Differential associations between sensory loss and neuropsychiatric symptoms in adults with and without a neurocognitive disorder

ABSTRACTBackground:To investigate the differential associations between sensory loss and neuropsychiatric symptoms among older adults with and without diagnosed neurocognitive disorder.Methods:The sample comprised 1,393 adults (52.3% men) aged between 72 and 79 years from a community-based cohort study. There were 213 cases of mild and 64 cases of major neurocognitive disorders. The main outcome was number of informant reported symptoms on the Neuropsychiatric Inventory (NPI). Sensory loss was defined by visual acuity worse the 0.3 logMAR (6/12 or 20/40) and self-reported hearing problems.Results:Clinically relevant NPI symptoms were reported in 182 (13.1%) participants, but no individual symptom occurred in more than 5% of the total sample. Among participants diagnosed with a major neurocognitive disorder, those with any sensory loss had over three times (95%CI: 1.72–11.78) greater rates of NPI symptoms than those with unimpaired levels of sensory functioning. There were no differences in the number of neuropsychiatric symptoms by type of sensory loss, and no additional risk associated with a dual sensory loss compared to a single sensory loss. There was no evidence of an association between sensory loss and number of neuropsychiatric symptoms among cognitively healthy adults.Conclusions:The extent to which this association is the result of underlying neuropathology, unmet need, or interpersonal factors is unclear. These findings have significant implications for dementia care settings, including hospitals and respite care, as patients with sensory loss are at increased risk of neuropsychiatric symptoms and may require additional psychosocial support. Interventions to manage sensory loss and reduce the impact of sensory limitations on neuropsychiatric symptoms are needed.

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302 - The Effectiveness and Safety of Electroconvulsive Therapy for Treatment Refractory Agitation or Aggression in Major Neurocognitive Disorder

International Psychogeriatrics ◽

10.1017/s1041610220002021 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 58-58

Author(s):

Simon Woo ◽

Peter Chan ◽

Robyn E Waxman ◽

Sarah Elmi ◽

Mafalda Musacchio ◽

...

Keyword(s):

Neuropsychiatric Symptoms ◽

Symptom Clusters ◽

Decision Makers ◽

Neurocognitive Disorder ◽

Increased Risk ◽

Valuable Treatment ◽

Psychiatric Conditions ◽

Treatment Refractory ◽

Refractory Symptom ◽

Inpatient Units

Introduction:Fifty to ninety percent of individuals with Major Neurocognitive Disorder (MNCD) have Neuropsychiatric Symptoms (NPS)1. Agitation and aggression are amongst the most persistent and treatment-refractory symptom clusters. Patients with these NPS are associated with increased risk of institutionalization, psychotropic medication use, caregiver burden, and mortality2.Safe and effective treatments for NPS are lacking. Consensus guidelines emphasize the initial use of non-pharmacologic approaches though supportive evidence is limited3.Extensive research has established the safety and efficacy of ECT in elderly patients with depression and other psychiatric conditions6. Clinical experience suggests that ECT is a valuable treatment option in MNCD-related treatment refractory NPS cases7-10. However, data supporting the efficacy and safety of this practice is scant.Materials and Method:Patients admitted to the geriatric psychiatry inpatient units who meet the inclusion criteria, were recruited from 2 Vancouver sites and 3 unit at Ontario Shores. These patients had an anesthesia consultation to evaluate their safety of going through ECT. Consent was obtained from their substitute decision makers. All patients enrolled are already on psychotropic medications.

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Association Between Sensory Loss and Falls Among Middle-Aged and Older Chinese Population: Cross-Sectional and Longitudinal Analyses

Frontiers in Medicine ◽

10.3389/fmed.2021.810159 ◽

2022 ◽

Vol 8 ◽

Author(s):

Yifan Zhou ◽

Yanping Hu ◽

Jianfeng Luo ◽

Yinwen Li ◽

Haiyun Liu ◽

...

Keyword(s):

