Is hospitalization a risk factor for cognitive decline in older age adults?

ABSTRACT Objectives: Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD). Methods: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen’s d = −0.25, 95% CI [−0.02, −0.49] I2 35%). Conclusions: There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.

Download Full-text

Prevalence of Cognitive Impairment and Dementia in Older Adults Living at High Altitude: A Systematic Review and Meta-Analysis

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000514471 ◽

2021 ◽

pp. 1-11

Author(s):

Diego Urrunaga-Pastor ◽

Diego Chambergo-Michilot ◽

Fernando M. Runzer-Colmenares ◽

Josmel Pacheco-Mendoza ◽

Vicente A. Benites-Zapata

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

High Altitude ◽

Web Of Science ◽

Meta Analysis ◽

Cross Sectional ◽

Language Restriction ◽

Newcastle Ottawa Scale ◽

Meta Analyses ◽

Ottawa Scale

Introduction: Dementia is a chronic disease with a variable prevalence throughout the world; however, this could be higher at high-altitude populations. We aimed to summarize the prevalence of cognitive impairment and dementia in older adults living at high altitude. Methods: We searched in PubMed, Medline, Scopus, Web of Science, and Embase and included the studies published from inception to July 20, 2020, with no language restriction, which reported the frequency of cognitive impairment or dementia in older adults living at high-altitude populations. Random-effects meta-analyses were performed to calculate the overall prevalence and 95% confidence intervals (95% CI) of cognitive impairment and dementia. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Results: Six studies were included (3,724 participants), and 5 of the 6 included studies were carried out in Latin America. The altitude ranged from 1,783 to 3,847 m, the proportion of women included varied from 38.7 to 65.6%, and the proportion of participants with elementary or illiterate educational level ranged from 71.7 to 97.6%. The overall prevalence of cognitive impairment was 22.0% (95% CI: 8–40, I2: 99%), and the overall prevalence of dementia was 11.0% (95% CI: 6–17, I2: 92%). In a subgroup analysis according to the instrument used to evaluate cognitive impairment, the prevalence of cognitive impairment was 21.0% (95% CI: 5–42, I2: 99%) in the MMSE group while the prevalence was 29.0% (95% CI: 0–78) in the non-MMSE group. Conclusions: The prevalence of cognitive impairment and dementia in older adults living at high altitude is almost twice the number reported in some world regions.

Download Full-text

Genetic Polymorphisms and the Risk of Diabetic Foot: A Systematic Review and Meta-Analyses

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620977599 ◽

2020 ◽

pp. 153473462097759

Author(s):

Jun Zhao ◽

Le-Xuan Zhang ◽

Yu-Ting Wang ◽

Yang Li ◽

Hong-Lin Chen, MD

Keyword(s):

Genetic Polymorphisms ◽

Diabetic Foot ◽

Protective Factor ◽

Meta Analysis ◽

Nucleotide Polymorphisms ◽

Asian Populations ◽

Tnf Α ◽

Newcastle Ottawa Scale ◽

Meta Analyses ◽

Relationship Of

Background Diabetic foot (DF) is a dangerous complication of diabetes. The aim of the study was to synthesize all the published single nucleotide polymorphisms (SNPs) of DF to objectively evaluate the relationship of SNPs and DF risks. Methods The HuGE database and CNKI were searched for eligible publications on genetic polymorphisms and the risk of DF systematically. The quality of literatures was evaluated by the Newcastle-Ottawa scale. Pooled odds ratios with a 95% confidence interval for SNPs were evaluated through 3 genetic models. Results Citing 29 different polymorphisms from 24 articles and the study met our selection criteria. There were 24 polymorphisms summarized systematically, and 5 merged polymorphisms for a meta-analysis: 9 positively associated with DF: HIF-1α rs11549465, TNF-α rs1800629, TLR-9 rs5743836, FIB rs6056, HSP70-2437C/T, VDR rs2228570, LOX rs1800449, ITLN1 rs2274907, and OPG rs2073617, but OPG rs3134069 was not a risk factor in DF; 6 negatively associated with DF: VEGF rs833061 and rs2010963, MCP-1 rs1024611, SDF-1 rs1801157, SIRT1 rs12778366, and OPG rs2073617. In addition, 13 polymorphisms were not associated with DF: MMP-9 rs3918242, eNOS rs1799983, VEGF rs3025039, -7C/T, rs1570360, rs13207351, and rs699947, IL-6 rs1800795, HIF-1α rs11549467, TNF-α rs361525, TLR-2 rs3804100, SIRT1 rs3758391, and TIMP-1 rs2070584. Conclusions The study provided some evidence for SNPs to the development of diabetic foot. The meta-analysis showed that rs1024611 of MCP-1 may be regarded as a protective factor, especially in Asian populations. Other loci indicated inconsistent results.

