What you need to know about: delirium in older adults in hospital

2021 ◽  
pp. 1-10
Author(s):  
Howell T Jones ◽  
Daniel HJ Davis
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Environmental Factors ◽  
Acute Onset ◽  
Clinical Syndrome ◽  
Acute Illness ◽  
Fluctuating Course ◽  
Hospital Acquired ◽  
Severe Deterioration

Delirium is a clinical syndrome characterised by a disturbance of perception, consciousness and/or cognitive function, with an acute onset, fluctuating course and a severe deterioration arising over hours or days. Delirium is usually triggered by a combination of influences including acute illness, surgery, drugs and environmental factors. It is commonly seen in older people presenting to hospital, but can also develop during hospitalisation. There are three types of delirium: hypoactive, hyperactive and mixed. All patients over 65 years old presenting to hospital should be screened for delirium using the ‘4AT’ tool. An alternate method for diagnosing hospital-acquired delirium is described. This article outlines a 10-stage method for diagnosing, managing and preventing delirium, with emphasis on which areas of the history and examination should be prioritised, what the salient investigations are and both non-pharmacological and pharmacological approaches to preventing and treating delirium. Finally, this article explores which patients require specialist referrals or investigations and how to best follow up patients with delirium.

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.

scholarly journals LONGITUDINAL ASSOCIATION BETWEEN SERUM 25 HYDROXY VITAMIN D AND COGNITIVE FUNCTION AMONG ICELANDIC OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S484-S484
Author(s):  
Hrafnhildur Eymundsdottir ◽  
Milan Chang ◽  
Olof Geirsdottir ◽  
Maria Jonsdottir ◽  
Palmi V Jonsson ◽  
...  
Keyword(s):  
Older Adults ◽  
Vitamin D ◽  
Cognitive Function ◽  
Memory Function ◽  
Related Factors ◽  
High Tendency ◽  
25 Hydroxy Vitamin D ◽  
Longitudinal Associations ◽  
Low Levels

Abstract Studies have indicated that low levels of serum 25 hydroxy vitamin D (25OHD) are associated with lower cognitive function among older adults while longitudinal studies have revealed controversial results. The aim was to investigate the longitudinal associations between 25OHD and cognitive function among older adults with 5-years follow up. The Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study (N=3411) assessed cognitive function measuring memory function, speed of processing and executive function. 25OHD was measured using the Liaison chemiluminescence immunoassay and used as a continuous variable. Multivariate linear analysis, adjusting for numerous confounding factors, was used to calculate the longitudinal associations. All analyses were performed separated by gender. There was a high tendency for low levels of 25OHD i.e. 29.6% men and 37.7% women had hypovitaminosis D (&lt;50 nmol/l). Both men and women had significantly lower scores in all aspects of cognitive function at the follow-up time period. Unadjusted correlations between 25OHD and cognitive functions showed a stronger correlation for women, whereas women had lower scores in all aspects of cognitive function associated with low 25OHD. After adjusting for potential confounders, e.g. age, education, lifestyle and health-related factors, 25OHD and cognitive function were not significantly associated. Observational studies indicate that lower levels of vitamin D are associated with lower cognitive function. Intervention studies are yet to show a clear benefit from vitamin D supplementation. More longitudinal- and interventional studies, with longer follow-up duration, are needed.

scholarly journals When Culture Influences Genes: Positive Age Beliefs Amplify the Cognitive-Aging Benefit of APOE ε2

2020 ◽  
Vol 75 (8) ◽  
pp. e198-e203
Author(s):  
Becca R Levy ◽  
Martin D Slade ◽  
Robert H Pietrzak ◽  
Luigi Ferrucci
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cognitive Function ◽  
Environmental Factors ◽  
Cognitive Aging ◽  
Self Perceptions ◽  
Cognitive Benefit ◽  
Study Participants ◽  
The Impact ◽  
Retirement Study