Chinese Population ◽

Developed Countries ◽

Falls Prevention ◽

Sensory Loss ◽

Time Varying ◽

Middle Aged ◽

Cross Sectional ◽

Dual Sensory Loss ◽

Older Chinese ◽

The Impact

Introduction: Previous studies have suggested that sensory loss is linked to falls. However, most of these studies were cross-sectional designed, focused on single sensory loss, and were conducted in developed countries with mixed results. The current study aims to investigate the longitudinal relationship between hearing loss (HL), vision loss (VL) and dual sensory loss (DSL) with falls among middle-aged and older Chinese population over 7 years.Methods: The data was obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 7,623 Chinese older adults aged over 45 were included at baseline 2011 in this study. Self-reported falls and HL/VL/DSL were accepted. Other confounding variables included age, sex, BMI, educational level, marital status, various physical disorders and lifestyles. The impact of baseline sensory status on baseline prevalence of falls and incident falls over 7 years were assessed using logistic regression analyses. A logistic mixed model was used to assess the association between time-varying sensory loss with incident falls over 7 years after adjusted with multi-confounding factors.Results: Single and dual sensory loss groups had significantly higher prevalence of falls compared to no sensory loss (NSL) group (DSL: 22.4%, HL: 17.4%, VL: 15.7%, NSL: 12.3%). Baseline HL (OR: 1.503, 95% CI: 1.240–1.820), VL (OR: 1.330, 95% CI: 1.075–1.646) and DSL (OR: 2.061, 95% CI: 1.768–2.404) were significantly associated with prevalence of falls. For longitudinal observation over 7 years, baseline HL/DSL and persistence of all types of sensory loss were associated with incidence of falls. Time-varying HL (OR: 1.203, 95% CI: 1.070–1.354) and DSL (OR: 1.479, 95% CI: 1.343–1.629) were associated with incident falls after adjusted with multi-confounders, while VL was not.Conclusion: HL and DSL are significantly associated with both onset and increased incidence of falls over 7 year's observation in middle-aged and elderly Chinese population. Persistence or amelioration of sensory loss status could exert divergent influences on incidence of falls, which should be considered in the development of falls-prevention public health policies for aging population.

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Behind the Scene: Exploiting MC1R in Skin Cancer Risk and Prevention

Genes ◽

10.3390/genes12071093 ◽

2021 ◽

Vol 12 (7) ◽

pp. 1093

Author(s):

Michele Manganelli ◽

Stefania Guida ◽

Anna Ferretta ◽

Giovanni Pellacani ◽

Letizia Porcelli ◽

...

Keyword(s):

Melanocortin 1 Receptor ◽

Additional Risk ◽

Ultraviolet Exposure ◽

Skin Cancers ◽

Increased Risk ◽

Rising Incidence ◽

The Impact ◽

Common Malignancy ◽

Melanoma Skin

Melanoma and non-melanoma skin cancers (NMSCs) are the most frequent cancers of the skin in white populations. An increased risk in the development of skin cancers has been associated with the combination of several environmental factors (i.e., ultraviolet exposure) and genetic background, including melanocortin-1 receptor (MC1R) status. In the last few years, advances in the diagnosis of skin cancers provided a great impact on clinical practice. Despite these advances, NMSCs are still the most common malignancy in humans and melanoma still shows a rising incidence and a poor prognosis when diagnosed at an advanced stage. Efforts are required to underlie the genetic and clinical heterogeneity of melanoma and NMSCs, leading to an optimization of the management of affected patients. The clinical implications of the impact of germline MC1R variants in melanoma and NMSCs’ risk, together with the additional risk conferred by somatic mutations in other peculiar genes, as well as the role of MC1R screening in skin cancers’ prevention will be addressed in the current review.

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Estimating the Risks from COVID-19 Infection in Adult Chemotherapy Patients

10.1101/2020.03.18.20038067 ◽

2020 ◽

Cited By ~ 3

Author(s):

Matt Williams ◽

Kerlann Le Calvez ◽

Ella Mi ◽

Jiarong Chen ◽

Seema Dadhania ◽

...

Keyword(s):

Case Fatality ◽

Related Case ◽

Additional Risk ◽

Risk Of Death ◽

Age Related ◽

Increased Risk ◽

Chemotherapy Patients ◽

Influenza Outbreaks ◽

Rich Countries ◽

The Impact

AbstractThe SARS-CoV-2 (COVID-19) novel corona virus represents a significant health risk, particularly in older patients. Cancer is one of the leading causes of death in most rich countries, and delivering chemotherapy may be associated with increased risk in the presence of a pandemic infection. Estimating this risk is crucial in making decisions about balancing risks and benefits from administering chemotherapy. However, there are no specific data about chemotherapy risks per se. Here we develop a simple model to estimate the potential harms in patients undergoing chemotherapy during a COVID outbreak. We use age-related case fatality rates as a basis for estimating risk, and use previous data from risk of death during influenza outbreaks to estimate the additional risk associated with chemotherapy. We use data from randomised trials to estimate benefit across a range of curative and palliative settings, and address the balance of benefit against the risk of harm. We then use those data to estimate the impact on national chemotherapy delivery patterns.