Download Full-text

Clinical outcomes of cancer patients with COVID-19: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18600 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18600-e18600

Author(s):

Maryam Alasfour ◽

Salman Alawadi ◽

Malak AlMojel ◽

Philippos Apolinario Costa ◽

Priscila Barreto Coelho ◽

...

Keyword(s):

Mortality Rate ◽

Cancer Patients ◽

Clinical Outcomes ◽

Meta Analysis ◽

Small Sample ◽

Prediction Intervals ◽

Invasive Ventilation ◽

Newcastle Ottawa Scale ◽

Small Sample Sizes ◽

Meta Analyses

e18600 Background: Patients with coronavirus disease 2019 (COVID-19) and cancer have worse clinical outcomes compared to those without cancer. Primary studies have examined this population, but most had small sample sizes and conflicting results. Prior meta-analyses exclude most US and European data or only examine mortality. The present meta-analysis evaluates the prevalence of several clinical outcomes in cancer patients with COVID-19, including new emerging data from Europe and the US. Methods: A systematic search of PubMED, medRxiv, JMIR and Embase by two independent investigators included peer-reviewed papers and preprints up to July 8, 2020. The primary outcome was mortality. Other outcomes were ICU and non-ICU admission, mild, moderate and severe complications, ARDS, invasive ventilation, stable, and clinically improved rates. Study quality was assessed through the Newcastle–Ottawa scale. Random effects model was used to derive prevalence rates, their 95% confidence intervals (CI) and 95% prediction intervals (PI). Results: Thirty-four studies (N = 4,371) were included in the analysis. The mortality prevalence rate was 25.2% (95% CI: 21.1–29.7; 95% PI: 9.8-51.1; I 2 = 85.4), with 11.9% ICU admissions (95% CI: 9.2-15.4; 95% PI: 4.3-28.9; I 2= 77.8) and 25.2% clinically stable (95% CI: 21.1-29.7; 95% PI: 9.8-51.1; I 2 = 85.4). Furthermore, 42.5% developed severe complications (95% CI: 30.4-55.7; 95% PI: 8.2-85.9; I 2 = 94.3), with 22.7% developing ARDS (95% CI: 15.4-32.2; 95% PI: 5.8-58.6; I 2 = 82.4), and 11.3% needing invasive ventilation (95% CI: 6.7-18.4; 95% PI: 2.3-41.1; I 2 = 79.8). Post-follow up, 49% clinically improved (95% CI: 35.6-62.6; 95% PI: 9.8-89.4; I 2 = 92.5). All outcomes had large I 2 , suggesting high levels of heterogeneity among studies, and wide PIs indicating high variability within outcomes. Despite this variability, the mortality rate in cancer patients with COVID-19, even at the lower end of the PI (9.8%), is higher than the 2% mortality rate of the non-cancer with COVID-19 population, but not as high as what other meta-analyses conclude, which is around 25%. Conclusions: Patients with cancer who develop COVID-19 have a higher probability of mortality compared to the general population with COVID-19, but possibly not as high as previous studies have shown. A large proportion of them developed severe complications, but a larger proportion recovered. Prevalence of mortality and other outcomes published in prior meta-analyses did not report prediction intervals, which compromises the clinical utilization of such results.

