Screening for mild cognitive impairment in the preoperative setting: A narrative review

Contains fulltext : 251958.pdf (Publisher’s version ) (Open Access)Cognitive impairment predisposes patients to the development of delirium and postoperative cognitive dysfunction. In particular, in older patients, the adverse sequelae of cognitive decline in the perioperative period may contribute to adverse outcomes after surgical procedures. Subtle signs of cognitive impairment are often not previously diagnosed. Therefore, the aim of this review is to describe the available cognitive screeners suitable for preoperative screening and their psychometric properties for identifying mild cognitive impairment, as preoperative workup may improve perioperative care for patients at risk for postoperative cognitive dysfunction. Electronic systematic and snowball searches of PubMed, PsycInfo, ClinicalKey, and ScienceDirect were conducted for the period 2015–2020. Major inclusion criteria for articles included those that discussed a screener that included the cognitive domain ‘memory’, that had a duration time of less than 15 min, and that reported sensitivity and specificity to detect mild cognitive impairment. Studies about informant-based screeners were excluded. We provided an overview of the characteristics of the cognitive screener, such as interrater and test-retest reliability correlations, sensitivity and specificity for mild cognitive impairment and cognitive impairment, and duration of the screener and cutoff points. Of the 4775 identified titles, 3222 were excluded from further analysis because they were published prior to 2015. One thousand four hundred and forty-eight titles did not fulfill the inclusion criteria. All abstracts of 52 studies on 45 screeners were examined of which 10 met the inclusion criteria. For these 10 screeners, a further snowball search was performed to obtain related studies, resulting in 20 articles. Screeners included in this review were the Mini-Cog, MoCA, O3DY, AD8, SAGE, SLUMS, TICS(-M), QMCI, MMSE2, and Mini-ACE. The sensitivity and specificity range to detect MCI in an older population is the highest for the MoCA, with a sensitivity range of 81–93% and a specificity range of 74–89%. The MoCA, with the highest combination of sensitivity and specificity, is a feasible and valid routine screening of pre-surgical cognitive function. This warrants further implementation and validation studies in surgical pathways with a large proportion of older patients.21 p

Integrale of simpele frailty meting: de context moet leidend zijn

Dr. Gobbens en zijn promotor en co-promotoren kunnen om meerdere redenen gefeliciteerd worden met het proefschrift over een integrale benadering van het begrip frailty. De auteur en zijn begeleider hebben een serieuze inspanning geleverd om het begrip frailty vanuit een andere context te bezien, namelijk die van het integrale menselijke functioneren. Dat dit vanuit de Universiteit Tilburg gebeurt, met een rijke traditie in de sociale wetenschappen, lijkt haast vanzelfsprekend, maar is toch een belangrijke toevoeging. De context is immers in hoge mate bepalend voor het onderzoek aan het brede begrip frailty. Het kon eigenlijk dan ook niet anders dan dat een Tilburgs frailty proefschrift de sociale en psychische dimensie zou toevoegen aan het fysieke domein, dat tot nu toe dominant was in de frailty concepten. Deze aanpak past bovendien uitstekend bij de brede oriëntatie van de promotor, prof dr. Jos Schols. Aan het werk herkent men de meester

PHYSICAL ACTIVITY AND COGNITIVE FUNCTION OF LONG DISTANCE WALKERS: STUDYING FOUR DAYS MARCHES PARTICIPANTS.

OBJECTIVE: Studies show physical activity to be beneficial for cognitive function. However, studies usually included individuals who were not particularly inclined to exercise. Following research among master athletes, we examined associations between physical activity and cognitive function in participants of the International Nijmegen Four Days Marches. These individuals are also inclined to exercise. On 4 consecutive days > 40,000 participants walk a daily distance of 30-50 km (120-200 km or 75-125 miles in total). METHOD: Four Days Marches participants and less active or inactive control participants from the Nijmegen Exercise Study were examined. Self-reported current and lifelong physical activities were quantified in Metabolic Equivalent of Task minutes/day and training walking speed was estimated in km/h. Cognitive functioning in the domains of working memory, executive function, and visuospatial short-term memory was assessed using the validated Brain Aging Monitor. RESULTS: Data from 521 participants (mean age 54.7, standard deviation 12.9) showed neither positive associations between lifelong physical activity and working memory, executive function, and visuospatial short-term memory nor positive associations between current physical activity and cognitive functioning in these domains (P-values > 0.05). However, a positive association between training walking speed and working memory was revealed (age adjusted Beta = 0.18, P-value < 0.01). CONCLUSION: Walking speed, as a surrogate marker of fitness, but not lifelong and current physical activity levels were associated with cognitive function. Therefore, walking speed deserves more attention in research aimed at unravelling associations between physical activity and cognitive function

