scholarly journals Preoperative Cognitive Impairment and Postoperative Delirium Predict Decline in Activities of Daily Living after Cardiac Surgery—A Prospective, Observational Cohort Study

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 69
Author(s):  
Ulf Guenther ◽  
Falk Hoffmann ◽  
Oliver Dewald ◽  
Ramy Malek ◽  
Kathrin Brimmers ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Daily Living ◽  
Postoperative Delirium ◽  
Functional Decline ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Subsequent Treatment ◽  
Assessment Tools

Cardiac surgery and subsequent treatment in the intensive care unit (ICU) has been shown to be associated with functional decline, especially in elderly patients. Due to the different assessment tools and assessment periods, it remains yet unclear what parameters determine unfavorable outcomes. This study sought to identify risk factors during the entire perioperative period and focused on the decline in activity of daily living (ADL) half a year after cardiac surgery. Follow-ups of 125 patients were available. It was found that in the majority of patients (60%), the mean ADL declined by 4.9 points (95% CI, −6.4 to −3.5; p < 0.000). In the “No decline” -group, the ADL rose by 3.3 points (2.0 to 4.6; p < 0.001). A multiple regression analysis revealed that preoperative cognitive impairment (MMSE ≤ 26; Exp(B) 2.862 (95%CI, 1.192–6.872); p = 0.019) and duration of postoperative delirium ≥ 2 days (Exp(B) 3.534 (1.094–11.411); p = 0.035) was independently associated with ADL decline half a year after the operation and ICU. Of note, preoperative ADL per se was neither associated with baseline cognitive function nor a risk factor for functional decline. We conclude that the preoperative assessment of cognitive function, rather than functional assessments, should be part of risk stratification when planning complex cardiosurgical procedures.

scholarly journals Saffron for mild cognitive impairment and dementia: a systematic review and meta-analysis of randomised clinical trials

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zahra Ayati ◽  
Guoyan Yang ◽  
Mohammad Hossein Ayati ◽  
Seyed Ahmad Emami ◽  
Dennis Chang
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Clinical Trials ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Function ◽  
Daily Living ◽  
Randomised Clinical Trials ◽  
Disease Assessment ◽  
Significant Difference

Abstract Background Saffron (stigma of Crocus sativus L.) from Iridaceae family is a well-known traditional herbal medicine that has been used for hundreds of years to treat several diseases such as depressive mood, cancer and cardiovascular disorders. Recently, anti-dementia property of saffron has been indicated. However, the effects of saffron for the management of dementia remain controversial. The aim of the present study is to explore the effectiveness and safety of saffron in treating mild cognitive impairment and dementia. Methods An electronic database search of some major English and Chinese databases was conducted until 31st May 2019 to identify relevant randomised clinical trials (RCT). The primary outcome was cognitive function and the secondary outcomes included daily living function, global clinical assessment, quality of life (QoL), psychiatric assessment and safety. Rev-Man 5.3 software was applied to perform the meta-analyses. Results A total of four RCTs were included in this review. The analysis revealed that saffron significantly improves cognitive function measured by the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) and Clinical Dementia Rating Scale-Sums of Boxes (CDR-SB), compared to placebo groups. In addition, there was no significant difference between saffron and conventional medicine, as measured by cognitive scales such as ADAS-cog and CDR-SB. Saffron improved daily living function, but the changes were not statistically significant. No serious adverse events were reported in the included studies. Conclusions Saffron may have the potential to improve cognitive function and activities of daily living in patients with Alzheimer’s disease and mild cognitive impairment (MCI). However, due to limited high-quality studies there is insufficient evidence to make any recommendations for clinical use. Further clinical trials on larger sample sizes are warranted to shed more light on its efficacy and safety.

scholarly journals Association between serum biomarkers and postoperative delirium after cardiac surgery

2019 ◽  
Vol 26 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Mindaugas Gailiušas ◽  
Judita Andrejaitienė ◽  
Edmundas Širvinskas ◽  
Darijus Krasauskas ◽  
Milda Švagždienė ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Delirium ◽  
Neuronal Damage ◽  
Artery Bypass ◽  
Neuron Specific Enolase ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Blood Levels ◽  
Increased Risk ◽  
The Individual

