de Chile, School of Medicine, Department of Neuroscience, Santiago, Chile.,Universidad de Chile, Hospital Clínico, Department of Neurology and Neurosurgery, Healthy Brain Unit, Santiago, Chile
| | - Marcela Tenorio
- Universidad de los Andes, School of Psychology, Santiago, Chile.,Millennium Institute for Caregiving Research, Santiago, Chile
| | - Ricardo Rosas
- Pontificia Universidad Católica de Chile, Center for the Development of Inclusion Technologies, Santiago, Chile
| | - Oscar López
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA.,University of Pittsburgh, Department of Neurology, Pittsburgh, PA, USA
| | - James Becker
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, USA.,University of Pittsburgh, Department of Neurology, Pittsburgh, PA, USA.,University of Pittsburgh, Department of Psychology, Pittsburgh, PA, USA
| | - Andrea Slachevsky
- Gerosciences Center for Brain Health and Metabolism, Santiago, Chile.,Universidad de Chile, Faculty of Medicine, Hospital del Salvador, Memory and Neuropsychiatric Clinic, Neurology Department, Santiago, Chile.,Universidad de Chile, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Department, Neuroscience and East Neuroscience Departments, Santiago, Chile.,Universidad del Desarrollo, Clínica Alemana, Department of Medicine, Neurology Unit, Santiago, Chile
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13
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De Stefano A, Di Giovanni P, Kulamarva G, Di Fonzo F, Massaro T, Contini A, Dispenza F, Cazzato C. Changes in Speech Range Profile Are Associated with Cognitive Impairment. Dement Neurocogn Disord 2021; 20:89-98. [PMID: 34795772 DOI: 10.12779/dnd.2021.20.4.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose The aim of this study was to describe the variations in the speech range profile (SRP) of patients affected by cognitive decline. Methods We collected the data of patients managed for suspected voice and speech disorders, and suspected cognitive impairment. Patients underwent an Ear Nose and Throat evaluation and Mini-Mental State Examination (MMSE). To obtain SRP, we asked the patients to read 18 sentences twice, at their most comfortable pitch and loudness as they would do in daily conversation, and recorded their voice on to computer software. Results The study included 61 patients. The relationship between the MMSE score and SRP parameters was established. Increased severity of the MMSE score resulted in a statistically significant reduction in the average values of the semitones to the phonetogram, and the medium and maximum sound pressure levels (p<0.001). The maximum predictivity of MMSE was based on the highly significant values of semitones (p<0.001) and the maximum sound pressure levels (p=0.010). Conclusions The differences in SRP between the various groups were analyzed. Specifically, the SRP value decreased with increasing severity of cognitive decline. SRP was useful in highlighting the relationship between all cognitive declines tested and speech.
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14
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Hillebrand SL, Reijnierse EM, Meskers CGM, Maier AB. Orthostatic hypotension assessed by active standing is associated with worse cognition in geriatric rehabilitation inpatients, RESORT. Arch Gerontol Geriatr 2021; 96:104482. [PMID: 34284300 DOI: 10.1016/j.archger.2021.104482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Geriatric rehabilitation inpatients who suffer from acute and chronic diseases that aggravate blood pressure (BP) dysregulation, may be particularly susceptible to orthostatic hypotension (OH). OH may increase the risk of cerebral small vessel disease and subsequent white matter hyperintensities inducing cognitive impairment (CI). This study investigates the association between OH and cognition in geriatric rehabilitation inpatients. MATERIALS AND METHODS Geriatric rehabilitation inpatients of the observational, longitudinal REStORing health of acutely unwell adulTs (RESORT) cohort in Melbourne, Australia, underwent intermittent BP measurements during active standing or partial postural change to sitting (when unable to stand). OH was defined as a systolic BP drop ≥20 mmHg and/or diastolic BP drop ≥10 mmHg within three minutes after postural change. CI included dementia diagnosis, Mini-Mental State Examination (MMSE) score <24 points (categorized as 18-23 (mild CI) and <18 points (severe CI)), Montreal Cognitive Assessment score <26 points or Rowland Universal Dementia Assessment Scale score <23 points. RESULTS In geriatric rehabilitation inpatients (n=1232, mean age 82.3 years (SD 8.2), 57.5% female), OH, CI and dementia prevalence was 20.0%, 61.0% and 20.4% respectively. MMSE was scored 18-23 in 32.6% and <18 points in 27.8% of patients (n=1033). In standing patients (51.7%), OH was associated with CI (p=0.045) and dementia (p=0.021), with a trend for MMSE scores <18 points (p=0.080), but not for MMSE scores 18-23 points (p=0.528). No association was found between seated OH and cognition. CONCLUSION OH assessed by active standing using intermittent BP measurements was associated with worse cognition in geriatric rehabilitation inpatients.
