Atypical presentation of anti-N-methyl-D-aspartate receptor encephalitis in a 61-year-old Hispanic man

2020 ◽  
Vol 13 (12) ◽  
pp. e238347
Author(s):  
Esme Irvine ◽  
Debra Cheng ◽  
Daa Xiao
Keyword(s):  
Older Adults ◽  
Mental Status ◽  
Acute Onset ◽  
Differential Diagnoses ◽  
Psychiatric History ◽  
Atypical Presentation ◽  
Aspartate Receptor ◽  
Personality Changes

A 61-year-old Hispanic man with no psychiatric history presented with an acute onset of personality changes, including aggression and hypersexuality, which progressed to hallucinations and fluctuations in mental status, and was diagnosed with anti-N-methyl-D-aspartate receptor encephalitis. This report emphasises the importance of having anti-NDMA receptor encephalitis on the list of differential diagnoses in acute, unprovoked personality changes in older adults.

scholarly journals Patient Factors and Hospital Outcomes Associated With Atypical Presentation in Hospitalized Older Adults With COVID-19 During the First Surge of the Pandemic

2021 ◽  
Author(s):  
Allison Marziliano ◽  
Edith Burns ◽  
Lakshpaul Chauhan ◽  
Yan Liu ◽  
Alex Makhnevich ◽  
...  
Keyword(s):  
Older Adults ◽  
Mental Status ◽  
Language Processing ◽  
Functional Decline ◽  
Female Gender ◽  
Altered Mental Status ◽  
Care Hospital ◽  
Atypical Presentation ◽  
Hospital Outcomes ◽  
Atypical Presentations

Abstract Background Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic. Methods Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems’ hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status. Results Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit–level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations. Conclusion Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.

scholarly journals Encephalopathy an Atypical Presentation of Intussusception: A Case Report

2020 ◽  
Vol 8 (1) ◽  
pp. 41-44
Author(s):  
Venma Mampilly ◽  
Sasikumar Manalumukkil Sankaran ◽  
Ramaraj Subbiah
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Early Diagnosis ◽  
Pediatric Emergency ◽  
Acute Onset ◽  
Differential Diagnoses ◽  
Atypical Presentation ◽  
Neurological Manifestations ◽  
Abdominal Symptoms

Background: Intussusception Encephalopathy is a pediatric emergency where a stuporous child presents with or without abdominal symptoms. Neurological manifestations of intussusception are an atypical presentation of this condition. It often misleads clinicians to other differential diagnoses of encephalopathy. The Case: We present to you a case of an 11-month-old child presented with encephalopathy, acute in onset with underlying intussusception. Conclusion: Intussusception encephalopathy is a pediatric emergency. It should be kept as a differential diagnosis when a child presents with complaints of acute onset of drowsiness with or without abdominal symptoms. Early diagnosis could save grave complications and improve the prognosis.

NESTORE Ontology: a Multi-Domain Semantic Tool for the Characterization of Older Adults Status and Behaviour to Promote Healthy Ageing by IoT Systems (Preprint)

2020 ◽  
Author(s):  
Alfonso Mastropietro ◽  
Filippo Palumbo ◽  
Silvia Orte ◽  
Michele Girolami ◽  
Francesco Furfari ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Mental Status ◽  
Scientific Knowledge ◽  
Social Behaviour ◽  
Physical Activity Behaviour ◽  
Healthy Ageing ◽  
Physiological Status ◽  
Ageing Population ◽  
Activity Behaviour

BACKGROUND The constant progression in number and share of the ageing population will likely have deep effects in most of the industrialized countries. The Internet of Things (IoT) paradigm can play a key role in facilitating independent living of the ageing population thus trying to reduce the burden on the society. Considering that ageing is a multi-factorial physiological process, the development of novel IoT systems, tools and devices, specifically targeted to older people, must be based on a holistic framework built on robust scientific knowledge in different scientific domains. OBJECTIVE A novel semantic formalization was developed, based on a multidomain healthy ageing model, to support structuring and standardizing heterogeneous scientific knowledge about ageing. The main aim of the paper is to present the new NESTORE ontology, with the purpose thus extending the available ontologies provided by universAAL-IoT (uAAL-IoT). METHODS Well-assessed scientific knowledge, specifically selected to target older adults aged between 65 and 75, was formalized into a holistic model using a multi-domain approach including three main different dimensions related to well-being: (i) Physiological Status and Physical Activity Behaviour, (ii) Nutrition, and (iii) Cognitive and Mental Status and Social Behaviour. Based on this model, within the NESTORE H2020 project, a new ontology was developed in the uAAL-IoT framework, which provides modelling tools and a set of core ontologies. RESULTS The NESTORE ontologies cover all the needed concepts to represent 5 significant domains of ageing. In total, 12 sub-ontologies were modelled with more than 60 classes and sub-classes referenced among them by using more than 100 relations and around 20 enumerations. NESTORE increases the uAAL ontologies collection by 40% and expand the uAAL domain usage for Physiological Status and Physical Activity Behaviour (8 ontologies), Nutrition (3 ontologies) and Cognitive and Mental Status and Social Behaviour (4 ontologies). CONCLUSIONS NESTORE ontology provides innovation both in terms of semantic content and technological approach. The thoroughly use of this ontology can support the development of a decision support system, to promote healthy ageing, with the capacity to do dynamic multi-scale modelling of user-specific data based on the semantic annotations of users’ profile.