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401 - The Costs of Agitation: A Literature Review

International Psychogeriatrics ◽

10.1017/s1041610220002549 ◽

2020 ◽

Vol 32 (S1) ◽

pp. 117-117

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Literature Review ◽

Service Use ◽

Neuropsychiatric Symptoms ◽

Unmet Need ◽

Cochrane Library ◽

Future Research ◽

The Cost ◽

The Impact

PRESENTING AUTHOR:Mary Michael, Vice President, Patient Advocacy and Stakeholder Management, Otsuka America Pharmaceutical, Inc.OBJECTIVE:To evaluate the extent to which the cost of both treated and untreated agitation in Alzheimer’s disease has been studied in order to inform future research and development of predictive models of the cost of untreated agitation in Alzheimer’s disease.BACKGROUND:There is inadequate understanding of the costs of agitation in Alzheimer’s disease in the scientific and academic literature. Agitation in Alzheimer’s disease contributes to negative social and financial outcomes for people with the condition, their care partners, and health systems. When left untreated, the impact of these outcomes is exacerbated, yet the scale of this impact is unknown. This gap in the literature both reflects and perpetuates the broader under-recognition of agitation as a serious unmet need in the Alzheimer’s community. Conversely, a better understanding of the costs can help elevate agitation within the global Alzheimer’s dialogue.METHODS:We used MEDLINE, PubMed, PsychINFO the Cochrane Library and Google Scholar databases to identify relevant articles published between 2000 until May 2020. We also reviewed reliable literature published outside of these databases. Keywords utilized in the search include agitation in Alzheimer’s, neuropsychiatric symptoms of Alzheimer’s, cost of informal and formal care, Medicare and Medicaid costs, economic costs associated to delirium, among others. Only articles in English were included. Inclusion and exclusion criteria were determined by study design, data source and population studied, number of cases included in analysis, source of health service use or cost data, statistical methods and agitation in Alzheimer’s attributable and/or incremental costs.RESULTS:Results will describe the breadth and depth to which costs of treated and untreated agitation in Alzheimer’s have been examined, indicating data and statistical methodology used.CONCLUSIONS:This literature review serves as the basis for understanding global costs of agitation in Alzheimer’s disease. From our analysis, we recommend that further cost modeling activities be conducted. We also urge the greater community to use these findings to elevate agitation to the top of the Alzheimer’s agenda.

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Impact of sight and hearing loss in patients with Norrie disease: advantages of Dual Sensory clinics in patient care

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000781 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000781

Author(s):

Jane C Sowden ◽

Corné J Kros ◽

Tony Sirimanna ◽

Waheeda Pagarkar ◽

Ngozi Oluonye ◽

...

Keyword(s):

Hearing Loss ◽

Sensory Loss ◽

Clinical Environment ◽

Norrie Disease ◽

Seizure Disorders ◽

Routine Monitoring ◽

Dual Sensory Loss ◽

Clinical Environments ◽

Neurological Features ◽

The Impact

Norrie disease (ND) is a rare, X-linked condition of visual and auditory impairment, often presenting with additional neurological features and developmental delays of varying severity. While all affected patients are born blind, or lose their vision in infancy, progressive sensorineural hearing loss develops in the majority of cases and is typically detected in the second decade of life. A range of additional symptoms of ND, such as seizure disorders, typically appear from a young age, but it is difficult to predict the range of symptoms ND patients will experience. After growing up without vision, hearing loss represents the greatest worry for many patients with ND, as they may lose the ability to participate in previously enjoyed activities or to communicate with others.Dual sensory loss has a physical, psychosocial and financial impact on both patients with ND and their families. Routine monitoring of the condition is required in order to identify, treat and provide support for emerging health problems, leading to a large burden of medical appointments. Many patients need to travel long distances to meet with specialists, representing a further burden on time and finances. Additionally, the rare nature of dual sensory impairment in children means that few clinical environments are designed to meet their needs. Dual Sensory clinics are multidisciplinary environments designed for sensory-impaired children and have been suggested to alleviate the impact of diseases involving sensory loss such as ND.Here, we discuss the diagnosis, monitoring and management of ND and the impact it has on paediatric patients and their caregivers. We describe the potential for dual sensory clinics to reduce disease burden through providing an appropriate clinical environment, access to multiple clinical experts in one visit, and ease of monitoring for patients with ND.

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The Effect of Mental Health and Psychosocial Support (MHPS)Training on The Public Awareness of New Habitual Adaptations (NHA): A Pilot Research

Jurnal Keperawatan Soedirman ◽

10.20884/1.jks.2021.16.3.1869 ◽

2021 ◽

Vol 16 (3) ◽

Author(s):

Susanti Niman ◽

Habsyah Saparidah Agustina ◽

Sri Wahyuni ◽

Niken Yuniar Sari ◽

Retty Octi Syafrini ◽

...

