Dementia and Geriatric Cognitive Disorders Extra最新文献

Background: Switzerland's demographic trends show, as elsewhere on the planet, increasing numbers of older and very old adults. This suggests that its healthcare system will suffer serious repercussions, including in the use of care and especially the use of emergency services. Significant numbers of older adults will be at risk of developing multiple chronic conditions including one or more geriatric syndromes, such as frailty and delirium. Few studies to date have documented associations between frailty and delirium.

Aim: To explore the relationships between frailty and delirium in older adult patients consulting (n = 114) at an emergency department (ED) in Switzerland.

Method: A cross-sectional study was conducted in a peripheral hospital ED in the French-speaking part of Switzerland. Frailty was assessed using the Tilburg Frailty Indicator (TFI). Delirium was assessed using the Confusion Assessment Method (CAM). Participants' cognitive states were assessed using the 6-item Cognitive Impairment Test (6CIT) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQ-CODE), completed by the participant's most significant informal caregiver.

Results: The mean participant age was 77.6 years (SD = 7.7); the majority of the subjects were women (54%). The participants took an average of 4.7 different medications a day (SD = 3.2, median = 4). More than half (62%) of the participants were frail; 2 and 14% presented signs and symptoms of delirium and subsyndromal delirium, respectively. A weak but significant association between scores for frailty and delirium (p < 0.05) was demonstrated, and clinical observation confirmed this. A 4-h follow-up measurement of delirium in the ED revealed no significant or clinical difference.

Conclusion: Although the literature describes strong associations between frailty and delirium in surgical units and community care settings, the present study only demonstrated a weak-to-moderate association between frailty and delirium in our ED.

Aim: The aim of this study was to determine Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) evaluations that will enable better understanding of the severity of Alzheimer's disease (AD).

Methods: AD patients were evaluated by Functional Independence Measure (FIM), Hyogo Activities of Daily Living Scale (HADLS), and Assessment of Motor and Process Skills (AMPS) to identify the assessments that will enable highly precise discrimination of AD Clinical Dementia Rating (CDR) 2 (moderate) and CDR3 (severe) using receiver operating characteristic (ROC) curve and discriminant analyses.

Results: The participants were 75 AD patients (CDR2 = 50, mean age = 80.3 ± 5.9 years; CDR3 = 25, mean age = 78.3 ± 9.0 years). The evaluation methods consisted of FIM, HADLS, and AMPS. The results were divided into FIM-M, FIM-C, HADLS-ADL, HADLS-IADL, AMPS-motor skills, and AMPS-process skills. The values for the area under the curve (AUC) were compared by ROC curve and discriminant analyses. AUC values for FIM-C and AMPS-process skills were 0.956 and 0.947, respectively. With these two evaluations only, values ≥0.9 were shown. Moreover, the AUC of the discrimination score (combination of the FIM-C and AMPS-process skills) was significantly higher than those for FIM-M, FIM-C, HADLS-ADL, HADLS-IADL, and AMPS-motor skills.

Conclusions: The results demonstrated that evaluation by FIM-C and AMPS-process skills methods was useful for discriminating between CDR2 (moderate) and CDR3 (severe) AD. Moreover, the results indicated that these two evaluation methods enabled more accurate determination of severity and the spared capabilities of AD patients.

Background/aims: The available episodic memory tests are not specifically constructed to examine older subjects. Their use in outpatient memory clinics may result in aborted test administration. We used a strict adherence to the test protocol in cognitively healthy, amnestic mild cognitive impairment (aMCI), and Alzheimer's disease dementia subjects to assess the possibility of preventing this.

Methods: This is a cross-sectional study in memory outpatient subjects with a mean age of 74.5 years. Primary study outcomes were: number of missing values and test results in the Visual Association Test (VAT) and the 15 Word Test (15WT).

Results: A strict adherence to the test protocol resulted in a 10-fold decrease in the number of missing values in the VAT. For the 15WT this could not be realized mostly because the test was deemed too demanding for 1 in 6 patients.

Conclusions: This study is one of the few examining the applicability of well-known episodic memory tests in older subjects. A strict adherence to the test protocol reduced the number of missing values. Floor effects were stronger for the 15WT than for the VAT. Results favor the use of the VAT in senior subjects and show the unsuitability of the 15WT in this group.

Background: Requests for physician-assisted death (PAD) in patients with cognitive impairment are complex and require careful consideration. Of particular difficulty is determination of whether the request is voluntary and well considered.

Results: Euthanasia and physician-assisted suicide (PAS) are both legal in The Netherlands, Luxemburg, Colombia, and Canada. Euthanasia is legal in Belgium, while PAS is legal in Switzerland and Oregon, Washington, Montana, Vermont, and California (USA). Upon a PAD request, evaluation of the capacity to consent medical treatment is relevant for the decision-making process, while evaluation of testamentary capacity is appropriate before an advance euthanasia directive is written. Anosognosia assessment throughout the Alzheimer's disease continuum provides essential and relevant information regarding the voluntary and well-considered nature of the PAD request; meanwhile, early assessment of hypernosognosia or subjective cognitive decline assists in formulation of a clinical prognosis. Furthermore, the assessment of physical and psychological suffering should incorporate verbal and nonverbal cues as well as consideration of the psychosocial factors that might affect due care criteria.

Conclusion: The clinical approach to a PAD request should consider the legal framework and the decision-making capacity, assess memory deficit awareness and the perception of suffering, and evaluate mental competency when considered pertinent.