Download Full-text

Long-Term Cognitive Decline After Stroke: An Individual Participant Data Meta-Analysis

Stroke ◽

10.1161/strokeaha.121.035796 ◽

2021 ◽

Author(s):

Jessica W. Lo ◽

John D. Crawford ◽

David W. Desmond ◽

Hee-Joon Bae ◽

Jae-Sung Lim ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Function ◽

Cognitive Decline ◽

Recurrent Stroke ◽

Meta Analysis ◽

Older Age ◽

Individual Participant Data ◽

Individual Participant ◽

Global Cognition

Background and Purpose: Poststroke cognitive impairment is common, but the trajectory and magnitude of cognitive decline after stroke is unclear. We examined the course and determinants of cognitive change after stroke using individual participant data from the Stroke and Cognition Consortium. Methods: Nine longitudinal hospital-based cohorts from 7 countries were included. Neuropsychological test scores and normative data were used to calculate standardized scores for global cognition and 5 cognitive domains. One-step individual participant data meta-analysis was used to examine the rate of change in cognitive function and risk factors for cognitive decline after stroke. Stroke-free controls were included to examine rate differences. Based on the literature and our own data that showed short-term improvement in cognitive function after stroke, key analyses were restricted to the period beginning 1-year poststroke to focus on its long-term effects. Results: A total of 1488 patients (mean age, 66.3 years; SD, 11.1; 98% ischemic stroke) were followed for a median of 2.68 years (25th–75th percentile: 1.21–4.14 years). After an initial period of improvement through up to 1-year poststroke, decline was seen in global cognition and all domains except executive function after adjusting for age, sex, education, vascular risk factors, and stroke characteristics (−0.053 SD/year [95% CI, −0.073 to −0.033]; P <0.001 for global cognition). Recurrent stroke and older age were associated with faster decline. Decline was significantly faster in patients with stroke compared with controls (difference=−0.078 SD/year [95% CI, −0.11 to −0.045]; P <0.001 for global cognition in a subgroup analysis). Conclusions: Patients with stroke experience cognitive decline that is faster than that of stroke-free controls from 1 to 3 years after onset. An increased rate of decline is associated with older age and recurrent stroke.

Download Full-text

The effectiveness of serious games in improving memory among elderly people with cognitive impairment: A systematic review and meta-analysis (Preprint)

10.2196/preprints.35202 ◽

2021 ◽

Author(s):

Alaa Abd-alrazaq ◽

Dari Alhuwail ◽

Eiman Al-Jafar ◽

Arfan Ahmed ◽

Shuja Mohd Reagu ◽

...

Keyword(s):

Systematic Review ◽

Working Memory ◽

Cognitive Impairment ◽

Verbal Memory ◽

Serious Games ◽

Meta Analysis ◽

The Elderly ◽

Quality Of Evidence ◽

Meta Analyses

BACKGROUND Memory, one of the main cognitive functions, is known to decline by age. Serious games have been used for improving memory among the elderly. The effectiveness of serious games in improving memory has been investigated by several systematic reviews; however, they are limited by design and methodological weaknesses. OBJECTIVE This study aims to assess the effectiveness of serious games in improving memory among the elderly with cognitive impairment. METHODS A systematic review of randomized controlled trials (RCTs) was carried out. The search sources included searching 8 databases, screening reference lists of the included studies and relevant reviews, and checking studies that cited the included studies. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Extracted data were synthesized using a narrative approach and a statistical approach (i.e., meta-analysis), as appropriate. RESULTS Out of 466 citations retrieved, 18 studies met the eligibility criteria of this review. Of those, 15 RCTs were eventually included in 10 meta-analyses. We found that serious games are more effective than no or passive interventions in improving non-verbal memory (P=0.002) and working memory (P=0.02), but not verbal memory (P=0.13). The review also showed that serious games are more effective than conventional exercises in improving verbal memory (P=0.004), but not for non-verbal memory (P=0.12) and working memory (P=0.49). Serious games were as effective as conventional cognitive activities in improving verbal memory (P=0.07), non-verbal memory (P=0.94), and working memory (P=0.08) among the elderly with cognitive impairment. Lastly, the effect of adaptive serious games on working memory was comparable to non-adaptive serious games (P=0.08). CONCLUSIONS Serious games have the potential to improve verbal, non-verbal, and working memory among elderly people with cognitive impairment. However, our findings should be interpreted cautiously given that most meta-analyses were based on a few studies (≤3) and judged to have a low quality of evidence. Therefore, serious games should be offered as supplemental to existing proven and safe interventions, rather than a complete substitute until further, more robust evidence is available. Future studies should investigate the short and long-term effects of serious games on memory and other cognitive abilities among people from different age groups with or without cognitive impairment.