Background. In cardiac surgery, patients face an increased risk of developing postoperative delirium (POD) that is associated with poor outcomes. Neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP) have shown some promising results as potential tools for POD risk stratification, diagnosis, monitoring, and prognosis. Methods. Prospective single-centre study enrolled 44 patients undergoing elective coronary artery bypass grafting (CABG) and/ or valve procedures using cardiopulmonary bypass (CPB). The patients were assessed and monitored preoperatively, during surgery, and in the early postoperative period. The blood levels of NSE and GFAP were measured before and after surgery. The early POD was assessed by CAM-ICU criteria and patients were assigned to the POD group (with POD) or to the NPOD group (without POD) retrospectively. Results. The incidence of POD was 18.2%. After surgery, NSE significantly increased in the whole sample (p = 0.002). Comparing between groups, NSE significantly increased in the POD group after surgery (p = 0.042). ΔGFAP (before/after operation) for the whole sample was statistically significant (p = 0.022). There was a significant correlation between ΔGFAP and the lowest MAP during surgery in the POD group (p = 0.033). Conclusions. Our study demonstrated that NSE and GFAP are associated with early POD. An increase in NSE level during the perioperative period may be associated with subclinical neuronal damage. Serum GFAP levels show the damage of glial cells. Further studies are needed to find the factors influencing the individual limits of optimal MAP during surgery.

scholarly journals Modifications in anesthesia for geriatric patients

2016 ◽  
Vol 84 (2) ◽  
pp. 10-11
Author(s):  
Brandon Chau ◽  
Alexander Levit
Keyword(s):  
Daily Living ◽  
Patient Monitoring ◽  
Postoperative Delirium ◽  
Geriatric Patients ◽  
Postoperative Morbidity ◽  
Perioperative Period ◽  
The Elderly ◽  
Organ Function ◽  
Age Related ◽  
Geriatric Anesthesia

The volume of geriatric surgery is expected to increase dramatically by 2020, requiring a more widespread appreciation of the unique risks and challenges of anesthesia in the elderly. Changes in pharmacokinetics along with age-related changes in organ function have important implications for patient monitoring and dosing of anesthetic, analgesic, and sedative medications. Preoperative screening for risk of postoperative morbidity is improved with an assessment of activities of daily living, and regional anesthesia may be considered to reduce the risk of postoperative delirium, although this remains controversial. Specific homeostatic parameters should be closely monitored in the perioperative period. The approach to anesthesia in geriatric patients should not be merely extrapolated from younger patients, and further evidence specific to geriatric anesthesia will improve surgical outcomes.

scholarly journals Frailty assessment in older urological patients prior to surgery: a systematic review and narrative synthesis

2020 ◽  
Vol 12 ◽  
pp. 175628722091661 ◽  
Author(s):  
Andrea Haren ◽  
Rajni Lal ◽  
David Walker ◽  
Rajesh Nair ◽  
Judith Partridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Care ◽  
Preoperative Assessment ◽  
Perioperative Period ◽  
Adverse Outcomes ◽  
Assessment Tools ◽  
Postoperative Outcomes ◽  
Narrative Synthesis ◽  
Standard Clinical Practice ◽  
Increased Risk

Background: Radical cystectomy (RC) and urinary diversion are the recommended treatment for patients with muscle invasive bladder cancer. This is complex surgery, associated with significant patient morbidity and mortality. Frailty has been shown to be an independent risk factor for adverse outcomes in several surgical populations. Preoperative assessment of frailty is advocated in current guidelines but is not yet standard clinical practice. Aims: This systematic review and narrative synthesis aims to examine whether patients undergoing RC are assessed for frailty, what tools are used, and whether an association is found between frailty and adverse outcomes in this population. Results: Nine studies, published within the last 4 years, describe the use of tools reporting to measure frailty in the RC population. All demonstrate increased risk of adverse postoperative outcomes with higher frailty levels. Only one study used a validated frailty tool. The majority of studies measure frailty using variations on a tool derived from a large database (ACS-NSQIP) effectively counting co-morbidities, rather than assessing the multidomain nature of the frailty syndrome. Conclusion: The recognition of frailty as an important consideration in the perioperative period is welcome. This systematic review and narrative synthesis demonstrates the need for collaboration in research and delivery of clinical care for older surgical patients. Such collaboration may provide clarity regarding terms such as frailty and multimorbidity, preventing the development of assessment tools inaccurately measuring these discreet syndromes interchangeably. More accurate assessment of patients in terms of frailty, multimorbidity and functional status may allow better modification and shared decision making leading to improved postoperative outcomes in older patients undergoing RC.

scholarly journals Neuropsychological and Functional Impact of COVID-19 on Mild Cognitive Impairment

