Mini-Mental State Examination score and B-type natriuretic peptide as predictors of cardiovascular and total mortality in an elderly general population

Abstract

Introduction. The aim of the present study was to examine the power of B-type natriuretic peptide (BNP) and mild cognitive impairment as independent predictors of total and cardiovascular mortality in combination with established cardiovascular risk markers in an elderly general population without severe cognitive impairment.

Methods. A total of 499 individuals, aged more than 75 years, were examined and followed up for a median of 7.9 years in a prospective population-based stratified cohort study carried out in eastern Finland. The Cox proportional hazards regression model was used to determine the impact of multiple factors on total and cardiovascular mortality.

Results. In a multivariable model including established cardiovascular risk factors and conditions, both continuous BNP (adjusted hazard ratio (HR) 1.44 for a 1-SD change; 95% confidence interval (CI) 1.22–1.77; P < 0.001) and continuous MMSE score (HR 0.81 for a 1-SD change; 95% CI 0.70–0.94; P = 0.007) were independently associated with all-cause mortality. In a multivariable model, BNP remained a significant predictor of cardiovascular mortality, while MMSE score lost its significance.

Conclusions. BNP, a measure of cardiovascular burden, and MMSE score 18–23, an indicator of mild cognitive impairment, are both independent predictors of total mortality. BNP and MMSE score may potentially be useful in screening elderly patients for elevated risk of mortality.     

≥75岁急诊心房颤动患者的预后分析——中国急诊心房颤动研究的亚组分析

目的:了解老年（年龄≥75岁）急诊心房颤动（房颤）患者的预后情况,分析不良预后的危险因素。方法:2009年至2011年在全国20家医院连续入选急诊就诊、年龄≥75岁房颤患者为本研究对象,收集患者基线资料和治疗情况,并进行1年随访,主要终点事件为全因死亡,次要终点事件为心血管死亡、卒中、大出血事件及主要不良事件。应用单因素和多因素Cox回归模型分析上述事件的独立危险因素。结果:共入选766例老年急诊房颤患者,年龄(80.76±4.66)岁,女性占56.9%。1年的全因病死率为24.3%,心血管病死率为12.8%,卒中发生率为10.6%,主要不良事件发生率33.6%,再入院率32%。多因素Cox回归模型分析显示年龄（ HR1.073,95% CI 1.042~1.105）、心率（ HR 1.008,95% CI 1.002~1.013）、痴呆/认知障碍史（ HR 1.849,95% CI 1.016~3.365）、既往慢性阻塞性肺疾病史（ HR 1.824,95% CI 1.303~2.551）为老年房颤患者1年死亡的独立危险因素。女性（ HR 1.664,95% CI 1.036~2.675）、高血压病史（ HR 2.035,95% CI 1.080~3.836）、痴呆/认知障碍史（ HR 2.773,95% CI 1.220~6.302）、为老年房颤患者1年卒中的独立危险因素。 结论:老年急诊房颤患者的预后较差,年龄、心率、痴呆/认知障碍史、慢性阻塞性肺疾病史是老年急诊房颤患者1年全因死亡和主要不良事件的独立危险因素;女性、高血压病史、痴呆/认知障碍史为老年急诊房颤患者1年卒中的独立危险因素。     

高血压与老年人认知功能障碍的相关性

目的探讨老年人高血压与认知功能障碍的相关性 方法选择2011年1月~2013年12月在我院就诊的原发性老年高血压患者（病程5年以上）326例作为观察组,并选取老年健康人群320例作对照。对选择对象采用中文版简易智能量表评定认知功能,对两组人群采用对照分析的方法。 结果（1）高血压组患者的简易智能量表得分均明显低于正常对照组（P<0.01）;高血压组患者的轻度认知功能障碍比例明显高于正常对照组（P<0.01）;（2）随着血压分级的升高,简易智能量表得分呈下降趋势,轻度认知功能障碍的患病率也随之增高,差异均有显著性意义（P<0.01）;（3）轻度认知功能障碍患病率与高血压分级、LDL-c、OGTT2 h血糖呈显著正相关。 结论（1）高血压疾病与老年人认知障碍的发生关系密切,并且高血压程度越高,认知障碍越严重;（2）老年人认知障碍与高血压分级、低密度脂蛋白、OGTT2 h血糖等危险因素相关。      