Download Full-text

The Student Risk Screening Scale: A Reliability and Validity Generalization Meta-Analysis

Journal of Emotional and Behavioral Disorders ◽

10.1177/1063426617710207 ◽

2017 ◽

Vol 26 (3) ◽

pp. 143-155 ◽

Cited By ~ 3

Author(s):

Stephen P. Kilgus ◽

Katie Eklund ◽

Daniel M. Maggin ◽

Crystal N. Taylor ◽

Amanda N. Allen

Keyword(s):

Internal Consistency ◽

Externalizing Behavior ◽

Meta Analysis ◽

Reliability And Validity ◽

Future Research ◽

Risk Screening ◽

Validity Generalization ◽

Meta Analyses ◽

Student Risk ◽

Screening Scale

The purpose of this study was to conduct reliability and validity generalization meta-analyses of evidence regarding the Student Risk Screening Scale (SRSS), a universal screener for externalizing behavior problems. A systematic review of the literature resulted in the identification of 17 studies inclusive of evidence regarding SRSS score (a) internal consistency reliability (i.e., alpha coefficients), and/or (b) criterion-related validity (e.g., correlations between the SRSS and various outcomes). Multilevel meta-analyses indicated that across studies, SRSS scores were associated with adequate internal consistency (α = .83). Analyses further suggested the SRSS was a valid indicator of both social and behavioral outcomes ( r = .52) and academic outcomes ( r = .42). Follow-up analyses suggested that in accordance with theory-driven expectations, the SRSS was a stronger indicator of externalizing problems and broad behavior outcomes relative to alternative outcomes (e.g., internalizing problems). Limitations and directions for future research are discussed, including recommendations for the collection of additional SRSS diagnostic accuracy evidence.

Download Full-text

Comparing Bayesian Posterior Passing with Meta-analysis

10.31234/osf.io/ke9wn ◽

2020 ◽

Author(s):

Joshua Pritsker

Keyword(s):

Publication Bias ◽

Fixed Effects ◽

Meta Analysis ◽

Future Research ◽

Meta Analyses

Brand, von der Post, Ounsley, and Morgan (2019) introduced Bayesian posterior passing as an alternative to traditional meta-analyses. In this commentary I relate their procedure to traditional meta-analysis, showing that posterior passing is equivalent to fixed effects meta-analysis. To overcome the limitations of simple posterior passing, I introduce improved posterior passing methods to account for heterogeneity and publication bias. Additionally, practical limitations of posterior passing and the role that it can play in future research are discussed.

Download Full-text

Obsessive healthy eating and orthorexic eating tendencies in sport and exercise contexts: A systematic review and meta-analysis

Journal of Behavioral Addictions ◽

10.1556/2006.2021.00004 ◽

2021 ◽

Author(s):

Jana Strahler ◽

Hanna Wachten ◽

Anett Mueller-Alcazar

Keyword(s):

