A Neurologist's Practical Approach to Cognitive Impairment

2021 ◽  
Vol 41 (06) ◽  
pp. 686-698
Author(s):  
Philip W. Tipton ◽  
Gregory S. Day ◽  
Neill Graff-Radford
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Public Awareness ◽  
Practical Approach ◽  
Rapid Progression ◽  
Algorithmic Approach ◽  
Global Prevalence ◽  
Health Care Crisis ◽  
Motor Abnormalities ◽  
General Concern

AbstractThe global prevalence of dementia is expected to triple by the year 2050. This impending health care crisis has led to new heights of public awareness and general concern regarding cognitive impairment. Subsequently, clinicians are seeing more and more people presenting with cognitive concerns. It is important that clinicians meet these concerns with a strategy promoting accurate diagnoses. We have diagramed and described a practical approach to cognitive impairment. Through an algorithmic approach, we determine the presence and severity of cognitive impairment, systematically evaluate domains of function, and use this information to determine the next steps in evaluation. We also discuss how to proceed when cognitive impairment is associated with motor abnormalities or rapid progression.

scholarly journals Telemedicine Algorithm for the Management of Dizzy Patients

2020 ◽  
Vol 163 (5) ◽  
pp. 857-859
Author(s):  
Divya A. Chari ◽  
Matthew J. Wu ◽  
Matthew G. Crowson ◽  
Elliott D. Kozin ◽  
Steven D. Rauch
Keyword(s):  
Public Health ◽  
Health Care ◽  
Best Practices ◽  
Physical Examination ◽  
Practical Approach ◽  
Algorithmic Approach ◽  
Health Concerns ◽  
Near Term ◽  
Dizzy Patient ◽  
Acute Crisis

As a result of the COVID-19 pandemic, telemedicine has been thrust to the forefront of health care. Despite its inherent limitations, telemedicine offers many advantages to both patient and physician as an alternative to in-person evaluation of select patients. In the near term, telemedicine allows nonpandemic care to proceed while observing appropriate public health concerns to minimize the spread of pandemic pathogens. Thus, it behooves practitioners to use telemedicine consultations for common otolaryngology complaints. Assessment of the dizzy patient is well-suited to an algorithmic approach that can be adapted to a telemedicine setting. As best practices for telemedicine have yet to be defined, we present herein a practical approach to the history and limited physical examination of the dizzy patient in the telemedicine setting for the general otolaryngologist. Indeed, once the acute crisis has abated, we suspect that this approach will continue to be an effective way to manage dizzy patients.

scholarly journals Temporal trajectory of biofluid markers in Parkinson’s disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Seok Baek ◽  
Myung Jun Lee ◽  
Han-Kyeol Kim ◽  
Chul Hyoung Lyoo
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Amyloid Β ◽  
Rapid Progression ◽  
Neurofilament Light Chain ◽  
Neurofilament Light ◽  
Using Data ◽  
Negative Exponential ◽  
T Tau

AbstractFull dynamics of biofluid biomarkers have been unknown in patients with Parkinson’s disease (PD). Using data from 396 PD patients and 182 controls in the Parkinson's Progression Markers Initiative (PPMI) database, we estimated long-term temporal trajectories of CSF α-synuclein (α-syn), amyloid-β (Aβ), total tau (t-tau), phosphorylated tau (p-tau) and serum neurofilament light chain (NfL) by integrating function between the baseline levels and annual changes. At baseline, PD patients showed lower CSF α-syn, Aβ, t-tau and p-tau levels than those of the controls. In all PD patients, CSF α-syn and Aβ decreased in a negative exponential pattern before the onset of motor symptoms, whereas CSF t-tau and p-tau, and serum NfL increased. Patients with cognitive impairment exhibited faster decline of Aβ and α-syn and faster rise of t-tau, p-tau and NfL, when compared to those without. Similarly, low Aβ group showed earlier decline of α-syn, faster rise of t-tau, p-tau and NfL, and faster decline of cognitive performances, when compared to high Aβ group. Our results suggest that longitudinal changes in biomarkers can be influenced by cognitive impairment and Aβ burden at baseline. PD patients with Aβ pathology may be associated with early appearance of α-synuclein pathology, rapid progression of axonal degeneration and neurodegeneration, and consequently greater cognitive decline.