老年脑血管狭窄患者认知功能的改变及影响因素

目的 观察老年脑血管狭窄患者认知功能的改变,并分析影响因素。方法 选取200例老年缺血性脑血管病患者作为研究对象,对其脑血管狭窄情况、脑血管病危险因素情况及存在脑血管狭窄患者的精神状态检查量表(MMSE)评分及认知功能障碍发生率进行观察和比较。结果 有脑血管狭窄患者的年龄、合并高血压比例、合并糖尿病比例、血浆同型半胱氨酸(Hcy)水平、血浆纤维蛋白原水平、血清总胆固醇水平均显著高于无脑血管狭窄的患者(t=4.223、3.812、3.635,χ2=33.734、9.814,均P0.05);轻度狭窄患者的MMSE总分、即刻回忆力评分、注意计算力评分、延迟回忆力评分均显著高于中度狭窄患者或重度狭窄患者,中度狭窄患者的MMSE总分、延迟回忆力评分均显著高于重度狭窄患者,重度狭窄患者的认知功能障碍发生率显著高于中度狭窄患者,中度狭窄患者的认知功能障碍发生率显著高于轻度狭窄患者,差异均有统计学意义(P0.05);Logistic多元回归分析结果显示,患者发生认知功能障碍与年龄(OR=1.397)、合并高血压(OR=1.456)、血浆Hcy水平(OR=1.658)和脑血管狭窄程度(OR=2.138)具有相关性(均P0.05)。结论 脑血管狭窄可能参与了认知功能损害的病理过程,可作为预测患者认知功能障碍发生风险的辅助指标。     

老年缺血性脑卒中患者社会网络与认知功能的相关性研究

目的探讨老年脑卒中患者社会网络与认知功能及其各领域的相关性。方法采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、记忆与执行筛查量表(分为MES-M和MES-E)、语言功能量表(LAST)、社会网络量表(LSWS-6)对2018年8月-2019年5月复旦大学附属上海市第五人民医院收治的141例老年脑卒中患者进行评估;采用Pearson和Spearman相关对认知功能的影响因素进行单因素分析,基于社会网络影响健康结局的理论和单因素分析结果建立结构方程模型。结果研究对象中认知障碍与轻度认知障碍发生率分别为33.3%和94.3%。路径分析显示:年龄、婚姻状况、文化程度、有氧运动、抑郁状态、神经功能缺损评分(NIHSS)等直接和(或)间接影响老年患者认知功能,社会网络在文化程度与MMSE、MoCA、MES-M之间起中介作用,中介效应值分别为0.047、0.065、0.092,社会网络在抑郁状态与MMSE之间的中介效应值为-0.105。结论脑卒中后认知障碍在老年缺血性脑卒中患者中十分常见,受多种因素影响,抑郁状态和社会网络均对认知功能有显著影响,社会网络在抑郁状态与认知功能之间起中介作用。医护人员及其照顾者应注意加强老年患者社会交往活动,以延缓脑卒中后认知障碍进展过程。     

脑卒中相关白质疏松改变对认知功能的影响

目的探讨脑卒中相关的白质疏松(leukoariosis,LA)改变是否影响认知功能。方法利用简易精神状态量表(MMSE)作为认知功能的测评工具,比较LA伴腔隙梗死、单纯腔隙梗死、健康对照组间MMSE分值。结果LA组MMSE评分最低,与腔隙梗死及健康对照组间比较均有显著性差异(P<0.01);重度LA组MMSE评分最低,与轻度组及无LA组间比较均有显著性差异(P<0.01);半球前部LA与MMSE评分间有相关关系。结论重度LA对认知功能有影响;LA累及的部位不同对认知功能影响也不同,其中以半球前部LA影响最大。     

