P072: Using the Bergman-Paris Question to detect ED seniors’ cognitive impairment and functional status

Introduction: Mild Cognitive Impairment (MCI) remains frequently undiagnosed and Emergency Department (ED) guidelines suggest screening for CI. The Bergman-Paris Question (BPQ) which is currently used in memory clinics, is a one-question screening test administered to the patient’s relative; a negative answer suggests presence of CI. We sought to validate if the BPQ would be associated with MCI and functional status in ED elders. Methods: A planned sub-study of the prospective MIDI-INDEED study on ED-induced delirium, which included patients from 4 Canadian EDs was realized. Inclusion criteria were: patients ≥65 y.o., with and ED stay ≥8 hours, admitted to the hospital, non-delirious at the end of the first 8 hours and independent or semi-independent. Eligible patients were assessed in ED and at 60 days after ED visit using validated screening tests: the Telephone Interview for Cognitive Status-modified (TICS-m) for CI and the Older Americans Resources and Services scale (OARS) for functional status. The BPQ was asked at any time depending on the availability of a relative. Patients with a TICS-m score <31 are considered to have MCI. Data from patients with incident delirium, and those with documented dementia was individually analyzed. Univariate and multivariate analyses were used to ascertain outcomes. Results: 167 patients had a BPQ response, 126 (75.5%) were negative, and 41 positive (24.5%). For MCI, 40 (32.8%) patients of the negative group have a TICS-m below 31 comparatively to 6 (14.3%) for the positive group (p=0.2). The BPQ was significantly associated with functional status. The mean OARS scores were 25.1 (3.9) in the negative group and 27.1 (1.3) in the positive group. This difference was maintained at 60 days. The number of delirium in the negative group was 24 (18%) vs 2 (5%) in the positive group (p=0.04). Conclusion: BPQ could provide detection of MCI but further validation in a larger population is needed. BPQ was interestingly associated with ED-induced delirium and dementia. Detection of functional status and frailty shows good results. More research is needed to evaluate the usefulness of the BPQ “single” question for geriatric screening by ED professionals.

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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.

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Telemedicine assessment of long-term cognitive and functional status in anti-leucine-rich, glioma-inactivated 1 encephalitis

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000652 ◽

2019 ◽

Vol 7 (2) ◽

pp. e652 ◽

Cited By ~ 4

Author(s):

Nuria Sola-Valls ◽

Helena Ariño ◽

Domingo Escudero ◽

Elisabeth Solana ◽

Albert Lladó ◽

...

Keyword(s):

Cognitive Impairment ◽

Functional Status ◽

Verbal Memory ◽

Cognitive Reserve ◽

Disease Onset ◽

Cognitive Status ◽

Functional Activities ◽

Telephone Interviews ◽

Status Assessment

ObjectiveTo assess the feasibility of a structured telephone interview examining the long-term cognitive and functional status in anti–leucine-rich, glioma-inactivated 1 (LGI1) encephalitis.MethodsTelephone interviews were conducted with 37 patients after a median follow-up of 87 months from disease onset and 23 healthy controls matched for age and sex. Cognitive status was assessed with the telephone Mini-Mental State Examination (t-MMSE) and 3 tests exploring verbal memory, fluency, and executive function. Functional status was evaluated with the Functional Activities Questionnaire and the modified Rankin Scale (mRS). Patients were classified as normal, with mild cognitive impairment (MCI), or with dementia based on cognitive and functional status. Assessment of the cognitive reserve was performed with a structured questionnaire. Logistic regression analysis was applied to identify predictors of cognitive impairment.ResultsTelephone interviews were successful in 36/37 (97%) patients. Cognitive impairment was detected in 27 (75%) including 17 with MCI and 10 with dementia. Eight (29%) patients would have been misclassified using only the t-MMSE. Twenty-six (72%) patients were functionally independent according to the mRS, but only 9 (35%) were cognitively normal. Independent predictors for long-term cognitive impairment were a low cognitive reserve (OR = 1.36, 95% CI: 1.05–1.76; p = 0.02) and bilateral hippocampal hyperintensity at initial MRI (OR = 27.03, 95% CI: 1.87–390; p = 0.02).ConclusionsTelemedicine is a feasible tool to assess the cognitive and functional outcome in patients with anti-LGI1 encephalitis. Cognitive impairment is often missed if only functional scales are used. Premorbid cognitive reserve and MRI with bilateral hippocampal hyperintensity were predictors for long-term cognitive impairment.