A Simple and Practical Index to Measure Dementia-Related Quality of Life

AbstractBackgroundResearch on new treatments for dementia is gaining pace worldwide in an effort to alleviate this growing health care problem. The optimal evaluation of such interventions, however, calls for a practical and credible patient-reported outcome measure.ObjectivesTo describe the refinement of the Dementia Quality-of-life Instrument (DQI) and present its revised version.MethodsA prototype of the DQI was adapted to cover a broader range of health-related quality of life (HRQOL) and to improve consistency in the descriptions of its domains. A valuation study was then conducted to assign meaningful numbers to all DQI health states. Pairs of DQI states were presented to a sample of professionals working with people with dementia and a representative sample of the Dutch population. They had to repeatedly select the best DQI state, and their responses were statistically modeled to obtain values for each health state.ResultsIn total, 207 professionals working with people with dementia and 631 members of the general population completed the paired comparison tasks. Statistically significant differences between the two samples were found for the domains of social functioning, mood, and memory. Severe problems with physical health and severe memory problems were deemed most important by the general population. In contrast, severe mood problems were considered most important by professionals working with people with dementia.DiscussionThe DQI is a simple and feasible measurement instrument that expresses the overall HRQOL of people suffering from dementia in a single meaningful number. Current results suggest that revisiting the discussion of using values from the general population might be warranted in the dementia context

Het Ogilvie-syndroom bij oudere patiënten met multiproblematiek

Twee patiënten presenteren zich met het Ogilvie-syndroom, een acute intestinale pseudo-obstructie zonder mechanische obstructie. Bij beide patiënten was er sprake van multi-problematiek met infectie, elektrolietstoornissen en functionele achteruitgang. Dit ziektebeeld komt vooral voor bij zieke patiënten vanaf 60 jaar met multimorbiditeit die in het ziekenhuis of verpleeghuis verblijven. Met de vergrijzing zal de incidentie van dit ziektebeeld waarschijnlijk toenemen, met name bij de kwetsbare oudere patiënt. De precieze pathofysiologie is onbekend, maar er zijn in de literatuur aanwijzingen voor een multicausaal model dat autonome disregulatie van het colon veroorzaakt. Vroege herkenning en adequate behandeling kan het risico op complicaties en overlijden sterk doen verminderen, afhankelijk van de onderliggende comorbiditeit

Development of the Nurses' Observation Scale for Cognitive Abilities (NOSCA)

Background. To assess a patient's cognitive functioning is an important issue because nurses tailor their nursing interventions to the patient's cognitive abilities. Although some observation scales exist concerning one or more cognitive domains, so far, no scale has been available which assesses cognitive functioning in a comprehensive way. Objectives. To develop an observation scale with an accepted level of content validity and which assesses elderly patients' cognitive functioning in a comprehensive way. Methods. Delphi technique, a multidisciplinary panel developed the scale by consensus through four Delphi rounds (>70% agreement). The International Classification of Functioning/ICF was used as theoretical framework. Results. After the first two Delphi rounds, the panel reached consensus about 8 cognitive domains and 17 sub domains. After two other rounds, 39 items were selected, divided over 8 domains and 17 sub domains. Discussion. The Nurses' Observation Scale Cognitive Abilities (NOSCA) was successfully designed. The content validity of the scale is high because the scale sufficiently represents the concept of cognitive functioning: the experts reached a consensus of 70% or higher on all domains and items included; and no domains or items were lacking. As a next step, the psychometric qualities of the NOSCA will have to be tested

Precondition Inference via Partitioning of Initial States

Precondition inference is a non-trivial task with several applications in program analysis and verification. We present a novel iterative method for automatically deriving sufficient preconditions for safety and unsafety of programs which introduces a new dimension of modularity. Each iteration maintains over-approximations of the set of \emph{safe} and \emph{unsafe} \emph{initial} states. Then we repeatedly use the current abstractions to partition the program's \emph{initial} states into those known to be safe, known to be unsafe and unknown, and construct a revised program focusing on those initial states that are not yet known to be safe or unsafe. An experimental evaluation of the method on a set of software verification benchmarks shows that it can solve problems which are not solvable using previous methods.Comment: 19 pages, 8 figure

Cerebrospinal Fluid Biomarkers in Diagnosing Alzheimer's Disease in Clinical Practice: An Illustration with 3 Case Reports

Analysis of the brain specific biomarkers amyloid β42 (Aβ42) and total tau (t-tau) protein in cerebrospinal fluid (CSF) has a sensitivity and specificity of more than 85% for differentiating Alzheimer's Disease (AD) from non-demented controls. International guidelines are contradictory in their advice on the use of CSF biomarkers in AD diagnostics, resulting in a lack of consistency in clinical practice. We present three case reports that illustrate clinical practice according to the Dutch and European guidelines and portray the value of CSF biomarker analysis as an add-on diagnostic to the standard diagnostic workup for AD