Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions

Background  Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission.  Methods  Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined ‘cognitive spectrum disorder’ (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes.  Results  A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without – LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (allP < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year.  Conclusions  CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on condition-specific pathways such as those for dementia or delirium alone

Exomorfología y anatomía de órganos vegetativos aéreos en especies de Flourensia DC. (Asteraceae) con importancia fitoquímica

El género Flourensia DC. es americano y comprende 32 especies. Son arbustos resinosos utilizados en medicina popular; poseen un potencial valor económico, por lo que, en algunas especies representantes, se han caracterizado sus compuestos químicos y determinado algunos posibles usos. En el presente trabajo, se estudió la exomorfología y anatomía de órganos vegetativos de F. hirta S. F. Blake, F. leptopoda S. F. Blake, F. niederleinii S. F. Blake y F. tortuosa Griseb., especies endémicas del centro de Argentina. Se observó que todas son similares en cuanto a la anatomía de hoja y tallo. En cuanto al estudio de la epidermis foliar, se concluye que es posible diferenciar las especies teniendo en cuenta la frecuencia estomática y la presencia de tricomas. Finalmente, las diferencias más notables se encontraron en la exomorfología foliar ya que se observó una gran variación en cuanto a la forma de las hojas y tamaño de las láminas y pecíolos. Con respecto a las estructuras secretoras, se encontraron tricomas y conductos secretores esquizógenos en las hojas y los tallos de todas las especies, las cuales serían responsables de la producción y secreción de las resinas.The genus Flourensia DC. is American and comprises 32 species. They are resiniferous shrubs used in folk medicine. As they have potential economic value, its chemical compounds have been characterized and some possible uses identified. In this work, the exomorphology and anatomy of vegetative organs of F. hirta S. F. Blake, F. leptopoda S. F. Blake, F. niederleinii S. F. Blake and F. tortuosa Griseb., endemic species from central Argentina, have been studied. All species are similar in leaf and stem anatomy. Regarding the epidermis, it is possible to differentiate the species according to the stomatal frequency and the presence of trichomes. Finally, the most remarkable differences were found in leaf exomorphology, since there was a large variation in shape and size of blades and petioles. Concerning the secretory structures, trichomes and secretory ducts were found in the leaves and stems of all species, which would be responsible for the production and secretion of the resins

Détection des troubles cognitifs en pratique clinique [Detection of cognitive disorders in clinical practice].

The detection rate of cognitive impairment by general practitioners in elderly hospitalised and ambulatory population is low, ranging from 50 to 73%, and from 24 to 42%, respectively. This is insufficient regarding the importance of an early diagnosis of dementia and Alzheimer's disease, for the patient and his/her proxies, but also for the primary care physician in charge. Thus, all general practitioners should have a strategy for the evaluation of cognitive impairment in elderly patient

Cognitive impairment in elderly medical inpatients: detection and associated six-month outcomes.

OBJECTIVE: The authors examined the relationship of cognitive impairment at hospital admission to 6-month outcome (hospital readmission, nursing home admission, and death) in a cohort of elderly medical inpatients. METHODS: A group of 401 medical inpatients age 75 and older underwent a comprehensive geriatric assessment at hospital admission and were followed up for 6 months. Cognitive impairment was defined as a score <24 on the Mini-Mental State Exam. Detection was assessed through blinded review of discharge summary. Follow-up data were gathered from the centralized billing system (hospital and nursing home admissions) and from proxies (death). RESULTS: Cognitive impairment was present in 129 patients (32.3%). Only 48 (37.2%) were detected; these had more severe impairment than undetected cases. During follow-up, cognitive impairment, whether detected or not, was associated with death and nursing home admission. After adjustment for health, functional, and socioeconomic status, an independent association remained only for nursing home admission in subjects with detected impairment. Those with undetected impairment appeared to be at intermediate risk, but this relationship was not statistically significant. CONCLUSION: In these elderly medical inpatients, cognitive impairment was frequent, rarely detected, and associated with nursing home admission during follow-up. Although this association was stronger in those with detected impairment, these results support the view that acute hospitalization presents an opportunity to better detect cognitive impairment in elderly patients and target further interventions to prevent adverse outcomes such as nursing home admission