Laughter, communication problems and dementia

2008 ◽  
Vol 5 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Camilla Lindholm
Keyword(s):  
Cognitive Impairment ◽  
Elderly Patients ◽  
Language Production ◽  
The Elderly ◽  
Memory Work ◽  
Communication Problems ◽  
Conversational Skills ◽  
Communication Difficulties ◽  
Institutional Contexts ◽  
Definition Of

This article investigates how the elderly with dementia and their professional caregivers use laughter as a device to deal with problems related to language production and comprehension. The data consist of two game-playing situations, used to engage the elderly people in memory work. The article shows how the elderly patients recurrently laugh to acknowledge communication difficulties and to show awareness of their potential non-competency. The professional caregivers are shown to use slightly different strategies for responding to laughter segments initiated by the patients, either making the shortcomings part of the conversation or avoiding referring to the lapse explicitly. The laughter strategies used by the patients are compared to those reported in the CA-literature on laughter. It is well known that laughter is used in sequences of trouble and delicacy in both ordinary and institutional contexts, but my study shows that speakers with dementia laugh when they encounter problems related to language production and comprehension. This functional expansion in relation to premorbid occurrence is evidence that laughter fits the definition of compensatory behaviour utilized to overcome communication barriers. Certain conversational skills are preserved in individuals with dementia, but due to their cognitive impairment these resources are utilized in a slightly different way than by healthy speakers.

Letter to the Editor: Craniopharyngiomas in the elderly: the crucial influence of tumor topography on surgical risk assessment

2021 ◽  
Author(s):  
José M. Pascual ◽  
Ruth Prieto
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Tumor Tissue ◽  
Significant Proportion ◽  
Wide Band ◽  
The Elderly ◽  
Surgical Risk ◽  
Definition Of ◽  
Weighted Sequences ◽  
Tumor Topography

Classifying CPs within the overly vague, uninformative category “suprasellar” prevents gaining any true insight regarding the risks associated with the surgical procedure employed. Routine MRI obtained with conventional T1- and T2-weighted sequences along the midsagittal and coronal trans-infundibular planes allow an accurate and reliable preoperative definition of CP topography. CPs developing primarily within the infundibulum and/or tuberal region of the hypothalamus, as well as those wholly located within the 3V, should be distinguished preoperatively from those lesions originally expanding beneath the 3V floor (3VF), the true suprasellar tumors. Among adult patients, about 40% of CPs correspond to infundibulo-tuberal tumors expanding primarily within the 3VF, above an intact pituitary gland and stalk. This subgroup of CPs shows strong adherences to the surrounding hypothalamus, as they are embedded within a wide band of reactive gliotic tissue, usually infiltrated by microscopic finger-like solid cords of tumor tissue. In elderly patients, a significant proportion of CPs correspond to papillary tumors developing above an intact 3VF, usually showing small pedicle-like or sessile-like attachments to the infundibulum. With the current diagnostic MRI workup routinely employed for CPs, it is possible, for the majority of lesions, to preoperatively differentiate these topographical variants and predict the type of CP-hypothalamus relationship that will be found during surgery.

scholarly journals How to Treat Hepatocellular Carcinoma in Elderly Patients

2021 ◽  
Vol 14 (3) ◽  
pp. 233
Author(s):  
Piera Federico ◽  
Emilio Francesco Giunta ◽  
Annalisa Pappalardo ◽  
Andrea Tufo ◽  
Gianpaolo Marte ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Elderly Population ◽  
Primary Tumour ◽  
The Elderly ◽  
Chronic Liver Diseases ◽  
Old Patients ◽  
Choice Of Treatment ◽  
Definition Of ◽  
Optimal Treatment Strategy

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.

scholarly journals COT-16 INDICATION OF SYSTEMIC THERAPY FOR ELDER PATIENTS WITH BRAIN TUMORS: A SYSTEMATIC REVIEW AND PERSPECTIVE

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii43-ii43
Author(s):  
Yoko Nakasu ◽  
Koichi Mitsuya ◽  
Satoshi Nakasu ◽  
Kazuhiko Nozaki
Keyword(s):  
Elderly Patients ◽  
Systemic Therapy ◽  
Brain Tumours ◽  
Performance Status ◽  
The Elderly ◽  
Assessment Tools ◽  
Geriatric Population ◽  
Pubmed Database ◽  
Group 2 ◽  
Definition Of