Abstract Objectives Most studies of aging cognition have focused on risk factors for worse performance and on either genetic or environmental factors. In contrast, we examined whether 2 factors known to individually benefit aging cognition may interact to produce better cognition: environment-based positive age beliefs and the APOE ε2 gene. Method The sample consisted of 3,895 Health and Retirement Study participants who were 60 years or older at baseline and completed as many as 5 assessments of cognition over 8 years. Results As predicted, positive age beliefs amplified the cognitive benefit of APOE ε2. In contrast, negative age beliefs suppressed the cognitive benefit of APOE ε2. We also found that positive age beliefs contributed nearly 15 times more than APOE ε2 to better cognition. Discussion This study provides the first known evidence that self-perceptions can influence the impact of a gene on cognition. The results underscore the importance of combined psychosocial and biological approaches to understanding cognitive function in older adults.

scholarly journals Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e040098
Author(s):  
Bingyan Gong ◽  
Shaomei Shang ◽  
Chao Wu
Keyword(s):  
Older Adults ◽  
Regression Analysis ◽  
Longitudinal Study ◽  
Cognitive Function ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Visuospatial Ability ◽  
Cross Sectional ◽  
Adl Disability

ObjectivesThis study aimed to investigate the relationship between disability and domain-specific cognitive function in older adults with chronic obstructive pulmonary disease (COPD).DesignCross-sectional analyses combined with retrospective longitudinal analyses.SettingWe included 450 communities in China.ParticipantsIn this study, 1022 (mean age: 68.6±6.3; 612 males) and 152 (mean age: 67.0±5.2; 83 males) older adults with COPD from the China Health and Retirement Longitudinal Study were included in a cross-sectional multivariate linear regression analysis and a longitudinal logistic regression analysis, respectively.Outcome measuresDisability was determined by the difficulty or inability to complete 1 of the 12 activity items in basic activities of daily living (ADL) and instrumental ADL. The cognitive dimensions of episodic memory, attention/numerical ability, orientation to time, and visuospatial ability were assessed via the immediate/delayed recall task, serial sevens task, naming the current date and pentagon-figure-drawing tasks, respectively.ResultsOf 1022 older respondents with COPD at wave-4, 48.5% had ADL disability. Declines in the global cognitive function (β (95% CI)=−0.627 (−1.214 to –0.040)), orientation to time (β (95% CI)=−0.207 (−0.364 to –0.050)) and visuospatial ability (β (95% CI)=−0.068 (−0.127 to –0.009)) were significantly associated with the presence of ADL disability, when demographic and health-related variables were adjusted. Of 152 older participants with COPD and without ADL disability in wave-2, 61 (40.1 %) developed disability over a 2-year follow-up. Relative to the participants without a decline in orientation to tine, those with the condition had greater odds of incidence of ADL disability increased by a factor of about 1.46 over a 2-year follow-up.ConclusionsIn older adults with COPD, orientation to time and visuospatial inability are vulnerable to the presence of a disability. Prevention of a decline in orientation to time might help prevent disability in older people with COPD.

scholarly journals Longitudinal relationships between subjective fatigue, cognitive function, and everyday functioning in old age

2012 ◽  
Vol 25 (2) ◽  
pp. 275-285 ◽  
Author(s):  
Feng Lin ◽  
Ding-Geng Chen ◽  
David E. Vance ◽  
Karlene K. Ball ◽  
Mark Mapstone
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Latent Class ◽  
Growth Mixture Modeling ◽  
Community Dwelling ◽  
Everyday Functioning ◽  
Subjective Fatigue ◽  
Community Dwelling Older Adults ◽  
Over Time