2020 ◽  
Vol 35 ◽  
pp. 153331752096087
Author(s):  
Kalpana P. Padala ◽  
Christopher M. Parkes ◽  
Prasad R. Padala
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Case Report ◽  
Mild Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Older Adult ◽  
Daily Living ◽  
Functional Decline ◽  
Depression And Anxiety ◽  
Physically Active

We present a case report to showcase that behavioral, cognitive, and functional decline may be associated with COVID-19 stay-home guidance among older adults with pre-existent cognitive impairment. In a functionally independent and physically active older adult with Mild Cognitive Impairment, there was worsening in depression and anxiety symptoms associated with the restrictions of COVID-19. Functional decline was also noted as assessed by Instrumental Activities of Daily Living. We discuss solutions to mitigate the effects of COVID-19 restrictions in this vulnerable population.

scholarly journals Age, Period, and Cohort Effects on Activities of Daily Living, Physical Performance, and Cognitive Functioning Impairment Among the Oldest-Old in China

2019 ◽  
Vol 75 (6) ◽  
pp. 1214-1221 ◽  
Author(s):  
Pei-Dong Zhang ◽  
Yue-Bin Lv ◽  
Zhi-Hao Li ◽  
Zhao-Xue Yin ◽  
Fu-Rong Li ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Activities Of Daily Living ◽  
Physical Performance ◽  
Functional Impairment ◽  
Daily Living ◽  
Oldest Old ◽  
Cohort Effects ◽  
Birth Cohorts ◽  
Function Impairment

Abstract Background The aim of this study was to examine the trends in impairment regarding activities of daily living (ADL), physical performance, and cognitive function among the oldest-old (those aged 80 and older) in China between 1998 and 2014. Methods We used data on 34,297 oldest-old individuals from the seven waves of the Chinese Longitudinal Healthy Longevity Study. We estimated age, period, and cohort effects on the prevalence of self-reported ADL impairment, tested physical performance and cognitive function impairment using the age–period–cohort model. Results Regarding age, the prevalence of ADL, physical performance, and cognitive function impairment were highest in the centenarians, but they did not increase with age in this population. Among the literate subgroup, the prevalence of cognitive impairment increased more rapidly with age than that in the illiterate subgroup. Regarding period, the prevalence of self-reported and tested physical impairment slowly increased between 1998 and 2014, but cognitive impairment remained stable. Regarding cohort, ADL impairment continuously decreased. However, physical and cognitive impairment remained stable after a brief decline in the early birth cohorts. Conclusions The results suggest that the age effect is still the most obvious effect regarding several types of functional impairment. The likelihood of a younger person experiencing functional impairment may not change significantly, but ADL is likely to be amenable to improvement resulting from improved medical and social care. Therefore, increased care for the oldest-old may considerably improve their quality of life, particularly regarding their basic ADL.

scholarly journals Neurocognitive function monitoring

2015 ◽  
Vol 02 (03) ◽  
pp. 246-256 ◽  
Author(s):  
Dilip Kulkarni ◽  
Srilata Moningi
Keyword(s):  
Cognitive Function ◽  
Risk Stratification ◽  
Elderly Patients ◽  
Cognitive Functioning ◽  
Cognitive Assessment ◽  
Perioperative Period ◽  
Assessment Tools ◽  
Major Surgery ◽  
Neurosurgical Procedures ◽  
Preoperative Patient

AbstractNeuro-cognitive dysfunction quite frequently occurs after major surgery particularly in elderly patients. Cognitive function monitoring becomes an important tool in the perioperative period, especially for patients undergoing neurosurgical procedures as these patients are at a greater risk because of the nature of surgery. Many cognitive assessment tools were described, but selecting a tool or combination of tools to assess depends on preoperative patient condition, availability of informant and post-operative course. The cognitive functioning monitoring is crucial for risk stratification to allow for subsequent prophylaxis, surveillance, and treatment of post-operative cognition dysfunction.

Effect of Baduanjin exercise on cognitive function in patients with post-stroke cognitive impairment: a randomized controlled trial

2020 ◽  
Vol 34 (8) ◽  
pp. 1028-1039 ◽  
Author(s):  
Guohua Zheng ◽  
Yuhui Zheng ◽  
Zhenyu Xiong ◽  
Bingzhao Ye
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Function ◽  
Outcome Measures ◽  
Daily Living ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Control Group ◽  
Rehabilitation Treatment ◽  
Global Cognitive Function ◽  
Delayed Recognition

