Cognitive impairment in elderly patients with rheumatic disease and the effect of disease-modifying anti-rheumatic drugs

<P>Background: Type 2 diabetes (T2DM) is a risk factor for Alzheimer’s disease and mild cognitive impairment. The etiology of cognitive impairment in people with T2DM is uncertain but, chronic hyperglycemia, cerebral micro vascular disease, severe hypoglycemia, and increased prevalence of macro vascular disease are implicated. </P><P> Objectives: To determine the serum levels of soluble vascular adhesion molecule (sVCAM-1) and highly sensitive C-reactive protein (hs-CRP) in elderly type 2 diabetics with mild cognitive impairment (MCI). Methods: Our study was conducted on 90 elderly subjects (aged 60 years old or more). They were divided into Group І, 30 patients with T2DM and mild cognitive impairment, group ІІ, 30 patients with T2DM without cognitive impairment and group III, 30 healthy subjects as a control group. They were subjected to history taking, full clinical examination, anthropometric measurement, the Addenbrooke’s Cognitive Examination III (ACE---III 2012), Fasting plasma glucose, 2 hours plasma glucose, HbA1c, lipid profile, protein/creatinine ratio, serum sVCAM-1 and hs-CRP. Results: Serum levels of sVCAM-1 in diabetic elderly patients with MCI were significantly higher (946.7 ± 162.01 ng/ml) than diabetic elderly patients without cognitive impairment (479.06 ± 65.27 ng/ml) and control (263.7 ± 72.05 ng/ml) with (P=0.002). Serum levels of Hs-CRP in diabetic elderly patients with MCI were significantly higher than as diabetic elderly patients without cognitive impairment and control with (P=0.005). Conclusion: Elderly diabetic patients with mild cognitive impairment have higher levels of soluble adhesion molecules and markers of low-grade systemic inflammation than other groups.</P>

Download Full-text

Comparison of intravenous sedation using midazolam during dental treatment in elderly patients with/without dementia: a prospective, controlled clinical trial

Scientific Reports ◽

10.1038/s41598-021-83122-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuichi Tatsuno ◽

Yoshinari Morimoto ◽

Megumi Hayashi ◽

Takatoshi Iida

Keyword(s):

Regression Analysis ◽

Cognitive Impairment ◽

Elderly Patients ◽

Multiple Regression Analysis ◽

Multiple Regression ◽

Intravenous Sedation ◽

Negative Group ◽

Severe Dementia ◽

Positive Group ◽

Significant Difference

AbstractThe effects of intravenous sedation with midazolam on the cerebral function of elderly patients with severe dementia are unclear. This study aimed to evaluate its effects on parameters such as brainwaves and cerebral blood flow (CBF) and compare them between elderly individuals with dementia and without cognitive impairment. Ten patients with severe dementia and 10 without cognitive impairment were registered. The bispectral index (BIS) and normalized tissue hemoglobin index (nTHI), which reflects CBF using near-infrared spectroscopy, were measured. Midazolam was administered until a Modified Observer’s Assessment of Alertness/Sedation score of 2 was reached. The chi-squared, Mann–Whitney U, Wilcoxon signed-rank, and Friedman tests and multiple regression analysis were used for comparisons. Whereas a similar decline in BIS values was observed in both groups after midazolam administration (P < 0.018), there was a significant decrease by 9% in the nTHI of the dementia-positive group (P < 0.013). However, there was no significant difference in the nTHI between the dementia-positive and dementia-negative group according to the multiple regression analysis (P = 0.058). In the dementia-negative group, none of the measured values differed from the baseline values. In the dementia-positive group, sedation with midazolam resulted in a 9% decrease in the CBF.

Download Full-text

Preoperative Cognitive Impairment as a Predictor of Postoperative Outcomes in Elderly Patients Undergoing Spinal Surgery for Degenerative Spinal Disease

Journal of Clinical Medicine ◽

10.3390/jcm10071385 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1385

Author(s):

Hyung Cheol Kim ◽

Seong Bae An ◽

Hyeongseok Jeon ◽

Tae Woo Kim ◽

Jae Keun Oh ◽

...

Keyword(s):

Cognitive Impairment ◽

Elderly Patients ◽

Mental State ◽

Mini Mental State Examination ◽

Operation Time ◽

Cognitive Status ◽

Blood Analysis ◽

Spinal Disease ◽

Degenerative Spinal Disease ◽

State Examination

Cognitive status has been reported to affect the peri-operative and post-operative outcomes of certain surgical procedures. This prospective study investigated the effect of preoperative cognitive impairment on the postoperative course of elderly patients (n = 122, >65 years), following spine surgery for degenerative spinal disease. Data on demographic characteristics, medical history, and blood analysis results were collected. Preoperative cognition was assessed using the mini-mental state examination, and patients were divided into three groups: normal cognition, mild cognitive impairment, and moderate-to-severe cognitive impairment. Discharge destinations (p = 0.014) and postoperative cardiopulmonary complications (p = 0.037) significantly differed based on the cognitive status. Operation time (p = 0.049), white blood cell count (p = 0.022), platelet count (p = 0.013), the mini-mental state examination score (p = 0.033), and the Beck Depression Inventory score (p = 0.041) were significantly associated with the length of hospital stay. Our investigation demonstrated that improved understanding of preoperative cognitive status may be helpful in surgical decision-making and postoperative care of elderly patients with degenerative spinal disease.