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Inhome Service Use by Caregivers and Their Elders: Does Cognitive Status Make a Difference?

Canadian Journal on Aging / La Revue canadienne du vieillissement ◽

10.1017/s0714980800001513 ◽

2002 ◽

Vol 21 (2) ◽

pp. 257-271 ◽

Cited By ~ 7

Author(s):

Pamela Hawranik

Keyword(s):

Cognitive Impairment ◽

Functional Status ◽

Service Use ◽

Living Arrangement ◽

Cognitive Status ◽

Personal Care ◽

Care Services ◽

Significant Factors

ABSTRACTThe intent of this study was to examine the effect of cognitive status on the use of inhome services by caregivers and their elders. Data from the screening, clinical and community-caregiver phases of the Manitoba Study on Health and Aging (MSHA-1) were analysed utilizing a modified Andersen-Newman model. The findings indicated that those with dementia were more likely to use personal care services and use two or more inhome services than caregivers and their elders with no cognitive impairment and those with cognitive impairment but no dementia. Functional status of the elder and living arrangement of the caregiver and elder were strongly associated with the use of specific inhome services and with overall use. Policy and research implications of the findings including other significant factors such as caregiver employment, are presented.

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Links between Cognitive Status and Trace Element Levels in Hair for an Environmentally Exposed Population: A Case Study in the Surroundings of the Estarreja Industrial Area

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224560 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4560 ◽

Cited By ~ 6

Author(s):

Marina M. S. Cabral Pinto ◽

Paula Marinho-Reis ◽

Agostinho Almeida ◽

Edgar Pinto ◽

Orquídia Neves ◽

...

Keyword(s):

Cognitive Impairment ◽

Industrial Area ◽

Cognitive Status ◽

Anthropogenic Sources ◽

Screening Tests ◽

Cognitive Screening ◽

Predictive Diagnosis ◽

Exposed Population ◽

Icp Ms ◽

Hair Samples

In the present study, trace elements (TE) levels were evaluated in scalp hair along the continuum from healthy subjects (HS) to patients suffering from subjective memory concerns (SMC), and/or mild cognitive impairment (MCI), and those with already installed dementia (DEM) in order to: (i) assess the effects of environmental and lifestyle factors on TE concentrations and (ii) evaluate the analyzed elements as possible diagnostic biomarkers for the disease. The study involved 79 mainly permanent residents, >55 years old, from the city of Estarreja (northern Portugal), a former industrial area. The health status of the participants was assessed by means of a complete socio-demographic questionnaire and through cognitive screening tests, namely the Mini-Mental State Examination (MMSE). The test scores were categorized and used in the statistical analysis. Hair samples were collected and analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) ICP-MS for selected TE. Dementia appears to be associated with higher age, the female gender, lower education level, and longer residence time in the study area. In addition, most of the participants diagnosed with dementia frequently consume home-grown foodstuffs, some irrigated with contaminated well water. The calculation of the TE enrichment factors of soil samples collected in kitchen gardens/small farms in the vicinity of the Estarreja Chemical Complex (ECC) reinforces the degree of Hg soil contamination in the area, due to anthropogenic sources that can be a source for the population Hg exposure route among others. Mercury levels in hair differed significantly between the four individual groups (HS, SMC, MCI, and DEM), increasing from healthy to dementia participants. Improved diagnostic results can be obtained using hair TE signatures coupled with MMSE scores. This strategy may prove useful for predictive diagnosis in population screening for cognitive impairment.

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Cognitive Impairment Is Not a Predictor of Failure to Adhere to Anticoagulation of Stroke Patients with Atrial Fibrillation

Cerebrovascular Diseases ◽

10.1159/000381728 ◽

2015 ◽

Vol 39 (5-6) ◽

pp. 325-331 ◽

Cited By ~ 4

Author(s):

Solveig Horstmann ◽

Timolaos Rizos ◽

Michaela Saribas ◽

Evdokia Efthymiou ◽

Geraldine Rauch ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Cognitive Impairment ◽