Abstract BACKGROUND Little is known about indications and outcome prediction of systemic therapy for elderly patients with brain tumours. Clinical conditions of individuals are heterogenous from healthy to frail or diseased,moreover,are often reversible. METHOD We retrieved the literature of brain tumour,systemic therapy,chemotherapy,immunotherapy,in randomized controlled trials (RCTs) and reviews on PubMed database from 2008 to 2018. RESULTS 1) Definition of elderly by age in years: Depending on each protocol,the definition is arbitrary. Patients older than 60 or 70 years are usually in the elderly group. 2) Systemic evaluation: Performance status (PS) and visceral function are not sufficient to assess elderly patients. Assessment tools specifically developed for the geriatric population are recommended to evaluate individual patients. 3) Effects and toxicity of systemic therapy: Only a few RCT showed no inferiority of outcome in patients older than 60 or 65 years. There are only few evidences about the senile fragility of blood-brain barrier or distribution of drugs in the elderly brain. Molecular subtyping of brain tumours might predict the effects and toxicities of therapies for elderly patients. CONCLUSION Feasibility of modern systemic therapies are not well studied for elderly patients with brain tumours. Clinical condition varies in individual elderly patients. We need prospective studies of systemic therapy in elderly patients based on an eligibility with not only chronologic age but comprehensive geriatric assessments.

scholarly journals Social Assistant Humanoid Robots for Dementia of the Elderly: A Scoping Review

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Xiangyu Liu
Keyword(s):  
Qualitative Research ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Older People ◽  
Research Method ◽  
The Elderly ◽  
Humanoid Robots ◽  
Future Research ◽  
Future Studies ◽  
Method Analysis

In recent years, many cognitive care robots have been developed. There is also a form of the companion pet, and there are also robots that can be personified and talk with the elderly. Also, some telecommunications equipment can be replaced to help older people connect to the telecommunications community. However, the need for such robots is still unclear in the focus of this area of being able to interact, talk to, and connect with family and society. Although many studies in the existing literature that tell how to research to verify their efficacy, methods of defining effects can pave the way for future studies. This is what this article will show. The article included qualitative research searches and screenings, effect summaries, and research method analysis. The problem to be solved in this article is how to use and measure the effectiveness of conversational humanoids in nursing elderly patients with cognitive impairment. We also hope to provide some guidance for future research on cognitive impairment.

scholarly journals A systematic review: comparative analysis of the effects of propofol and sevoflurane on postoperative cognitive function in elderly patients with lung cancer

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haitao Sun ◽  
Guohua Zhang ◽  
Bolun Ai ◽  
Huimin Zhang ◽  
Xiangyi Kong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Adverse Effect ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Meta Analysis ◽  
The Elderly ◽  
Independent Effect ◽  
Related Phenomenon

Abstract Background The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patients. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate, as is the number and amounts of drugs used and the “depth of anesthesia.” So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer. Methods This study is a systematic review and meta-analysis for controlled clinical studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 h after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed-effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6 h (11 studies; SMD -1.391, 95% CI -2.024, − 0.757; p < 0.001), MMSE 24 h (14 studies; SMD -1.106, 95% CI -1.588, − 0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, − 0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, − 0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

Patients with special needs

2010 ◽  
Author(s):  
Gillian M Hood ◽  
Suyin GM Tan
Keyword(s):  
Intellectual Disability ◽  
Special Needs ◽  
Hearing Impairment ◽  
Disease Process ◽  
The Elderly ◽  
Communication Problem ◽  
Communication Problems ◽  
Communication Difficulties ◽  
Patients With Special Needs ◽  
Hospital Inpatients

Most anaesthetists recognize that there are specific groups of patients with whom communication is especially difficult due to issues relating to language. These groups are patients in whom a disease process interferes with communication—for example intellectual disability or hearing impairment, those with whom we do not share a common tongue, and those patients whose cultural background differs from ours. Patients with communication difficulties are disproportionately represented in the hospital population for a variety of reasons. The elderly form the bulk of hospital inpatients and are much more likely to have problems such as dementia, confusion, sedation and dysphasia. It is important to be cognisant of the issues that may arise with patients who have communication problems and, in addition to being aware of these problems, it helps to have a structured way of approaching the issue. Reading the patients’ notes prior to consultation gives advance warning of issues such as dementia or hearing impairment and allows communication to be tailored to the patients’ needs. Sometimes the patients’ understanding of language may be difficult to assess on first meeting—anaesthetists have all encountered patients who answer questions with a smiling ‘yes’ or ‘no’, only to subsequently discover their comprehension has been minimal. Enquiring of relatives, friends and staff helps to give a picture of a patient’s ability to communicate in the chosen language. Similarly, enquiring of the patient how communication can be facilitated, is helpful. … ‘It says in your notes that you have trouble finding words since your strok —is there anything I can do to make it easier for you to speak?’… Once the communication problem has been delineated it makes it easier to move on to the next step. Having orientated oneself to the patient’s particular problems with communication, it is also important to orientate the staff with whom one is working. …‘Rob, we are going to see Mr Smith now. He’s had problems with alcohol withdrawal over the last few days and he is still a bit confused. It is probably best if just one of us does the talking — are you happy to do that? ’ Not: ‘I wish you wouldn’t contradict me when I’m talking to patients…’ …

scholarly journals Blueberry Extracts Supplementation Improves Cognitive Function in Elderly Patients with Mild Cognitive Impairment (P14-013-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Yugang Jiang ◽  
Shoudan Sun
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Natural Science ◽  
Intervention Study ◽  
The Elderly ◽  
The State ◽  
Control Group ◽  
Cognitive Aptitude