Download Full-text

Ventilatory defects and treatable traits in very elderly patients

Science Progress ◽

10.1177/00368504211013171 ◽

2021 ◽

Vol 104 (2) ◽

pp. 003685042110131

Author(s):

João Gaspar-Marques ◽

Teresa Palmeiro ◽

Iolanda Caires ◽

Paula Leiria Pinto ◽

Nuno Neuparth ◽

...

Keyword(s):

Cognitive Impairment ◽

Elderly Patients ◽

Elderly Care ◽

Airflow Limitation ◽

The Novel ◽

Z Score ◽

Very Elderly ◽

Chronic Respiratory Diseases ◽

Novel Association ◽

Peripheral Pulse

Though the approach used to classify chronic respiratory diseases is changing to a treatable-traits (TT) approach, data regarding very elderly patients is lacking. The objectives of this study were to assess TT frequency in very elderly patients and to study the link between extrapulmonary TT and ventilatory defects. Individuals (≥75 years) residing in elderly care centres answered a standardised questionnaire, underwent spirometry, atopy and fractional exhaled nitric oxide assessments and had their blood pressure and peripheral pulse oximetry measured. Pulmonary, extrapulmonary and behavioural TT were evaluated. Outcome variables were an airflow limitation (post-bronchodilator z-score FEV1/FVC<−1.64) and a restrictive spirometry pattern (z-score FEV1/FVC ≥ +1.64 and z-score FVC<−1.64). Seventy-two percent of the individuals who took part in the study ( n = 234) were women, and the median age of participants was 86 (IQR: 7.4). At least one pulmonary TT was identified in 105 (44.9%) individuals. The most frequent extrapulmonary TTs were: persistent systemic inflammation (47.0%), anaemia (34.4%), depression (32.5%) and obesity (27.4). Airflow limitation was exclusively associated with smoking (OR 5.03; 95% CI 1.56–16.22). A restrictive spirometry pattern was associated with cognitive impairment (OR: 3.89; 95% CI: 1.55–9.79). A high frequency of various TTs was found. The novel association between a restrictive spirometry pattern and cognitive impairment highlights the urgency of clinical research on this vulnerable age group.

Download Full-text

Postoperative delirium in elderly patients is associated with subsequent cognitive impairment

British Journal of Anaesthesia ◽

10.1093/bja/aex130 ◽

2017 ◽

Vol 119 (2) ◽

pp. 316-323 ◽

Cited By ~ 65

Author(s):

J. Sprung ◽

R.O. Roberts ◽

T.N. Weingarten ◽

A. Nunes Cavalcante ◽

D.S. Knopman ◽

...

Keyword(s):

Cognitive Impairment ◽

Elderly Patients ◽

Postoperative Delirium

Download Full-text

Low-dose oral prolonged-release oxycodone/naloxone for chronic pain in elderly patients with cognitive impairment: an efficacy–tolerability pilot study

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s98511 ◽

2016 ◽

pp. 559 ◽

Cited By ~ 8

Author(s):

Emiliano Petrò ◽

Elena Ruffini ◽

Melania Cappuccio ◽

Valeria Guerini ◽

Gloria Belotti ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Impairment ◽

Elderly Patients ◽

Low Dose ◽

Prolonged Release ◽

Dose Oral

Download Full-text

Similarity of response to biologics between elderly-onset rheumatoid arthritis (EORA) and non-EORA elderly patients: from the FIRST registry

The Journal of Rheumatology ◽

10.3899/jrheum.201135 ◽

2021 ◽

pp. jrheum.201135

Author(s):

Sae Ochi ◽

Fumitaka Mizoguchi ◽

Kazuhisa Nakano ◽

Yoshiya Tanaka

Keyword(s):

Rheumatoid Arthritis ◽

Elderly Patients ◽

Disease Activity ◽

Trajectory Analysis ◽

Response Patterns ◽

Efficacy And Safety ◽

Significant Difference ◽

Elderly Onset ◽

Disease Modifying ◽

Elderly Onset Rheumatoid Arthritis

Objective Increasing numbers of patients are developing rheumatoid arthritis (RA) at an older age, and optimal treatment of elderly-onset RA (EORA) patients is attracting greater attention. This study aimed to analyze the efficacy and safety of biological/targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in EORA and non-EORA elderly patients. Methods A cohort of RA patients treated with b/tsDMARDs were retrospectively analyzed. Among patients who were ≥60 years old, those who developed RA after age 60 years were categorized as EORA, while others were categorized as non-EORA elderly. Disease activity were compared between the EORA and non-EORA elderly groups. Results In total, 1,040 patients were categorized as EORA and 710 as non-EORA elderly. There were not significant differences in characteristics at baseline between the two groups. The proportion of patients with low and high disease activity was comparable at week 2, 22 and 54 between in the EORA and the non-EORA elderly group. There was not significant difference in reasons of the discontinuation of b/tsDMARDs between the two groups. Elderly onset did not affect changes in CDAI and HAQ-DI as well as reasons of the discontinuation between the two groups. The trajectory analysis on CDAI-responses to b/tsDMARDs for 54 weeks identified three response patterns. The proportions of patients categorized into each group and CDAI-response trajectories to b/tsDMARDs were very similar between EORA and non-EORA elderly patients. Conclusion CDAI response patterns to b/tsDMARDs and hazard ratio of adverse events were similar between EORA and non-EORA elderly patients.

Download Full-text