Objective: To investigate the effectiveness and safety of Baduanjin training on the cognitive function in stroke survivors with cognitive impairment. Design: A randomized, two-arm parallel controlled trial with allocation concealment and assessors blinding. Setting: Community centre of Fuzhou city, China. Subjects: A total of 48 participants were recruited and randomly allocated into the Baduanjin exercise intervention or control group. Interventions: The control group maintained original medication and rehabilitation treatment. The Baduanjin training group received 24-week Baduanjin training with a frequency of three days a week and 40 minutes a day based on original medication and rehabilitation treatment. Main outcome measures: The primary outcome was global cognitive function. Secondary outcome measures included the specific domains of cognition (i.e. memory, processing speed, execution, attention and visuospatial ability) and activities daily living. Results: In total, 41 (Baduanjin n = 22, control n = 19) participants completed 24-week treatment and data collection. Mean differences between groups at 24-week treatment were statistically significant for global cognitive function (MoCA: 2.54 (0.91 to 4.16)), execution (TMT-A: −42.4 (−75.0 to −9.8); TMT-B: −71.3 (−130.6 to −12.1)), memory (immediate recall: 2.11 (0.49 to 3.73); short-term delayed recognition: 2.47 (0.58 to 4.35) and long-term delayed recognition: 1.68(0.18 to 3.17)), attention (response time of alertness: −245.5 (−387 to −104)) and activities of daily living (modified Barthel Index). Conclusion: Regular Baduanjin training is associated with less loss of cognitive function in patients after stroke.

scholarly journals The Role of Functional Assessment as an Outcome Measure in Antidementia Treatment

2007 ◽  
Vol 34 (S1) ◽  
pp. S47-S51 ◽  
Author(s):  
Fadi Massoud
Keyword(s):  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Functional Assessment ◽  
Daily Living ◽  
Outcome Measure ◽  
Functional Decline ◽  
Evaluation Of Performance ◽  
Intervention Trials ◽  
Assessment Scales

Functional assessment refers to the evaluation of performance in basic activities of daily living, instrumental activities of daily living, professional duties, and hobbies. This assessment is particularly relevant in the evaluation of cognitive impairment. In fact, functional decline represents a core feature of dementia according to the DSM-IV criteria. Clinically, functional deterioration represents a diagnostic marker, can be used to chart the course of the disease, and as a prognostic marker as it contributes significantly to caregiver burden and institutionalization. For all these reasons, functional assessment has been widely used as an outcome measure in intervention trials of Alzheimer disease (AD). Appropriate function assessment scales have been developed for use in clinical trials of AD. Studies have shown that functional decline benefits from pharmacological interventions in AD and some other cognitive syndromes. This benefit translates into a stabilization ranging between 6 to 12 months compared to a gradual deterioration in the placebo group. There is rarely reversibility for IADL's lost. There are no functional scales specifically designed for assessment of subjects with non-AD cognitive impairment. Scales specifically developed for Mild Cognitive Impairment and other dementias are needed.

Postoperative Delirium is Associated with Postoperative Cognitive Dysfunction at One Week after Cardiac Surgery with Cardiopulmonary Bypass

2009 ◽  
Vol 105 (3) ◽  
pp. 921-932 ◽  
Author(s):  
Judith A. Hudetz ◽  
Alison J. Byrne ◽  
Kathleen M. Patterson ◽  
Paul S. Pagel ◽  
David C. Warltier
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Cardiopulmonary Bypass ◽  
Cognitive Dysfunction ◽  
Postoperative Delirium ◽  
Postoperative Cognitive Dysfunction ◽  
Surgical Patients ◽  
Nonverbal Memory ◽  
Surgery Group

Postoperative delirium with cognitive impairment frequently occurs after cardiac surgery. It was hypothesized that delirium is associated with residual postoperative cognitive dysfunction in patients after surgery using cardiopulmonary bypass. Male cardiac surgical patients ( M age = 66 yr., SD = 8; M education = 13 yr., SD = 2) and nonsurgical controls ( M age = 62, SD = 7; M education = 12, SD = 2) 55 years of age or older were balanced on age and education. Delirium was assessed by the Intensive Care Delirium Screening Checklist preoperatively and for up to 5 days postoperatively. Recent verbal and nonverbal memory and executive functions were assessed (as scores on particular tests) before and 1 wk. after surgery. In 56 patients studied ( n = 28 Surgery; n=28 Nonsurgery), nine patients from the Surgery group developed delirium. In the Surgery group, the proportion of patients having postoperative cognitive dysfunction was significantly greater in those who experienced delirium (89%) compared with those who did not (37%). The odds of developing this dysfunction in patients with delirium were 14 times greater than those who did not. Postoperative delirium is associated with scores for residual postoperative cognitive dysfunction 1 wk. after cardiac surgery.

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