Keyword(s):

Mental Health ◽

Psychosocial Support ◽

Public Awareness ◽

Health Condition ◽

P Value ◽

Increased Risk ◽

Significant Difference ◽

Before And After ◽

Quasi Experimental ◽

The Impact

Background: The COVID-19 pandemic has a physical impact and on the mental health condition of the community. The existence of psychological distress due to the Covid 19 pandemic will affect the body's physiological conditions, such as reduced immune system responses and increased risk of infection, and the impact on mental health. The COVID-19 pandemic demands a change in people's behavior. Mental health and psychosocial support training is very important for the community so that the community can actively maintain mental and physical health. The research objective is to identify the effect of DKJPS training on awareness of new adaptation readiness. Method: The research was conducted through a quasi-experimental pre-post-test without control on 44 participants in the DKJPS training. Result: there is a significant difference between awareness of adaptation new habits before and after training (p-value 0.001). Conclusion: Mental health and psychosocial support training conducted in the community can increase public awareness of new adaptation habits independently.

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COVD-31. THE STATE OF NEURO-ONCOLOGY DURING THE COVID-19 PANDEMIC: A WORLDWIDE ASSESSMENT

Neuro-Oncology ◽

10.1093/neuonc/noaa215.112 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii27-ii27

Author(s):

Maciej Mrugala ◽

Quinn Ostrom ◽

Shelley Pressley ◽

Alissa Thomas ◽

Jeffrey S Wefel ◽

...

Keyword(s):

Psychosocial Support ◽

Academic Career ◽

Treatment Options ◽

Family Satisfaction ◽

Phase Iii ◽

Institutional Pressure ◽

Use Of Technology ◽

Investigational Treatment ◽

Increased Risk ◽

The Impact

Abstract To assess the impact of the pandemic on the field, we performed an international web-based survey of practitioners, scientists, and trainees from 21 neuro-oncology organizations across 6 continents from April 24 through May 17. Of 582 respondents, 258 (45%) were in the US, and 314 (55%) were international. 80.4% were affiliated with academic institutions. 94% respondents reported changes in clinical practice; 95% reported conversion to telemedicine for at least some appointments. However, almost 10% practitioners felt the need to see patients in person specifically because of billing concerns and perceived institutional pressure. Over 50% believed neuro-oncology patients were at increased risk of contracting COVID-19. 67% practitioners suspended enrollment for at least one clinical trial: 53% suspended phase II and 62% suspended phase III trial enrollment. 71% clinicians feared for their or their families’ safety, specifically because of their clinical duties. 20% percent said they did not have enough PPE to work safely; about the same percentage were unhappy with their institutions’ response to the pandemic. 43% believed the pandemic would negatively affect their academic career, and 52% fellowship program directors were worried about losing funding for their training programs. While 69% respondents reported increased stress, 44% were offered no psychosocial support. 37% had their salary reduced. 36% researchers had to temporarily close their laboratories. In contrast, the pandemic created positive changes in perceived patient and family satisfaction, quality of communication, and use of technology to deliver care and interactions with other practitioners. CONCLUSIONS: The pandemic has altered standard treatment schedules and limited investigational treatment options for patients. In some cases, clinicians felt institutional pressure to continue conducting billable in-person visits when telemedicine visits would have sufficed. A lack of institutional support created anxiety among clinicians and researchers. We make specific recommendations to guide clinical and scientific infrastructure moving forward.

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Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000275 ◽

2017 ◽

Vol 87 (1-2) ◽

pp. 10-16 ◽

Cited By ~ 1

Author(s):

Salah Gariballa ◽

Awad Alessa

Keyword(s):

Nutritional Status ◽

Inductively Coupled Plasma ◽

Older Patients ◽

Controlled Trial ◽

Prognostic Indicators ◽

Hospitalised Patients ◽

Increased Risk ◽

Co Morbidity ◽

The Impact ◽

Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

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Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

VASA ◽

10.1024/0301-1526/a000447 ◽

2015 ◽

Vol 44 (4) ◽

pp. 313-323 ◽

Cited By ~ 6

Author(s):

Lea Weingarz ◽

Marc Schindewolf ◽

Jan Schwonberg ◽

Carola Hecking ◽

Zsuzsanna Wolf ◽

...

Keyword(s):

Factor V Leiden ◽

Cox Proportional Hazards ◽

First Episode ◽

Factor V ◽

Factor V Leiden Mutation ◽

Younger Patients ◽

Risk Of Recurrence ◽

G20210a Mutation ◽

Increased Risk ◽

The Impact

Abstract. Background: Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient’s age at the time of the first VTE. Patients and methods: Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy. Results: Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years. Conclusions: Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

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