Functional Status ◽

Cognitive Performance ◽

Functional Disability ◽

Cognitive Status ◽

Stroke Severity ◽

Detailed Medical History

Background: Oral anticoagulation (OAC) with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) is an effective strategy that is used for stroke prevention in patients with atrial fibrillation (AF). However, OAC is underused particularly in elderly patients, who are often physically disabled or cognitively impaired. We aimed at evaluating the effect of cognitive status and disability on OAC adherence 1 year after stroke or TIA. Methods: In this prospective, single-center, observational study patients with ischemic stroke or TIA were consecutively included between 3/2011 and 9/2012. The detailed medical history, basic demographic variables, cardiovascular risk factors, stroke severity according to the National Institutes of Health Stroke Scale (NIHSS), medication including OAC were all recorded. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA) score at baseline. The functional status was assessed by recording activities and instrumental activities of daily living, respectively (ADL, IADL). After 12 months, patients had a follow-up visit to reassess the cognitive and functional status (MoCA, ADL and IADL) and to document the current use of OAC. Results: In total, 12 months after the ischemic stroke or TIA AF had been diagnosed in 160/586 (27.3%). Of these, 151 patients (94.4%) were treated with OAC. OAC was performed using VKA in 79/151 (52.3%) and DOACs in 72/151 (47.7%). Cognitive impairment at 12 months follow-up was not associated with the absence of OAC treatment. However, regression analysis revealed that patients with AF with physical (ADL) and functional disability (IADL) were less likely to be treated with OAC (p = 0.08 and p = 0.04, respectively) 12 months after a stroke. None of these two factors, however, was independently associated with nonadherence to OAC 12 months after stroke. Although cognitive performance was similar in patients receiving VKA and direct anticoagulants (DOAC), adherence to VKA tended to be lower (82.6 vs. 94.6%, p = 0.12). Conclusions: In stroke and TIA patients with AF, the multifactorial medical and functional constellation rather than cognitive impairment specifically can be an obstacle for long-term OAC.

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Stable Serum Potassium After Intracerebral Hemorrhage Is Predictive of Primary Aldosteronism

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.607 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A298-A299

Author(s):

Makoto Arai ◽

Katsunari Kiko ◽

Shigeru Oya

Keyword(s):

Intracerebral Hemorrhage ◽

Serum Potassium ◽

Primary Aldosteronism ◽

Functional Independence Measure ◽

Plasma Renin ◽

Functional Independence ◽

Screening Tests ◽

Negative Group ◽

Plasma Aldosterone Concentration ◽

Positive Group

Abstract Background: Primary aldosteronism (PA) is a well-known risk factor for cardiovascular complications including intracerebral hemorrhage (ICH). Still, there seem to be many PA patients who have been missing the opportunities for the diagnosis of PA even after stroke. PA screening tests in all stroke patients are, however, inefficient. Here we focused on ICH, where hypertension has a great contribution, and searched for the indications of performing PA screening tests in ICH patients. Methods: 1) Out of 181 ICH patients admitted to our hospital between June 2016 and February 2017, 126 patients of hypertensive ICH were enrolled in this study. Plasma aldosterone concentration (PAC), plasma renin activity (PRA) and other hormones were measured in the morning two days after admission. 2) 1,242 hypertensive ICH patients admitted to our hospital after January 2013 were retrospectively reviewed Results: 1) After excluding those who had been taking medications which could intervene with PAC or PRA on admission, nine patients were positive for PA screening (PAC/PRA ratio >200 and PAC >120 pg/mL) and 46 were negative. Age (68.6 vs 67.1 y), sex (male 66.7 vs 67.3 %) and blood pressure (172/97 vs 177/100 mmHg) were similar between these two groups. Serum potassium was slightly lower in positive group on admission (3.6 vs 3.9 mmol/L; P=0.108), and the difference became more evident two days later (3.7 vs 4.0 mmol/L; P=0.042). There were no differences in other hormones including cortisol and catecholamine on day 2. PA positive patients had more severe motor or cognitive impairments (Functional independence measure 58 vs 95; P=0.015). 2) After collecting 25 clinical parameters in 1,242 hypertensive ICH patients, dimension reduction procedure using t-SNE certainly divided these patients into clusters compatible with PA screening tests. Only 4% of PA positive group showed serum potassium lower than 3.5 mmol/L on admission (sensitivity 97%), and the increase in serum potassium during the first 2 days were milder in PA positive group (P=0.001). Discussion: This is the largest study ever that investigated the clinical features of PA in ICH patients. We uncovered that transitional changes of serum potassium after the onset of ICH were efficient markers to decide who should go on to PA screening tests. ICH increases sympathetic activity and subsequent renin secretion, resulting in low serum potassium even in PA negative group. But about two days later, when its activity peaked out, serum potassium in PA negative group restores to their original states while that in PA positive group are stable due to constitutive secretion of aldosterone. Since ICH patients with PA are at higher risk for recurrent hemorrhage and other complications, diagnosis of PA is important even after the occurrence of ICH. PA screening should not be awaited just because they have developed ICH.