Systematic Review ◽

Gender Differences ◽

Healthy Eating ◽

Meta Analysis ◽

Group Analysis ◽

Future Research ◽

Exercise Behaviors ◽

Sport And Exercise ◽

Underlying Mechanisms ◽

Meta Analyses

AbstractBackgroundOrthorexia Nervosa (ON) and exercise addiction (ExAdd) are two phenomena believed to overlap. We conducted a meta-analysis exploring the link between ON and (addictive) exercise behaviors.MethodsA systematic review of major databases and gray literature was carried out for studies reporting on ON and (addictive) exercise behaviors. Random effects meta-analyses were undertaken calculating correlations between ON and (addictive) exercise behaviors. A sub-group analysis investigated gender differences.ResultsTwenty-five studies with 10,134 participants (mean age = 25.21; 56.4% female) were included. Analyses showed a small overall correlation between ON and exercise (21 studies, r = 0.12, 95% CI |0.06–0.18|) and a medium overall correlation between ON and ExAdd (7 studies, r = 0.29, 95% CI |0.13–0.45|). Gender differences were negligible.ConclusionsOrthorexic eating correlated slightly and moderately with exercise and ExAdd, respectively, expressing some unique and shared variance of these behaviors. While this does not suggest ON and addictive exercising to be independent, it does not indicate substantial comorbidity. Future research should focus on clinical relevance, underlying mechanisms, vulnerability, and risk factors.

Download Full-text

Internet Use and Psychological Well-Being

Encyclopedia of Cyber Behavior ◽

10.4018/978-1-4666-0315-8.ch026 ◽

2012 ◽

pp. 302-314 ◽

Cited By ~ 3

Author(s):

Chiungjung Huang

Keyword(s):

Social Networking ◽

Social Networking Sites ◽

Internet Use ◽

Meta Analysis ◽

Well Being ◽

Social Networking Site ◽

Future Research ◽

Psychological Well Being ◽

Site Use ◽

Meta Analyses

The direction of the correlation between Internet use and psychological well-being is debatable. The displacement hypothesis indicates the correlation is negative, as Internet use for communication replaces face-to face-interaction. Conversely, the augmentation hypothesis suggests that the correlation is positive because Internet use for communication complements existing social interaction. While previous empirical findings about the relationship between Internet use and psychological well-being have been diverse, two previous meta-analyses and the present meta-analysis about the use of social networking sites and psychological well-being supported neither position, and found no relationship between Internet use and psychological well-being. Investigation of causal predominance between Internet use and psychological well-being, increased attention to measurement problems of social networking site use and older adults, and consideration of effects of indicators and moderators should be addressed in future research.

Download Full-text

Dry Eye Disease and Tear Cytokine Levels—A Meta-Analysis

International Journal of Molecular Sciences ◽

10.3390/ijms21093111 ◽

2020 ◽

Vol 21 (9) ◽

pp. 3111 ◽

Cited By ~ 3

Author(s):

Matilde Roda ◽

Ivan Corazza ◽

Maria Letizia Bacchi Reggiani ◽

Marco Pellegrini ◽

Leonardo Taroni ◽

...

Keyword(s):

Dry Eye ◽

Meta Analysis ◽

Interferon Γ ◽

Dry Eye Disease ◽

Eye Disease ◽

Model Study ◽

Newcastle Ottawa Scale ◽

Mean Differences ◽

Meta Analyses ◽

Factor Α

Background—It is recognized that inflammation is an underlying cause of dry eye disease (DED), with cytokine release involved. We systematically reviewed literature with meta-analyses to quantitatively summarize the levels of tear cytokines in DED. Methods—The PubMed, Embase, Web of Science, Ovid, Cochrane, and Scopus databases were reviewed until September 2019, and original articles investigating tear cytokines in DED patients were included. Differences of cytokines levels of DED patients and controls were summarized by standardized mean differences (SMD) using a random effects model. Study quality was assessed by applying Newcastle-Ottawa-Scale and the GRADE quality score. Methods of analytical procedures were included as covariate. Results—Thirteen articles investigating 342 DED patients and 205 healthy controls were included in the meta-analysis. The overall methodological quality of these studies was moderate. Systematic review of the selected articles revealed that DED patients had higher tear levels of interleukin (IL)-1β, IL-6, chemokine IL-8, IL-10, interferon-γ, IFN-γ, and tumor necrosis factor-α, TNF-α as compared to controls. Evidence was less strong for IL-2 and IL-17A. Conclusions—Data show that levels of tear cytokines in DED and control display a great variability, and further studies of higher quality enrolling a higher number of subjects are needed, to define a cut-off value.

Download Full-text