scholarly journals An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Morenike Oluwatoyin Folayan ◽  
◽  
Maha El Tantawi ◽  
Jorma I. Virtanen ◽  
Carlos Alberto Feldens ◽  
...  
Keyword(s):  
Health Care ◽  
Early Childhood ◽  
Linear Regression ◽  
Health Expenditure ◽  
Early Childhood Caries ◽  
Global Prevalence ◽  
Independent Variable ◽  
Service Coverage ◽  
Universal Health ◽  
Childhood Caries

Abstract Background Universal health care (UHC) may assist families whose children are most prone to early childhood caries (ECC) in accessing dental treatment and prevention. The purpose of this study was to determine the association between UHC, health expenditure and the global prevalence of ECC. Methods Health expenditure as percentage of gross domestic product, UHC service coverage index, and the percentage of 3–5-year-old children with ECC were compared among countries with various income levels using one-way analysis of variance (ANOVA). Three linear regression models were developed, and each was adjusted for the country income level with the prevalence of ECC in 3–5-year-old children being the dependent variable. In model 1, UHC service coverage index was the independent variable whereas in model 2, the independent variable was the health expenditure as percentage of GDP. Model 3 included both independent variables together. Regression coefficients (B), 95% confidence intervals (CIs), P values, and partial eta squared (ƞ2) as measure of effect size were calculated. Results Linear regression including both independent factors revealed that health expenditure as percentage of GDP (P < 0.0001) was significantly associated with the percentage of ECC in 3–5-year-old children while UHC service coverage index was not significantly associated with the prevalence of ECC (P = 0.05). Every 1% increase in GDP allocated to health expenditure was associated with a 3.7% lower percentage of children with ECC (B = − 3.71, 95% CI: − 5.51, − 1.91). UHC service coverage index was not associated with the percentage of children with ECC (B = 0.61, 95% CI: − 0.01, 1.23). The impact of health expenditure on the prevalence of ECC was stronger than that of UHC coverage on the prevalence of ECC (ƞ2 = 0.18 vs. 0.05). Conclusions Higher expenditure on health care may be associated with lower prevalence of ECC and may be a more viable approach to reducing early childhood oral health disparities than UHC alone. The findings suggest that currently, UHC is weakly associated with lower global prevalence of ECC.

scholarly journals Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study

Geriatrics ◽  
2021 ◽  
Vol 6 (3) ◽  
pp. 63
Author(s):  
Silvia Mejia-Arango ◽  
Jaqueline Avila ◽  
Brian Downer ◽  
Marc A. Garcia ◽  
Alejandra Michaels-Obregon ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cognitive Impairment ◽  
Cardiovascular Diseases ◽  
Educational Attainment ◽  
Access To Health Care ◽  
Sociodemographic Factors ◽  
Cognitive Status ◽  
Access To Health ◽  
Mexican Adults

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

scholarly journals Reply: Liver transplantation costs in the era of a health care crisis

2010 ◽  
Vol 16 (4) ◽  
pp. 535-535
Author(s):  
Paula M. Buchanan ◽  
Nino Dzebisashvili ◽  
Krista L. Lentine ◽  
David A. Axelrod ◽  
Mark A. Schnitzler ◽  
...  
Keyword(s):  
Health Care ◽  
Liver Transplantation ◽  
Health Care Crisis

Patient Power: Solving America's Health Care Crisis

1993 ◽  
Vol 60 (2) ◽  
pp. 523
Author(s):  
Dwight R. Lee ◽  
John C. Goodman ◽  
Gerald L. Musgrave
Keyword(s):  
Health Care ◽  
Health Care Crisis
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