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Affiliation(s)
- Sarah L Hillebrand
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, City Campus, Level 6 North, 300 Grattan Street, Parkville, Victoria 3050, Australia; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, de Boelelaan 1117, 1081 HZ Amsterdam, the Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, de Boelelaan 1117, 1081 HZ Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The University of Melbourne, The Royal Melbourne Hospital, City Campus, Level 6 North, 300 Grattan Street, Parkville, Victoria 3050, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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15
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Hess C, Levy B, Hashmi AZ, Hogan J, Greenspan S, Elber A, Falcon K, Driscoll DF. Subjective Versus Objective Assessment of Cognitive Functioning in Primary Care. J Am Board Fam Med 2020; 33:417-25. [PMID: 32430373 DOI: 10.3122/jabfm.2020.03.190265] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study examined the clinical utility of highly efficient subjective and objective screens of cognitive impairment. METHOD Participants (N = 124, age ≥ 65, mean = 73.59, SD = 6.26) completed a 2-item questionnaire of subjective memory functioning, a brief computerized cognitive test, and the Montreal Cognitive Assessment (MoCA). Next, participants were assigned to 1 of 4 conditions, based on their subjective (low/high) and objective (impaired/unimpaired) levels of cognitive functioning. Further analysis divided the sample into age-based groups (ie, age < 75, age ≥ 75). RESULTS The proportion of participants in the impaired subsample (ie, MoCA < 26), who reported a high level of subjective concern about their memory, was low (ie, 0.15). Among unimpaired participants, analysis detected significant group differences across subjective memory levels (P < .0003) and age (P < .005) categories on one of the three tasks of the computerized test (ie, cognitive control). In contrast, the MoCA offered no differentiation between these groups. CONCLUSION Screening protocols in which cognitive testing is administered subsequent to patient complaint are prone to underdiagnosis. In addition, common dementia screens are insensitive to subjective deficits and healthy cognitive aging. Therefore, they may lead to dismissing valid concerns that deserve preventive attention. Primary care needs efficient screening tools that are sensitive to prodromal decline.
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Lam J, Hlávka J, Mattke S. The Potential Emergence of Disease-Modifying Treatments for Alzheimer Disease: The Role of Primary Care in Managing the Patient Journey. J Am Board Fam Med 2019; 32:931-40. [PMID: 31704763 DOI: 10.3122/jabfm.2019.06.180328] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 06/27/2019] [Accepted: 06/27/2019] [Indexed: 11/08/2022] Open
Abstract
Despite recent setbacks, disease-modifying treatments (DMTs) for Alzheimer disease (AD) might become available within a few years. These DMTs are likely to be used in the early stages of AD to avoid the progression to manifest dementia, which implies that a large reservoir of prevalent cases would need to be evaluated when DMTs first become available. Primary care providers (PCPs) would play a vital role in managing the patient flow to specialty care. We review the literature on diagnostic tests that could be used by PCPs and estimate the impact of different testing approaches on demand for specialty care.While many tests have been evaluated, only the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) perform acceptably for detection of early-stage cognitive decline with sensitivities and specificities of 55% to 82% and 72% to 84%, respectively, for the MMSE; and 77% to 96% and 73% to 95%, respectively, for the MoCA. However, neither test is sufficiently specific for the AD pathology and would result in 4 to 5 false positives for each true positive. Blood-based tests for AD biomarkers may soon become available for clinical use. A plasma amyloid-β (Aβ) test has been shown to have a sensitivity of up to 97% and specificity of up to 81%. Adding this test to the MMSE or MoCA could reduce false positives by approximately 80%.These findings suggest a combination of brief cognitive tests and blood-based biomarker tests will allow PCPs to identify patients with potential early stage AD efficiently and triage them for further evaluation.
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Gupta A, Montgomery RN, Bedros V, Lesko J, Mahnken JD, Chakraborty S, Drew D, Klein JA, Thomas TS, Ilahe A, Budhiraja P, Brooks WM, Schmitt TM, Sarnak MJ, Burns JM, Cibrik DM. Subclinical Cognitive Impairment and Listing for Kidney Transplantation. Clin J Am Soc Nephrol 2019; 14:567-575. [PMID: 30890576 PMCID: PMC6450345 DOI: 10.2215/cjn.11010918] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/17/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment is common in patients with kidney disease and can affect physicians' perception and/or patients' ability to complete the pretransplant evaluation. We examined whether cognitive impairment influences the likelihood for transplant listing and whether patients with cognitive impairment take longer to be listed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a single-center longitudinal cohort study. Patients presenting for their index kidney transplant evaluation were screened for cognitive impairment using the Montreal Cognitive Assessment. A score <26 indicated cognitive impairment. The transplant selection committee was blinded to the scores. Kaplan-Meier analysis assessed time to active listing by level of cognition. A Cox proportional hazards model that included age, sex, race/ethnicity, smoking, coronary artery disease, and diabetes was constructed to evaluate the association between Montreal Cognitive Assessment score and listing for transplant. RESULTS In total, 349 patients who underwent Montreal Cognitive Assessment testing at their initial visit were included in the analysis. Patients with cognitive impairment were more likely to be older, black, and smokers. The time to listing in patients with cognitive impairment was longer than the time to listing in those with no cognitive impairment (median time, 10.6 versus 6.3 months; log rank test P=0.01). Cognitive impairment was independently associated with a lower likelihood of being listed for transplant (hazard ratio, 0.93 per unit lower Montreal Cognitive Assessment score; 95% confidence interval, 0.88 to 0.99; P=0.02). A lower proportion of patients with cognitive impairment were listed compared with patients without cognitive impairment at 1 month (2% versus 11%), 6 months (17% versus 37%), and 1 year (23% versus 41%), (P<0.001 for all). CONCLUSIONS Cognitive impairment is associated with a lower likelihood of being listed for kidney transplant, and is associated with longer time to transplant listing.
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Affiliation(s)
| | | | - Victor Bedros
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - John Lesko
- Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Shweta Chakraborty
- Transplant Administration, University of Kansas Health System, Kansas City, Kansas; and
| | - David Drew
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
| | | | | | | | | | | | | | - Mark J Sarnak
- Department of Internal Medicine, Tufts Medical Center, Boston, Massachusetts
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