OBJECTIVE
Infection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which causes coronavirus disease 2019 (COVID‐19), manifests with a wide spectrum of presentations. Most reports ...of COVID‐19 highlight fever and upper respiratory symptoms as the dominant initial presentations, consistent with the World Health Organization guidelines regarding suspected SARS‐CoV‐2 infection. However, atypical presentations of this disease have been evolving since the initial outbreak of the pandemic in December 2019. We report a case of an older male patient who presented at our hospital with an unusual manifestation of COVID‐19.
DESIGN
Brief report.
SETTING
A university hospital in Saudi Arabia.
PARTICIPANT
A 73‐year‐old man who presented with confusion in the absence of any respiratory symptoms or fever.
INTERVENTION
The patient was initially admitted with delirium and underwent a further work‐up.
MEASUREMENTS
Given his recent history of domestic travel and the declaration of a global COVID‐19 pandemic status, the patient was administered a swab test for SARS‐CoV‐2.
RESULTS
The patient's positive test led to a diagnosis of COVID‐19. Although he began to experience a spiking fever and mild upper respiratory symptoms, he recovered rapidly with no residual sequela.
CONCLUSION
The recognition of atypical presentations of COVID‐19 infection, such as delirium, is critical to the timely diagnosis, provision of appropriate care, and avoidance of outbreaks within healthcare facilities during this pandemic. J Am Geriatr Soc 68:1382‐1384, 2020.
Dementia is one of the most pressing health care issues of this century. As no curative treatment for dementia exists, research efforts are growing to identify effective lifestyle interventions to ...prevent or delay onset. One such promising strategy that promotes cognitive and brain health is engaging in physical exercise. However, current exercise recommendations are imprecise. To advance the potential of exercise as a preventative and treatment strategy, important questions regarding moderators (ie, biological sex and age) are being addressed in the literature. Biological sex is recognized as an important variable to consider in exercise efficacy on brain health, with females showing greater cognitive gains. This may be related to sex differences in underlying mechanisms. Here, we argue to better understand the sex differences in exercise efficacy, the timing of exercise intervention should also be considered. Specifically, we present the hypothesis that midlife in females is a critical window for the implementation of exercise as an early intervention to promote brain health and prevent dementia. Further, we speculate that exercise interventions targeting midlife will be of critical importance for the female brain, as females exit this period of the lifespan at greater risk for cognitive impairment. Given the potential sex differences in dementia risk and prevalence, it is imperative to assess potential sex differences in exercise efficacy as an early intervention during midlife.
Objectives
To examine whether good executive function (EF; the cognitive processes important for goal‐oriented and controlled behavior) at baseline and maintenance of EF over time predict maintenance ...of physical performance, functional status, physical activity, and mood over a 1‐year period, and conversely, to examine whether baseline functioning in these noncognitive domains predicts maintenance of EF over the same period of time.
Design
12‐month prospective cohort study.
Setting
Vancouver Falls Prevention Clinic.
Participants
Community‐dwelling older adults (N = 199; mean age 81.6 ± 6.5; 63% female) referred to the clinic after a fall.
Measurments
At each time point, structural equation modeling created a latent EF variable from performance on five EF tasks. Physical performance (physiological falls risk and gait speed), instrumental activities of daily living (IADLs), physical activity, and depressive symptoms were also assessed at each time point.
Results
Higher baseline EF predicted decreases in depressive symptoms (P = .005) and maintenance of IADLs (P = .006) from baseline to follow‐up. Improvements in EF correlated with increases in gait speed (P = .005) and physical activity (P = .03) and with the maintenance of IADLs (P = .002) over follow‐up. All effects were independent of demographic characteristics and global cognitive function. Baseline performance in the noncognitive domains did not predict changes in EF.
Conclusion
In older fallers, EF is a marker of resiliency in several noncognitive domains and should therefore be assessed. Furthermore, interventions to improve EF should be tested in older fallers with EF deficits.
Successful mobility requires appropriate decision-making. Seniors with reduced executive functioning-such as senior fallers-may be prone to poor mobility judgments, especially under dual-task ...conditions. We classified participants as "At-Risk" and "Not-At-Risk" for falls using a validated physiological falls-risk assessment. Dual-task performance was assessed in a virtual reality environment where participants crossed a simulated street by walking on a manual treadmill while listening to music or conversing on a phone. Those "At-Risk" experienced more collisions with oncoming cars and had longer crossing times in the Phone condition compared to controls. We conclude that poor mobility judgments during a dual-task leads to unsafe mobility for those at-risk for falls.