Abstract Objectives An intervention study was performed to determine if supplement containing blueberry extracts could improve cognitive function in the elderly patients with mild cognitive impairment (MCI). Methods Forty six MCI patients participated in the intervention study were paired based on their age, education level and initial the basic cognitive aptitude test (BCAT) scores and then randomly assigned to the intervention group (n = 23, which received 1.0 g/day of blueberry extracts) or blank control group (n = 23) . The endpoint was the improvement in cognitive function as evaluated by BCATs. All parameters were measured before and after the treatment period of 12 weeks. Results After 12 weeks of intervention, we observed significant improvement in their total BCAT score, space imagery efficiency, working memory and recognition memory of subjects in patients with blueberry extracts supplementation comparing to those in the control group (P = 0.006, 0.023, 0.000, 0.005, respectively). However the levels of inflammatory factors (IL-6 and TNF-α in serum) showed no significant changes after intervention. Conclusions The data indicated that blueberry has a beneficial effect on cognitive function of the elderly MCI patients, which might provide therapeutic potential for Alzheimer's disease. Funding Sources This work was supported by the State Key Program of National Natural Science Foundation of China and the State Key Program of National Natural Science Foundation of Tianjin. Supporting Tables, Images and/or Graphs

scholarly journals Comparative Analysis of the Effects of Propofol and Sevoflurane on Postoperative Cognitive Function in Elderly Patients with Lung Cancer

2019 ◽  
Author(s):  
Haitao Sun ◽  
Guohua Zhang ◽  
Bolun Ai ◽  
Huimin Zhang ◽  
xiangyi kong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Effect ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Fixed Effects ◽  
Meta Analysis ◽  
The Elderly ◽  
Independent Effect ◽  
Related Phenomenon

Abstract Background The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patient. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate as is the number and amounts of drugs used and the "depth of anesthesia". So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer. Methods This study is a meta-analysis for controlled-clinical-studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 hours after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6h (11 studies; SMD -1.391, 95% CI -2.024, -0.757; p < 0.001), MMSE 24h (14 studies; SMD -1.106, 95% CI -1.588, -0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, -0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, -0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

scholarly journals Comparative Analysis of the Effects of Propofol and Sevoflurane on Postoperative Cognitive Function in Elderly Patients with Lung Cancer

2019 ◽  
Author(s):  
Tao Yan ◽  
Bolun Ai ◽  
Huimin Zhang ◽  
Xiangyi Kong ◽  
Wan-Ting Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adverse Effect ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Fixed Effects ◽  
Meta Analysis ◽  
The Elderly ◽  
Independent Effect ◽  
Related Phenomenon

Abstract Background The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patient. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate as is the number and amounts of drugs used and the "depth of anesthesia". So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer. Methods This study is a systematic review and meta-analysis for controlled clinical studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 hours after surgery. SMDs along with 95% CIs were extracted and analyzed using random or fixed effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. Results We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6h (11 studies; SMD -1.391, 95% CI -2.024, -0.757; p < 0.001), MMSE 24h (14 studies; SMD -1.106, 95% CI -1.588, -0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, -0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, -0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). Conclusion Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

scholarly journals Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review

2021 ◽  
Author(s):  
Martina Rekatsina ◽  
Antonella Paladini ◽  
Dariusz Myrcik ◽  
Omar Viswanath ◽  
Ivan Urits ◽  
...  
Keyword(s):  
Nervous System ◽  
Cognitive Impairment ◽  
Elderly Patients ◽  
Pain Assessment ◽  
Full Text ◽  
Pain Perception ◽  
The Elderly ◽  
Clinical Approach ◽  
Advanced Dementia ◽  
Opioid Prescription

Background: Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in central nervous system along with changes in the peripheral nervous system due to aging have a significant impact in pain perception. Often clinicians decide to prescribe opioids in order to relief pain, also without a clear indication. Aim: This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods: A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles which were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by snowballing from the reference lists of the full-text articles. Results: This review discuss the complex physiological and pharmacological changes in elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer&rsquo;s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in elderly. Information regarding opioid prescription in nursing homes as well as recorded indications for opioids use, type and dosing of opioid and compliance of treatment in advanced dementia are also provided. Conclusions: Opioid prescription in elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients, need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.

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