ABSTRACTBackground: The present study examined the prospective relationships between subjective fatigue, cognitive function, and everyday functioning.Methods: A cohort study with secondary data analysis was conducted using data from 2,781 community-dwelling older adults without dementia who were enrolled to participate in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) randomized intervention trial. Measures included demographic and health information at baseline, and annual assessments of subjective fatigue, cognitive function (i.e. speed of processing, memory, and reasoning), and everyday functioning (i.e. everyday speed and everyday problem-solving) over five years.Results: Four distinct classes of subjective fatigue were identified using growth mixture modeling: one group complaining fatigue “some of the time” at baseline but “most of the time” at five-year follow-up (increased fatigue), one complaining fatigue “a good bit of the time” constantly over time (persistent fatigue), one complaining fatigue “most of the time” at baseline but “some of the time” at five-year follow-up (decreased fatigue), and the fourth complaining fatigue “some of the time” constantly over time (persistent energy). All domains of cognitive function and everyday functioning declined significantly over five years; and the decline rates, but not the baseline levels, differed by the latent class of subjective fatigue. Except for the decreased fatigue class, there were different degrees of significant associations between the decline rates of subjective fatigue and all domains of cognitive function and everyday functioning in other classes of subjective fatigue.Conclusion: Future interventions should address subjective fatigue when managing cognitive and functional abilities in community-dwelling older adults.

scholarly journals Longitudinal associations between hearing aid usage and cognition in community-dwelling Japanese older adults with moderate hearing loss

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258520
Author(s):  
Saiko Sugiura ◽  
Yukiko Nishita ◽  
Yasue Uchida ◽  
Mariko Shimono ◽  
Hirokazu Suzuki ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cognitive Function ◽  
Pure Tone ◽  
Community Dwelling ◽  
Pure Tone Average ◽  
Time Interaction ◽  
Picture Completion ◽  
Moderate Hearing Loss

We investigated the associations between hearing aids (HA) and the maintenance of cognitive function among community-dwelling older adults with moderate hearing loss. A total of 407 participants aged 60 years or older with moderate hearing loss were recruited from the National Institute for Longevity Sciences, Longitudinal Study for Aging (NILS-LSA). Moderate hearing loss was defined as a pure-tone average of 40–69 dB at 500, 1000, 2000, and 4000 Hz of the better ear, according to the definition proposed by the Japan Audiological Society. Cognitive function was evaluated using the four subtests of the Japanese version of the Wechsler Adult Intelligence Scale-Revised Short Forms (WAIS-R-SF): Information, Similarities, Picture completion, and Digit Symbol Substitution (DSST). A longitudinal analysis of 1192 observations with a mean follow-up period of 4.5 ± 3.9 years was performed. The HA use rate at any time during the follow-up period was 31.4%, and HA users were significantly younger (t-test, p = 0.001), had worse hearing (p < .0001) and higher education (p = 0.001), participated more frequently in the survey (p < .0001), and were less depressed (χ2 test, p = 0.003) than the older adults not using HA. General linear mixed models consisted of the fixed effects of HA use, follow-up time, and an HA use × time interaction term adjusted for age and pure-tone average thresholds at baseline, sex, education, and other possible confounders. HA use showed significant main effects on the scores for Picture completion and DSST after adjustment; scores were better in the HA use group than in the no HA use group. The HA use × time interaction was significant for the Information score (p = 0.040). The model-predicted 12-year slope with centralizing age indicated that the no HA use group showed greater decline over time on Information scores than did HA use group. The slopes did not differ between HA users and non-users for the Similarities, Picture completion and DSST. In conclusion, HA use may have a protective effect on the decline in general knowledge in older adults with moderate hearing loss.

scholarly journals The association between injurious falls and older adults’ cognitive function: the role of depressive mood and physical performance

2021 ◽  
Author(s):  
Caterina Trevisan ◽  
Enrico Ripamonti ◽  
Giulia Grande ◽  
Federico Triolo ◽  
Stina Ek ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Decline ◽  
Physical Performance ◽  
Walking Speed ◽  
Depressive Mood ◽  
Time Interval ◽  
Injurious Falls

