Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium

OBJECTIVES: To measure the prevalence of depressive symptoms, cognitive impairment, and delirium in patients with hip fracture and to estimate their effect on functional recovery, institutionalization, and death after surgical repair.
DESIGN: Prospective cohort.
SETTING: Hospital, follow-up to community and nursing home.
PARTICIPANTS: One hundred twenty-six patients aged 65 and older admitted for hip fracture repair.
MEASUREMENTS: Baseline measurements: Mini-Mental State Examination, Blessed Dementia Rating Scale, Geriatric Depression Scale, prefracture activities of daily living (ADLs), ambulatory status. The Confusion Assessment Method was used to diagnose in-hospital delirium. One- and 6-month outcomes were ADL decline, loss of ambulation, and new nursing home placement or death.
RESULTS: Twenty-two percent of patients had one cognitive or mood disorder, 30% had two, and 7% had three. At 1 month, each cognitive or mood disorder was independently associated with one or more adverse outcome. Considered together, each additional cognitive or mood disorder was associated with greater odds of 1 month outcomes (ADL decline: odds ratio (OR)=1.8, 95% confidence interval (CI)=1.1–2.9; decline in ambulation: OR=1.8, 95% CI=1.1–3.0; nursing home placement or death: OR=3.9, 95% CI=1.9–8.1).
CONCLUSION: Cognitive and mood disorders were common in elderly hip fracture patients and were associated with greater risk of poor outcomes, both independently and in combination. Recognition and treatment of these conditions may reduce adverse outcomes in this vulnerable population.     

中国老年人认知障碍患病率的系统评价

目的 系统评价我国老年人认知障碍患病率的现况.方法 使用计算机检索中英文数据库,筛选符合纳入条件的流行病学研究,提取资料并做偏倚风险评估.采用Stata 15.0软件进行系统评价.结果 共纳入32项原始研究,我国老年人认知障碍总体患病率为8.2％,男性的低于女性(7.9％ vs 9.6％).患病率随年龄增长而升高,随文...     

合并视力障碍的老年内科住院病人谵妄发生率及影响因素

目的 了解视力障碍的老年内科疾病病人住院期间谵妄发生率和相关影响因素.方法 采用前瞻性队列研究方法,入选2016年3月至2017年1月四川大学华西医院老年科存在视力障碍的老年住院病人.入院48 h内对病人进行视力检查和谵妄相关危险因素评估,从住院当天至住院第13天每隔一天对病人进行谵妄评估,记录住院期间有无发生谵妄,并...     

血管危险因素与老年认知功能障碍的研究进展

血管危险因素与老年认知功能障碍的发生密切相关。由血管危险因素引起的老年认知功能障碍的发病率逐年上升,严重危害老年人的健康。高血压、糖尿病、高脂血症和慢性脑低灌注等是影响老年认知功能的重要的血管危险因素。研究血管危险因素与老年认知功能障碍的关系及作用机制,对于老年认知功能障碍的早期诊断和早期干预,具有重要的社会学和医学意义。     

Dental health and cognitive impairment in an English national survey population

OBJECTIVES: To investigate the association between dental health and cognitive impairment and to examine the extent to which dental status accounts for the association between cognitive impairment and low body mass index (BMI) in a national survey sample. DESIGN: A secondary analysis of data from the Health Survey for England 2000. SETTING: A nationally representative cross-sectional population survey. PARTICIPANTS: Two thousand four hundred sixty-three adults aged 65 and older living in private households and 1,569 adults aged 65 and older living in care homes. MEASUREMENTS: Data collected by interview (self-reported or by proxy) included age, sex, level of education, disability, BMI, dental status, and cognitive function (Abbreviated Mental Test Score). RESULTS: Less than half of the community sample (40.4%) and 67.9% of the care home sample were edentulous; lack of teeth was significantly associated with cognitive impairment (odds ratio=3.59, 95% confidence interval=2.36-5.47). This association remained strong after adjustment for other covariates only in the community sample. Cognitive impairment was associated with lower BMI in both samples, but dental status did not explain this. CONCLUSION: Poor dentition is associated with cognitive impairment. Nutritional status in people with cognitive impairment is recognized to be at risk. Although dental health did not account for the association between cognitive impairment and low BMI in this sample, other possible nutritional consequences require further evaluation.     