脑白质病变与老年首次短暂性脑缺血/轻型卒中患者认知功能障碍的研究

目的探讨老年首次短暂性脑缺血/轻型卒中患者认知功能障碍与脑白质高信号（WMHs）的关系。 方法选取2015年1月至2018年12月无锡市锡山人民医院神经内科收治的,符合标准的105例老年首次短暂性脑缺血/轻型卒中患者,均行头颅MRI等检查,患者认知障碍根据蒙特利尔认知评估量表（MoCA）评分结果分为无认知障碍组、暂时性认知障碍组和持续性认知障碍组。采用单因素方差分析比较3组间年龄、美国国立卫生院卒中量表评分、MoCA评分的差异,组间差异两两比较应用q检验;采用χ²检验比较组间性别（男性）、高血压、糖尿病、高脂血症、MRI影像改变及梗死部位的差异;采用多因素Logistic回归分析老年首次短暂性脑缺血/轻型卒中患者发生认知功能障碍的危险因素。 结果持续性认知障碍组患者的年龄、男性比例和WMHs比例高于无认知障碍组,差异均具有统计学意义（P<0.05）;而在高血压、糖尿病、高脂血症、脑微出血、血管间隙扩大、腔隙性缺血灶、磁共振弥散加权成像（DWI）阳性病变及DWI显示脑梗死病变部位比较差异均无统计学意义（P均>0.05）。WMHs病变程度越严重,发生认知障碍的比例越高,差异具有统计学意义（P<0.05）。经校正年龄、性别、高血压、糖尿病等因素后,年龄和中-重度WMHs病变为老年首次短暂性脑缺血/轻型卒中后持续性认知功能障碍发生的独立危险因素（OR：1.08,95%CI：1.01~1.15,P=0.021;OR：1.66,95%CI：0.79~2.89,P=0.042）。 结论年龄和WMHs中-重度病变为老年首次短暂性脑缺血/轻型卒中患者第90天后发生持续性认知障碍的危险因素。     

抑郁和焦虑与老年认知障碍患者认知水平的相关性分析

目的：探讨老年认知障碍患者抑郁和焦虑评估的临床价值，分析老年认知功能减退的可能影响因素。方法：筛选2019年6月至2021年11月期间在复旦大学附属华山医院老年医学科门诊就诊的可疑认知障碍老年人群，检测其认知水平、抑郁和焦虑评分及相关生化指标。按照认知水平分为3组：非认知障碍组、轻度认知障碍组（MCI）及痴呆组。完成认知水平测试（MMSE+MoCA)及焦虑和抑郁评估（PHQ-9+GAD-7），同时完成甲状腺功能、梅毒/艾滋病血清标志物、血同型半胱氨酸（HCY）、叶酸、维生素B12、自身免疫性脑炎抗体等血液生化学检查及尿液阿尔兹海默相关神经丝蛋白（AD7c-NTP）检测。结果：共入组242例可疑老年认知障碍患者，其中非认知障碍组37例，MCI组62例，痴呆组143例，三组人群抑郁检出人数分别为12例（32.4%）、30例（48.4%）和82例(57.3%)，焦虑检出人数分别为10例(27.0%)、24例（38.7%）和72例（50.3%），非认知障碍组和痴呆组之间具有显著差异；三组人群之间甲状腺功能、梅毒/艾滋病血清标志物、自身免疫性脑炎抗体异常率均无明显差异；三组人群之间HCY、叶酸、AD7c-NTP异常率具有显著性差异，但维生素B12异常率无显著性差异；多元Logistics回归分析显示，与非认知障碍组比较，MCI组与年龄和GAD-7评分呈正相关；痴呆组与年龄、HCY水平、PHQ-9和GAD-7评分等危险因素之间存在正相关；痴呆组与MCI组比较，GAD-7评分明显增高(p＜0.05)，而两组年龄、HCY、叶酸和PHQ-9评分之间无明显差异。结论：老年认知障碍患者易伴抑郁、焦虑等不良情绪，抑郁和焦虑情绪与年龄、认知功能及HCY和叶酸水平之间存在一定相关性。以上研究提示门诊接诊可疑老年认知障碍患者时，有必要对患者进行认知功能评估的同时完善抑郁和焦虑评估。     