Abstract Background The impact of falls on cognitive function is unclear. We explored whether injurious falls are associated with cognitive decline in older adults, and evaluated the role of changes in psychological and physical health as mediators of such association. Methods This prospective study involved 2,267 community-dwelling participants in the Swedish National study on Aging and Care in Kungsholmen (≥60 years). Data on injurious falls (i.e., falls requiring medical attention) during each 3-year time interval of follow-up were obtained from national registers. Assessment of cognitive function (Mini-Mental State Examination[MMSE]), depressive mood (Montgomery-Åsberg Depression Rating Scale), and physical performance (walking speed) were carried out every 3 or 6 years over a 12-year follow-up. The association between falls and cognition was estimated through linear mixed effects models, and the mediating role of changes in depressive mood and physical performance was tested using mediation analysis. Results After adjusting for potential confounders, individuals who experienced injurious falls had a greater annual decline in MMSE in the subsequent time interval (β=-1.49, 95%CI:-1.84;-1.13), than those who did not. The association increased with the occurrence of ≥2 falls (β=-2.13, 95%CI:-2.70;-1.56). Worsening of walking speed and depressive mood explained around 26% and 8%, respectively, of the association between falls and cognitive decline. Conclusions Injurious falls are associated with greater cognitive decline, and this association is partly mediated by worsening of physical performance and, in a lesser extent, of depressive mood. These findings suggest that physical deficits and low mood are potential therapeutic targets for mitigating the association between falls and cognitive decline.

scholarly journals Plasma MCP-1 and changes on cognitive function in community-dwelling older adults

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Juan Luis Sanchez-Sanchez ◽  
Kelly V. Giudici ◽  
Sophie Guyonnet ◽  
Julien Delrieu ◽  
Yan Li ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Episodic Memory ◽  
Cognitive Decline ◽  
Continuous Variable ◽  
Community Dwelling ◽  
Clinical Dementia Rating ◽  
Delayed Recall ◽  
Domain Specific

Abstract Background Monocyte Chemoattractant Protein-1 (MCP-1), a glial-derived chemokine, mediates neuroinflammation and may regulate memory outcomes among older adults. We aimed to explore the associations of plasma MCP-1 levels (alone and in combination with β-amyloid deposition—Aβ42/40) with overall and domain-specific cognitive evolution among older adults. Methods Secondary analyses including 1097 subjects (mean age = 75.3 years ± 4.4; 63.8% women) from the Multidomain Alzheimer Preventive Trial (MAPT). MCP-1 (higher is worse) and Aβ42/40 (lower is worse) were measured in plasma collected at year 1. MCP-1 in continuous and as a dichotomy (values in the highest quartile (MCP-1+)) were used, as well as a dichotomy of Aβ42/40. Outcomes were measured annually over 4 years and included the following: cognitive composite z-score (CCS), the Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR) sum of boxes (overall cognitive function); composite executive function z-score, composite attention z-score, Free and Cued Selective Reminding Test (FCSRT - memory). Results Plasma MCP-1 as a continuous variable was associated with the worsening of episodic memory over 4 years of follow-up, specifically in measures of free and cued delayed recall. MCP-1+ was associated with worse evolution in the CCS (4-year between-group difference: β = −0.14, 95%CI = −0.26, −0.02) and the CDR sum of boxes (2-year: β = 0.19, 95%CI = 0.06, 0.32). In domain-specific analyses, MCP-1+ was associated with declines in the FCSRT delayed recall sub-domains. In the presence of low Aβ42/40, MCP-1+ was not associated with greater declines in cognitive functions. The interaction with continuous biomarker values Aβ42/40× MCP-1 × time was significant in models with CDR sum of boxes and FCSRT DTR as dependent variables. Conclusions Baseline plasma MCP-1 levels were associated with longitudinal declines in overall cognitive and episodic memory performance in older adults over a 4-year follow-up. How plasma MCP-1 interacts with Aβ42/40 to determine cognitive decline at different stages of cognitive decline/dementia should be clarified by further research. The MCP-1 association on cognitive decline was strongest in those with amyloid plaques, as measured by blood plasma Aβ42/40.

