European Journal of Internal Medicine最新文献

This paper provides a comprehensive overview of dementia in internal medicine hospital settings, highlighting its clinical detection, key red flags and frailty factors, as well as intervention perspectives. Dementia, a multifactorial neurocognitive syndrome represents a major global health challenge due to its rising prevalence, significant socioeconomic burden, and frequent comorbidity with chronic diseases. The paper underscores the importance of early identification and management of dementia in hospitalized older adults, emphasizing the heterogeneity of presentations including delirium, acute cognitive deterioration, and previously undiagnosed cases. It outlines biological, psychological, and social factors influencing dementia progression and frailty, advocating for holistic, biopsychosocial approaches. Clinical red flags and diagnostic pathways tailored for non-specialist hospital settings are discussed, alongside the role of biomarkers and neuroimaging in differential diagnosis. The paper details common neuropsychiatric symptoms of dementia and the challenges they pose for patient care. It stresses the need for dementia-friendly hospital models through environmental adaptation, staff training, and caregiver integration. Interventions addressing both formal healthcare workers and informal caregivers are reviewed too. Pharmacological treatments are considered with caution due to mixed efficacy and safety concerns, highlighting the growing role of novel anti-amyloid therapies under evaluation. Non-pharmacological cognitive and motor rehabilitation interventions are recognized as promising yet underutilized strategies. The paper advocates for integrated, person-centered dementia care models spanning hospital and community to improve outcomes and optimize resource use. The overarching message promotes early detection, multidimensional management, and systemic healthcare planning to meet the complex needs of this vulnerable population.

Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disease with a high risk of iron deficiency anemia secondary to epistaxis and gastrointestinal bleeding. Atrial fibrillation (AF) is associated with a high risk of ischemic stroke and oral anticoagulation therapy is indicated for its prevention. Percutaneous left atrial appendage closure (LAAC) is recommended to prevent stroke in patients with AF and high risk of bleeding such as HHT patients. However, double antiplatelet therapy at first, followed by long-term single antiplatelet therapy, is also recommended after the procedure to prevent device-related thrombus (DRT), which most HHT patients cannot tolerate. This prospective observational study describes 36 HHT patients with AF, 23 of whom underwent LAAC. To prevent DRT, simple antiplatelet therapy was indicated for 3 months if tolerated. In addition, a systematic review on LAAC in HHT patients was performed to compare our results with what has been previously reported. A total of 57 HHT patients with AF and LAAC were analysed. Although only 12.3% tolerated long-term simple antiplatelet therapy, none presented DRT during follow-up. Three ischemic events were reported but only one of them appears to be partially related to AF in a patient with significant leakage peri-device. In conclusion, percutaneous LAAC is a safe and potentially effective strategy for preventing ischemic stroke in HHT patients with AF. A simplified and personalized antiplatelet regimen was not associated with DRT or ischemic events.