老年阿尔茨海默病患者血清Lp-PLA2，NLRP3 水平表达及其与认知功能损害的相关性

目的 分析阿尔茨海默病(AD)患者血清脂蛋白相关磷脂酶A2(lipoprotein related phospholipase, Lp-PLA2),NOD 样受体家族蛋白3(nod-like receptor family protein 3, NLRP3)的表达,及其与认知功能损害的关系。方法 测定110例AD患者(AD组)及50例健康体检者(对照组)血清中Lp-PLA2和NLRP3表达水平,并采用蒙特利尔认知评估量表(MoCA)、简易精神状态量表(MMSE)和临床痴呆量表(CDR)评估患者认知能力。根据CDR评分将AD组患者分为轻度AD组(n=61)和中重度AD组(n=49)。分析各组血清Lp-PLA2和NLRP3表达水平与认知功能损害的相关性。结果 与轻度AD组比较,中重度AD组MoCA和MMSE评分均明显下降,CDR评分明显升高(t=10.21,9.17和7.96,均P<0.05)。与对照组比较,轻度、中重度AD组血清Lp-PLA2,NLRP3水平均明显升高(P<0.05)。与轻度AD组比较,中重度AD组血清Lp-PLA2,NLRP3水平亦显著升高(P<0.05)。Pearson线性相关分析显示,AD患者血清Lp-PLA2,NLRP3水平与MoCA,MMSE评分均呈显著正相关,与CDR评分呈显著负相关(P<0.05)。结论 AD患者血清Lp-PLA2,NLRP3表达异常升高,与认知功能损害密切相关,可作为反映认知功能损害程度的早期血清学标志物。     

Comparing Cardiovascular Safety of Febuxostat and Allopurinol in the Real World: A Population-Based Cohort Study

ObjectiveTo determine and compare the risk of cardiovascular events and mortality of febuxostat and allopurinol use.Patients and MethodsWe conducted a cohort study using the Taiwan National Health Insurance Research Database. New users of febuxostat and allopurinol between April 1, 2012 and December 31, 2015 were identified, and the two groups were 1:1 matched by propensity score, benzbromarone use history, renal impairment, and time of drug initiation. The risk of major adverse cardiovascular events (MACEs), venous thromboembolism (VTE), heart failure (HF) hospitalization, atrial fibrillation hospitalization, cardiovascular (CV) death, and all-cause mortality was assessed using Cox proportional hazards models. The dose-response relationship between xanthine oxidase inhibitor use and adverse CV outcomes were also determined.ResultsA total of 44,111 patients were included for each group, and all baseline covariates were well matched. Febuxostat users were at a significantly higher risk for HF hospitalization (hazard ratio [HR], 1.22; 95% CI, 1.13-1.33), atrial fibrillation hospitalization (HR, 1.19; 95% CI, 1.05-1.36), and CV death (HR, 1.19; 95% CI, 1.03-1.36) than allopurinol users, whereas no difference was found for the major adverse cardiac events composite endpoint, venous thromboembolism, myocardial infarction, ischemic stroke, and all-cause mortality. The elevated risk of HF hospitalization was consistent throughout the primary and sensitivity analyses. In addition, febuxostat increased the risk of adverse CV outcomes in a dose-dependent manner.ConclusionThe use of febuxostat, compared with allopurinol, was associated with a significantly increased risk of adverse CV events. Higher febuxostat doses had a greater impact. Further studies are needed to investigate the mechanisms linking febuxostat to adverse CV outcomes.     