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Using Cognitive Screening Tests in Audiology

American Journal of Audiology ◽

10.1044/2016_aja-16-0032 ◽

2016 ◽

Vol 25 (4) ◽

pp. 319-331 ◽

Cited By ~ 11

Author(s):

Jing Shen ◽

Melinda C. Anderson ◽

Kathryn H. Arehart ◽

Pamela E. Souza

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Health Care Professionals ◽

The United States ◽

Medical Intervention ◽

Cognitive Status ◽

Screening Tests ◽

Cognitive Screening

Purpose The population of the United States is aging. Those older adults are living longer than ever and have an increased desire for social participation. As a result, audiologists are likely to see an increased demand for service by older clients whose communication difficulty is caused by a combination of hearing loss and cognitive impairment. For these individuals, early detection of mild cognitive impairment is critical for providing timely medical intervention and social support. Method This tutorial provides information about cognition of older adults, mild cognitive impairment, and cognitive screening tests, with the purpose of assisting audiologists in identifying and appropriately referring potential cases of cognitive impairment. Results Topics addressed also include how to administer cognitive screening tests on individuals with hearing loss, how to use test results in audiology practice, and the potential of using cognitive screening tests for evaluating the benefit of clinical interventions. Conclusions As health care professionals who serve the aging population, audiologists are likely to encounter cases of undiagnosed cognitive impairment. In order to provide timely referral for medical assistance as well as an optimized individual outcome of audiologic interventions, audiologists should be trained to recognize an abnormality in older clients' cognitive status.

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Linkage between H. pylori Infection and TNF-α polymorphism in The Pregnant Women

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1298 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Ghaidaa Raheem Lateef ◽

Azhar Omaran Al-Thahab

Keyword(s):

Pregnant Women ◽

Serum Antibody ◽

Rapid Test ◽

Negative Group ◽

Positive Group ◽

Gynecology And Obstetrics ◽

Tnf Α ◽

Significant Difference ◽

Pcr Products ◽

H Pylori

A study was performed on 100 pregnant women in the outpatient department of gynecology and obstetrics of Maternity and Children Hospital in Al-Diwaniya City during the period between (March to September 2016). One hundred blood samples (50 for patients and 50 for control) were collected under the supervision of the treating gynecologist. The detection of Helicobacter. pylori was done by the use of the serum antibody Rapid test. The results showed that 50 (100%) were positive and 50 (100%) were negative for H. pylori in above method.All blood of patients and control samples were used for the extraction of genomic DNA,where the 107 bp PCR product size. Genotyping of the TNF-α-308 SNP (G/A)was performed by restriction fragment length polymorphism PCR (RFLP-PCR). PCR products were digested with restr NcoI iction enzyme. Individuals with the TNF-α-308(GG) homozygote produced digested DNA bands at 80,and 20 bp bp. A heterozygous genotype ofTNF-α-308 (GA)produced 107 bp,80 bp,and 20 bp bands. Individuals with the TNF-α-308 (AA) homozygote genotype had no amplicon digested and generated only one band of 107 bp. There was a significant difference in the frequency of the TNF-α-308(GG)genotype between H. pylori positive group and H. pylori negative group(72%,78% respectively). Also for GA genotype,there was a significant difference between H. pylori positive group and H. pylori negative group(24%,18% respectively). Concerning the frequency of the TNF-α-308 (AA)genotype between H. pylori positive group and H. pylori negative group,there was no significant difference between the two groups.