Subcortical ischemic vascular cognitive impairment (SIVCI) is the most preventable form of cognitive dysfunction. There is converging evidence from animal and human studies that indicate vascular ...injury as the primary cause of SIVCI. Currently, there are no curative pharmaceutical treatments for vascular dementia; however, exercise may be a promising strategy to combat SIVCI. This review will focus on the role of exercise as a strategy to prevent or slow the progression of SIVCI, with particular emphasis on the mechanisms by which exercise may improve cerebrovascular function. We propose that exercise may be an effective strategy to combat SIVCI by improving cognitive function, increasing the bioavailability of neurotrophins, stimulating endothelial function, and controlling vascular risk factors.
This article is part of the Special Issue “Vascular Dementia”.
Currently, there are no curative pharmaceutical treatments for subcortical ischemic vascular cognitive impairment (SIVCI). However, exercise may combat SIVCI by increasing the bioavailability of neurotrophins, improving cognitive function, stimulating endothelial function, and controlling vascular risk factors. We propose that exercise is a promising strategy to prevent or slow the progression of SIVCI.
This article is part of the Special Issue “Vascular Dementia”.
BACKGROUND
The Otago Exercise Program (OEP) has demonstrated cost‐effectiveness for the primary prevention of falls in a general community setting. The cost‐effectiveness of exercise as a secondary ...falls prevention (ie, preventing falls among those who have already fallen) strategy remains unknown. The primary objective was to estimate the cost‐effectiveness (incremental cost‐effectiveness/utility ratio) of the OEP from a healthcare system perspective.
DESIGN
A concurrent 12‐month prospective economic evaluation conducted alongside the Action Seniors! randomized critical trial (OEP compared with usual care).
SETTING
Vancouver Falls Prevention Clinic (Vancouver, BC, Canada; http://www.fallsclinic.ca).
PARTICIPANTS
A total of 344 community‐dwelling older adults, aged 70 years and older, who attended a geriatrician‐led Falls Prevention Clinic in Vancouver, after sustaining a fall in the previous 12 months.
MEASUREMENTS
Main outcome measures included: incidence rate ratio for falls, healthcare costs, incremental cost per fall prevented, and incremental cost per quality‐adjusted life year (QALY) gained.
RESULTS
The OEP costs $393 CAD per participant to implement. The incremental cost per fall prevented resulted in a savings of $2 CAD. The incremental cost per QALY gained (where QALYs were estimated using the Euro‐Qol 5D three‐level version EQ‐5D‐3L) indicated the OEP was less effective than usual care. The incremental cost per QALY gained (where QALYs were estimated using the Short Form 6D SF‐6D) indicated the OEP was more effective and less costly than usual care. The incremental QALYs estimated using the EQ‐5D‐3L and the SF‐6D were not clinically significant and close to zero, indicating no change in quality of life.
CONCLUSION
Compared with usual care, healthcare system costs are saved and falls are prevented when older fallers who attend a geriatrician‐led falls clinic are allocated to, and provided, the physiotherapist‐guided exercise‐based falls prevention program (the OEP).
Studies supporting the notion that physical activity and exercise can help alleviate the negative impact of age on the body and the mind abound. This literature review provides an overview of ...important findings in this fast growing research domain. Results from cross-sectional, longitudinal, and intervention studies with healthy older adults, frail patients, and persons suffering from mild cognitive impairment and dementia are reviewed and discussed. Together these finding suggest that physical exercise is a promising nonpharmaceutical intervention to prevent age-related cognitive decline and neurodegenerative diseases.
OBJECTIVES: To primarily ascertain the effect of the Otago Exercise Program (OEP) on physiological falls risk, functional mobility, and executive functioning after 6 months in older adults with a ...recent history of falls and to ascertain the effect of the OEP on falls during a 1‐year follow‐up period.
DESIGN: Randomized controlled trial.
SETTING: Dedicated falls clinics.
PARTICIPANTS: Seventy‐four adults aged 70 and older who presented to a healthcare professional after a fall.
INTERVENTION: The OEP, a home‐based program that consists of resistance training and balance training exercises.
MEASUREMENTS: Physiological falls risk was assessed using the Physiological Profile Assessment. Functional mobility was assessed using the Timed Up and Go Test. Three central executive functions were assessed: set shifting, using the Trail Making Test Part B; updating, using the verbal digits backward test; and response inhibition, using the Stroop Color‐Word Test. Falls were prospectively monitored using daily calendars.
RESULTS: At 6 months, there was no significant between‐group difference in physiological falls risk or functional mobility (P≥ .33). There was a significant between‐group difference in response inhibition (P=.05). A falls histogram revealed two outliers. With these cases removed, using negative binomial regression, the unadjusted incidence rate ratio of falls in the OEP group compared with the control group was 0.56. The adjusted incidence rate ratio was 0.47.
CONCLUSION: The OEP may reduce falls by improving cognitive performance.
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