老年轻度认知功能障碍与心输出量的关系

目的探讨老年轻度认知障碍和心输出量的关系。方法收集入选246例老年患者一般资料,行心脏彩色多普勒超声检查,用左心室射血分数(LVEF)和心输出量(CI)来评价心输出量,并应用蒙特利尔认知评估量表(Mo CA)对研究对象进行认知功能评定,符合轻度认知障碍(MCI)诊断118例为病例组,余128例为对照组。结果两组年龄、LVEF、CI差异有统计学意义(P10.01,P20.01,P3=0.045),病例组受教育程度与冠心病患者比例高于对照组,差异有统计学意义(16.1%比76.6%,P0.01;74.6%比59.4%,P=0.015);LVEF与Mo CA评分成正相关(r=0.157,P=0.014);多因素分析显示,与MCI有关的因素是年龄、受教育程度、LVEF、CI,其OR(95%CI)分别为1.126(1.065~1.191),0.068(0.034~0.138),0.935(0.894~0.978),0.724(0.528~0.993)。结论心输出量减少是老年轻度认知功能障碍的独立危险因素。     

社区认知障碍老年人生活质量调查及影响因素分析

目的：探讨社区认知障碍老年人生活质量的影响因素,为提高社区认知障碍老年人生活质量提供早期干预措施。方法采用中文简易智力状态量表（Mini-Mental State Examination,MMSE）、日常生活自理能力量表（Activities of Daily Living, ADL）、健康调查简表（the MOS Item Short From Health Survey, SF-36）和一般资料问卷,对随机抽取的西安市815例社区老年人进行轻度认知障碍筛查。采用多元线性逐步回归分析影响轻度认知障碍老年人生活质量的相关因素。结果西安市社区老年人认知障碍的患病率为18.2%。多元线性逐步回归分析显示：年龄、性别、配偶及日常生活自理能力是社区认知障碍老年人生活质量的影响因素（P<0.05）。结论高龄、女性、无配偶及自理能力障碍是影响社区认知障碍老年人生活质量的独立危险因素,要加强对这部分老年人的关爱,提高其生活质量。     

东小口社区老年人认知障碍的影响因素分析

目的分析东小口社区老年人认知障碍的影响因素。方法将东小口社区366例参加老年人健康体检者按照记忆障碍自评量表(AD8)评分是否≥2分分为观察组(≥2分,认知障碍患者,116例)与对照组(<2分,健康体检者,250例)。分析认知障碍发生的影响因素。结果两组的社会活动能力评分、SDS评分、ADL评分、受教育年限、高血压、卒中史比较,差异均具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,社会活动能力评分、SDS评分及卒中史均为影响老年人认知障碍的独立危险因素(P<0.05)。结论社会活动能力、SDS评分及卒中史均为影响东小口社区老年人认知障碍的危险因素,临床需针对以上因素进行对症干预,以降低其罹患认知障碍的风险。     

Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

PURPOSE: To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture. METHOD: Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6 +/- 7.2 years, Mini Mental State Examination (MMSE) score 11.25 +/- 5.9), 23 with possible cognitive impairment (age 83.9 +/- 6.8 years, MMSE 22.65 +/- 1.6) and 10 without cognitive impairment (age 77.6 +/- 7.4 years, MMSE 29.5 +/- 0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain (admission FIM minus discharge FIM), relative (to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA). RESULTS: Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted (age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p < 0.03). However, the functional gain related to baseline functional status (ANCOVA) was not significantly different between the groups. CONCLUSIONS: In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.     