scholarly journals Egg Consumption and Multi-Domain Cognitive Function in a Representative Sample of Older U.S. Adults (P14-004-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Nicholas Bishop ◽  
Krystle Zuniga ◽  
Bailey Noon
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Cognitive Performance ◽  
Representative Sample ◽  
Cognitive Change ◽  
Community Dwelling ◽  
Cognitive Health ◽  
Egg Consumption ◽  
Whole Egg

Abstract Objectives Existing research supports a positive relationship between egg intake and cognitive function in older populations, though the impact of whole egg consumption on multi-domain cognitive function and cognitive decline in representative samples of older adults has not been described. We examined the association between egg consumption, cognitive performance, and cognitive change in a representative sample of U.S. adults age 65 and older. Methods We drew observations from the 2012 and 2014 Health and Retirement Study (HRS) and the recently released 2013 Health Care and Nutrition Study (HCNS). The analytic sample contained 3835 respondents, representing a weighted population of 37,806,082 community-dwelling U.S. adults age 65 and older in 2013. Path analytic models were estimated to identify the association between egg consumption groups (none, ≤1 serving per week, 2–6 servings per week, ≥7 servings per week) and cognitive performance across domains of working memory, executive function, and global mental status. First-order autoregressive models were used to assess change in cognition over the two-year observational period. Results Though bivariate analyses suggested that moderate egg consumers had the best cognitive performance at baseline, egg consumption was not associated with cognitive performance or cognitive change when adjusting models for covariates known to have a robust association with cognitive health such as race/ethnicity, education, and physical activity. Follow-up analyses suggested that overall dietary intake was not meaningfully related to egg consumption, though intake of specific nutrients contained in eggs such as cholesterol and choline generally increased with greater egg consumption. Conclusions These results suggest that egg consumption does not benefit, nor is detrimental to, the cognitive health of older adults. Further studies of whole egg consumption and cognitive performance would benefit from controlled experimental settings, extended follow-up periods to measure cognitive change, and assessment of both community-dwelling and institutionalized older adults. Funding Sources This research was supported by funding from the American Egg Board/Egg Nutrition Center.

scholarly journals Intermittent Fasting Enhanced the Cognitive Function in Older Adults with Mild Cognitive Impairment by Inducing Biochemical and Metabolic changes: A 3-Year Progressive Study

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2644 ◽  
Author(s):  
Theng Choon Ooi ◽  
Asheila Meramat ◽  
Nor Fadilah Rajab ◽  
Suzana Shahar ◽  
Intan Safinar Ismail ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Successful Aging ◽  
Ketone Bodies ◽  
Fasting Blood Glucose ◽  
Elderly Subjects ◽  
Intermittent Fasting

Intermittent fasting (IF) refers to various dietary regimens that cycle between a period of non-fasting and a period of total fasting. This study aimed to determine the effects of IF on cognitive function among elderly individuals who practice IF who have mild cognitive impairment (MCI). A total of 99 elderly subjects with MCI of Malay ethnicity without any terminal illness were recruited from a larger cohort study, LRGS TUA. The subjects were divided into three groups, comprising those who were regularly practicing IF (r-IF), irregularly practicing IF (i-IF), and non-fasters (n-IF). Upon 36 months of follow-up, more MCI subjects in the r-IF group reverted to successful aging with no cognitive impairment and diseases (24.3%) compared to those in i-IF (14.2%) and n-IF groups (3.7%). The r-IF group’s subjects exhibited significant increment in superoxide dismutase (SOD) activity and reduction in body weight, levels of insulin, fasting blood glucose, malondialdehyde (MDA), C-reactive protein (CRP), and DNA damage. Moreover, metabolomics analysis showed that IF may modulate cognitive function via various metabolite pathways, including the synthesis and degradation of ketone bodies, butanoate metabolism, pyruvate metabolism, and glycolysis and gluconeogenesis pathways. Overall, the MCI-afflicted older adults who practiced IF regularly had better cognitive scores and reverted to better cognitive function at 36 months follow-up.

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