The relationship between a fish-rich diet and poststroke cognitive impairment: A cross-sectional study with a follow-up in China

Whether a fish-rich diet is positively associated with cognitive function after stroke remains unclear; thus, the present study investigated the relationship between them.The present study was part of a prospective multicenter study, in which 920 individuals (609 males, mean age, 62.78 ± 11.79 years) were included from November 2013 to December 2015. The cognitive function of the patients was evaluated, and the diagnosis of poststroke cognitive impairment (PSCI) was made during their stay in the hospital. A subgroup of 439 patients from a single center was followed up for 4 to 6 years and was reassessed for cognitive function.According to the diagnostic criteria, the PSCI prevalence was lower in the fish-rich diet group (P < .05). After adjusting for demographic and clinical variables by logistic regression, patients with a habit of consuming a fish-rich diet had a lower risk of developing PSCI than patients without a fish-rich diet (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.46–0.95). When MMSE score was considered the cognitive function outcome variable, the long-term cognitive function of the fish-rich diet group was better (28 [26–30] vs 27 [25–29], P < .01), but the statistical results were not significant after correcting for the related confounding factors (β: 0.13; 95% CI: −0.99–1.25; P = .82).There was a negative relationship between consuming a fish-rich diet and the prevalence of PSCI, and there was no statistically significant difference in the relationship of a fish-rich diet on long-term cognitive function after stroke, which requires further study.     

Mild cognitive impairment and 10-year trajectories of disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly cohort

OBJECTIVES: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI. DESIGN: Prospective cohort; 10 years of follow-up. SETTING: Community-based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa). PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged > or = 65; N = 3,673; 61.3% female; 99.9% white). MEASUREMENTS: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20-item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions. RESULTS: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (< or = 1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median = 0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range = 0.12-0.36). CONCLUSION: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability--a prerequisite for a diagnosis of dementia.     

Transfer bias and the association of cognitive impairment with falls

The authors hypothesized that cognitive impairment is associated with falls in older adults, but that transfer bias may obscure this association in cross-sectional community studies. The bias would arise if demented patients who fall are relatively unavailable to community surveys due to death or institutionalization. To test this hypothesis, a “dose-response” relationship between falls and cognitive impairment was tested for using data from a longitudinal cohort study of 157 patients with Alzheimer-type dementia. In a cross-sectional analysis of baseline data, when 96% of the cohort were community residents, the association between falls and cognitive impairment was insignificant (odds ratio for a 10-point change in Mini-mental State score =1.2, 95% confidence interval 0.76–1.9). Yet cognitive impairment at baseline predicted falls during three-year follow-up (OR=1.8, 95% CI 1.1–3.0). Both severity of dementia and falls were risk factors for death or institutionalization. Patients at highest risk for leaving the community during follow-up were those who became non-ambulatory. The authors conclude, based on longitudinal data, that there is a dose-response effect between cognitive impairment and falls. Transfer bias probably obscured the association at baseline. These data emphasize the importance of prospective studies of falls. Received from the Departments of Health Services and Medicine, University of Washington, Seattle, Washington, and the Northwest Health Services Research and Development Field Program, Seattle VAMC, Seattle, Washington. Supported in part by grants AG05136, AG06456, P50MH40014, and 5-R01-MH33041. Dr. Larson was a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine. Presented in part at the 1987 national meeting of the American Federation for Clinical Research. An abstract describing part of this work has been published (Clin Res 35:34A, 1987). The views expressed are those of the authors.