个体化作业疗法对老年脑卒中后认知障碍的影响

目的探讨个体化作业疗法对老年脑卒中认知障碍患者的康复疗效。方法60 例老年脑卒中认知障碍患者分为治疗组(n=30)和对照组(n=30),两组患者入院后均接受常规康复训练,治疗组在此基础上给予个体化作业治疗。治疗前后采用简易精神状态检查(MMSE)及改良Barthel 指数(MBI)进行评定。结果治疗后治疗组MMSE 评分显著高于治疗前(P<0.001),对照组治疗前后MMSE 评分无显著性差异(P>0.05)。治疗后,两组MBI 评分均高于治疗前(P<0.05),治疗组与对照组相比有非常高度显著性差异(P<0.001)。结论个体化作业疗法可明显改善老年脑卒中后认知障碍患者的认知功能,提高日常生活活动能力。     

Arterial stiffness independently predicts cardiovascular events in an elderly community — Longitudinal Investigation for the Longevity and Aging in Hokkaido County (LILAC) study

We investigated the predictive value of arterial stiffness to assess cardiovascular risk in elderly community-dwelling people by means of a multivariate Cox model. In 298 people older than 75 years (120 men and 178 women, average age: 79.6 years), brachial-ankle pulse wave velocity (baPWV) was measured between the right arm and ankle in a supine position. The LILAC study started on July 25, 2000, consultation was repeated yearly, and the last follow-up ended on November 30, 2004. During this follow-up span of 1227 days, there were nine cardiovascular deaths, the cause of death being myocardial infarction for two men and three women or stroke for two men and two women. In Cox proportional hazard models, baPWV as well as age, Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale Revised (HDSR) and the low-frequency/high-frequency (LF/HF) ratio showed a statistically significant association with the occurrence of cardiovascular death. A two-point increase in MMSE and HDSR score significantly protected against cardiovascular death, the relative risk (RR) being 0.776 (P = 0.0369) and 0.753 (P = 0.0029), respectively. The LF/HF ratio also was significant (P = 0.025), but the other indices of HRV were not. After adjustment for age and HDSR, a 200 cm/s increase in baPWV was associated with a 30.2% increase in risk (RR = 1.302, 95% CI: 1.110–1.525), and a 500 cm/s increase in baPWV with a 93.3% increase in risk (RR = 1.933, 95% CI: 1.300–2.874, P = 0.0011), whereas the LF/HF ratio was no longer associated with a statistically significant increase in cardiovascular mortality. In elderly community-dwelling people, arterial stiffness measured by means of baPWV predicted the occurrence of cardiovascular death beyond the prediction provided by age, gender, blood pressure and cognitive functions. baPWV should be added to the cardiovascular assessment in various clinical settings, including field medical surveys and preventive screening. The early detection of risk by chronomics allows the timely institution of prophylactic measures, thereby shifting the focus from rehabilitation to prehabilitation medicine, as a public service to several Japanese towns.     

老年2型糖尿病合并认知功能障碍患者血清骨钙素检测的意义

目的 探讨血清骨钙素在老年2型糖尿病(T2DM)合并认知功能障碍患者中的意义,为老年T2DM合并认知功能障碍患者早期干预提供依据。方法 选取上海交通大学附属第六人民医院临港院区就诊的150例患者作为研究对象,分为三组:(1)健康对照组(NC组);(2)2型糖尿病非认知障碍组(T2DM组);(3)2型糖尿病合并认知障碍组(CI-T2DM组),三组各50例,比较三组间患者血清骨钙素水平、一般生化指标和认知功能评分情况,并分析影响认知功能的相关因素,采用单因素和多元回归方法分析骨钙素与糖脂代谢及认知功能之间的关系。结果 与T2DM组比较,CI-T2DM组中腰围、糖化血红蛋白、内脏脂肪面积均升高,而骨钙素水平与简易精神状态检查量表(MMSE)评分下降; NC组、T2DM组、CI-T2DM组血清骨钙素水平逐渐下降,且组间差异有统计学意义;在老年T2DM人群中,MMSE评分与年龄、腰围、糖化血红蛋白及内脏脂肪面积呈负相关(P <0.05),而与骨钙素水平呈正相关(r=0.374,P <0.001);以骨钙素作为因变量,经多元线性回归分析发现,糖化血红蛋白、内脏脂肪面积、MMSE仍与骨钙...     

Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

Purpose:?To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture.

Method:?Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6?±?7.2 years, Mini Mental State Examination (MMSE) score 11.25?±?5.9), 23 with possible cognitive impairment (age 83.9?±?6.8 years, MMSE 22.65?±?1.6) and 10 without cognitive impairment (age 77.6?±?7.4 years, MMSE 29.5?±?0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain (admission FIM minus discharge FIM), relative (to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA).

Results:?Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted (age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p?<?0.03). However, the functional gain related to baseline functional status (ANCOVA) was not significantly different between the groups.

Conclusions:?In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.     

Verification of the Correlation between Cognitive Function and Lower Limb Muscle Strength for the Community-dwelling Elderly

[Purpose] The purpose of this study was to evaluate the lower limb muscle strength of the community-dwelling elderly, with or without cognitive decline, using isometric knee extension strength (IKES) and the 30-second chair stand test (CS-30). [Subjects] A total of 306 community-dwelling elderly participated in this study. Assessment items were the CS-30, IKES, Mini-Mental State Examination (MMSE), and Trail-Making Test Part A (TMT-A). [Methods] Participants were divided into three groups according to their MMSE score: cognitive impairment (MMSE ≤ 24), cognitive decline (MMSE 25 to 27), and normal (MMSE ≥ 28). We compared IKES and CS-30 among the three groups. [Results] IKES was not significantly different among the three groups. However, the CS-30 was significantly different among the three groups. Upon further analysis the CS-30 score of each group, when adjusted for age and TMT-A, did not indicate a significant difference. [Conclusion] These results suggest that the lower limb muscle strength of the elderly does not differ with cognitive decline. Moreover, we suggest that when using the CS-30 score as an indicator of lower limb muscle strength attentional function should be taken into account.Key words: Isometric knee extension strength, CS-30, Attentional function     

Developing a multivariable prognostic model for pancreatic endocrine tumors using the clinical data warehouse resources of a single institution

OBJECTIVE: Current staging systems are not accurate for classifying pancreatic endocrine tumors (PETs) by risk. Here, we developed a prognostic model for PETs and compared it to the WHO classification system. METHODS: We identified 98 patients diagnosed with PET at NewYork-Presbyterian Hospital/Columbia University Medical Center (1999 to 2009). Tumor and clinical characteristics were retrieved and associations with survival were assessed by univariate Cox analysis. A multivariable model was constructed and a risk score was calculated; the prognostic strength of our model was assessed with the concordance index. RESULTS: Our cohort had median age of 60 years and consisted of 61.2% women; median follow-up time was 10.4 months (range: 0.1-99.6) with a 5-year survival of 61.5%. The majority of PETs were non-functional and no difference was observed between functional and non-functional tumors with respect to WHO stage, age, pathologic characteristics or survival. Distant metastases, aspartate aminotransferase-AST and surgical resection (HR=3.39, 95% CI: 1.38-8.35, p=0.008, HR=3.73, 95% CI: 1.20-11.57, p=0.023 and HR=0.20, 95% CI: 0.08-0.51, p<0.001 respectively) were the strongest predictors in the univariate analysis. Age, perineural and/or lymphovascular invasion, distant metastases and AST were the independent prognostic factors in the final multivariable model; a risk score was calculated and classified patients into low (n=40), intermediate (n=48) and high risk (n=10) groups. The concordance index of our model was 0.93 compared to 0.72 for the WHO system. CONCLUSION: Our prognostic model was highly accurate in stratifying patients by risk; novel approaches as such could thus be incorporated into clinical decisions.