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Association of Cognitive Function Screening Results with Adherence and Performance in a Pedometer-Based Intervention

American Journal of Nephrology ◽

10.1159/000516130 ◽

2021 ◽

pp. 1-9

Author(s):

Anoop Sheshadri ◽

Piyawan Kittiskulnam ◽

Cynthia Delgado ◽

Rebecca L. Sudore ◽

Jennifer C. Lai ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Physical Performance ◽

Mixed Model ◽

Linear Mixed Model ◽

Controlled Trial ◽

Cognitive Status ◽

Dialysis Patients ◽

Exercise Interventions ◽

And Performance

Introduction: A randomized, controlled trial of a pedometer-based walking intervention with weekly activity goals led to increased walking among dialysis patients. We examined whether impairment per cognitive function screening is associated with adherence and performance in the intervention. Methods: Thirty dialysis patients were randomly assigned to a 3-month pedometer-based intervention with weekly goals. Participants were administered the Telephone Interview of Cognitive Status (TICS), a test of global mental status. We examined the association of levels of impairment on the TICS (≥33: unimpaired, 26–32: ambiguous impairment, 21–25: mild cognitive impairment [MCI]) with adherence, achieving weekly goals, and increasing steps, physical performance (Short Physical Performance Battery, SPPB), and self-reported physical function (PF) through multivariable linear mixed-model and logistic regression analyses adjusted for age, sex, BMI, dialysis modality, baseline steps, baseline SPPB, and stroke status. Results: One-third of participants were unimpaired, and 13% had MCI. Participants with worse results on cognitive function screening missed more calls and completed fewer weekly goals than participants with better results. During the intervention, a worse result on cognitive function screening was associated with smaller increases in steps compared to those without impairment: (ambiguous: −620 [95% CI −174, −1,415], MCI: −1,653 [95% CI −120, −3,187]); less improvement in SPPB (ambiguous: −0.22 points [95% CI −0.08, −0.44], MCI: −0.45 [95% CI −0.13, −0.77]); and less improvement in PF (ambiguous: −4.0 points [95% CI −12.2, 4.1], MCI: −14.0 [95% CI −24.9, −3.1]). During the postintervention period, a worse result on cognitive function screening was associated with smaller increases in SPPB (ambiguous: −0.54 [95% CI −1.27, 0.19], MCI: −0.97 [95% CI −0.37, −1.58]) and PF (ambiguous: −3.3 [95% CI −6.5, −0.04], MCI: −10.5 [95% CI −18.7, −2.3]). Discussion/Conclusion: Participants with worse results on cognitive function screening had worse adherence and derived less benefit from this pedometer-based intervention. Future exercise interventions should be developed incorporating methods to address cognitive impairment, for example, by including caregivers when planning such interventions.

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Potential application of dynamic contrast enhanced ultrasound in predicting microvascular invasion of hepatocellular carcinoma

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-201085 ◽

2021 ◽

pp. 1-9

Author(s):

Yi Dong ◽

Yijie Qiu ◽

Daohui Yang ◽

Lingyun Yu ◽

Dan Zuo ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Area Under The Curve ◽

Microvascular Invasion ◽

Contrast Enhanced Ultrasound ◽

Negative Group ◽

Clinical Value ◽

Positive Group ◽

Quantitative Perfusion ◽

Dynamic Contrast Enhanced ◽

Contrast Enhanced

OBJECTIVE: To investigate the clinical value of dynamic contrast enhanced ultrasound (D-CEUS) in predicting the microvascular invasion (MVI) of hepatocellular carcinoma (HCC). PATIENTS AND METHODS: In this retrospective study, 16 patients with surgery and histopathologically proved HCC lesions were included. Patients were classified according to the presence of MVI: MVI positive group (n = 6) and MVI negative group (n = 10). Contrast enhanced ultrasound (CEUS) examinations were performed within a week before surgery. Dynamic analysis was performed by VueBox ® software (Bracco, Italy). Three regions of interests (ROIs) were set in the center of HCC lesions, at the margin of HCC lesions and in the surrounding liver parenchyma accordingly. Time intensity curves (TICs) were generated and quantitative perfusion parameters including WiR (wash-in rate), WoR (wash-out rate), WiAUC (wash-in area under the curve), WoAUC (wash-out area under the curve) and WiPi (wash-in perfusion index) were obtained and analyzed. RESULTS: All of HCC lesions showed arterial hyperenhancement (100 %) and at the late phase as hypoenhancement (75 %) in CEUS. Among all CEUS quantitative parameters, the WiAUC and WoAUC were higher in MVI positive group than in MVI negative group in the center HCC lesions (P < 0.05), WiAUC, WoAUC and WiPI were higher in MVI positive group than in MVI negative group at the margin of HCC lesions. WiR and WoR were significant higher in MVI positive group. CONCLUSIONS: D-CEUS with quantitative perfusion analysis has potential clinical value in predicting the existence of MVI in HCC lesions.

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