scholarly journals Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

2021 ◽  
pp. 1-8
Author(s):  
Bin Yu ◽  
Andrew Steptoe ◽  
Yongjie Chen ◽  
Xiaohua Jia
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Episodic Memory ◽  
Cognitive Decline ◽  
Social Isolation ◽  
Mental Status ◽  
Chinese Older Adults ◽  
Confounding Variables

Abstract Background Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults. Methods This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up. Results Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = −0.03, p < 0.01; mental status: β = −0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = −0.05, p < 0.001; mental status: β = −0.03, p < 0.01) even after controlling for loneliness and all confounding variables. Conclusions Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

Haemiballism/haemichorea: an atypical presentation of ischaemic stroke

2021 ◽  
Vol 14 (6) ◽  
pp. e240439
Author(s):  
Raman Nohria ◽  
Stacey Bennett ◽  
Yasmin Ali O'Keefe
Keyword(s):  
Brain Mri ◽  
Acute Onset ◽  
Cerebral Peduncle ◽  
Atypical Presentation ◽  
Cerebrospinal Fluid Analysis ◽  
Medication Therapy ◽  
Fluid Analysis ◽  
Ct Head ◽  
The Right ◽  
Distressing Condition

A 76-year-old man was admitted to the hospital with acute onset of involuntary movements of the left side of his body. His neurological examination revealed he was oriented only to himself, and aforementioned movements of his left arm and leg. CT head demonstrated old infarcts in his right aspect of his pons and basal ganglia. Cerebrospinal fluid analysis was unremarkable. He initially had a normal blood glucose with an elevated anion gap and elevated creatine kinase. Brain MRI showed a small lacunar-type ischaemic infarct within the anteromedial aspect of the right cerebral peduncle, which localised to his haemiballism. To prevent worsening rhabdomyolysis associated with his haemiballism, the primary team initiated both tetrabenazine and diazepam. His movements improved after 1 week of medication therapy. This report discusses a thorough workup for this movement disorder and when to intervene for this distressing condition.

The Brain-Derived Neurotrophic Factor Functional Polymorphism and Hand Grip Strength Impact the Association between Brain-Derived Neurotrophic Factor Levels and Cognition in Older Adults in the United States

2022 ◽  
pp. 109980042110651
Author(s):  
Tingting Liu ◽  
Hongjin Li ◽  
Yvette P. Conley ◽  
Brian A. Primack ◽  
Jing Wang ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Grip Strength ◽  
Mental Status ◽  
Neurotrophic Factor ◽  
Brain Derived Neurotrophic Factor ◽  
Hand Grip Strength ◽  
Hand Grip ◽  
Serum Bdnf

Introduction Aging is associated with subtle cognitive decline in attention, memory, executive function, processing speed, and reasoning. Although lower brain-derived neurotrophic factor (BDNF) has been linked to cognitive decline among older adults, it is not known if the association differs among individuals with various BDNF Val66Met (rs6265) genotypes. In addition, it is not clear whether these associations vary by hand grip strength or physical activity (PA). Methods A total of 2904 older adults were included in this study using data from the Health and Retirement Study. Associations between serum BDNF and measures of cognitive function were evaluated using multivariable linear regression models stratified by Met allele status. PA and hand grip strength were added to the model to evaluate whether including these variables altered associations between serum BDNF and cognition. Results Mean age was 71.4 years old, and mean body mass index was 28.3 kg/m2. Serum BDNF levels were positively associated with higher total cognitive score (beta = 0.34, p = .07), mental status (beta = 0.16, p = .07), and word recall (beta = 0.22, p =.04) among Met carriers, while serum BDNF levels were negatively associated with mental status (beta = −0.09, p = .07) among non-Met carriers. Furthermore, associations changed when hand grip strength was added to the model but not when PA was added to the model. Conclusions The BDNF Val66Met variant may moderate the association between serum BDNF levels and cognitive function in older adults. Furthermore, such associations differ according to hand grip strength but not PA.

Nonarteritic Ischemic Optic Neuropathy

2019 ◽  
pp. 15-20
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Optic Neuropathy ◽  
Acute Onset ◽  
Anterior Ischemic Optic Neuropathy ◽  
Management Approach ◽  
Ischemic Optic Neuropathy ◽  
Common Condition ◽  
Fellow Eye ◽  
Eye Involvement

Nonarteritic anterior ischemic optic neuropathy is the most frequent cause of acute-onset optic neuropathy in older adults. Its exact pathogenesis remains uncertain, although it often occurs in patients with a small, structurally congested optic disc (“disc at risk”). In this chapter, we begin by reviewing the clinical features of nonarteritic anterior ischemic optic neuropathy. We then discuss the prognosis for recovery of vision and fellow eye involvement. We review the risk factors and precipitating factors for this condition. We list the medications that have been associated with this condition. Lastly, we review the workup and management approach for this common condition.

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