The Mini-Mental State Examination (MMSE) is commonly used as a screening tool to detect dementia. However, it performs poorly in identifying persons with mild neurocognitive disorder. The Saint Louis ...University Mental Status (SLUMS) examination is a 30-point screening questionnaire that tests for orientation, memory, attention, and executive functions.
The objective of this study was to compare SLUMS and the MMSE for detecting dementia and mild neurocognitive disorder (MNCD) using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) criteria.
Patients at the Veterans' Affairs Geriatric Research, Education and Clinical Center, St. Louis, MO (N = 702) were clinically classified as having normal cognitive functioning, MNCD, or dementia based on DSM–IV criteria. The SLUMS and MMSE were administered for comparison.
Mean age was 75.3 years (standard deviation: 5.5). Regarding education, 62.4% of the sample had at least completed high school and 30.6% had not. Sensitivity and specificity were calculated and receiver operator curves (ROCs) generated for SLUMS and MMSE as a function of diagnosis (MCND versus dementia) and education. Both the SLUMS and MMSE produced acceptable ROCs for the diagnosis of dementia, but the ROCs for SLUMS were better than the MMSE for the diagnosis of MNCD in both education groups.
These results suggest that the SLUMS and MMSE have comparable sensitivities, specificities, and area under the curve in detecting dementia. Although the definition of MNCD is controversial, the authors believe that the SLUMS is possibly better at detecting mild neurocognitive disorder, which the MMSE failed to detect, but this needs to be further investigated.
Constipation in long-term care Tariq, Syed H
Journal of the American Medical Directors Association,
05/2007, Letnik:
8, Številka:
4
Journal Article
Recenzirano
Constipation is more common in older adults and accounts for increased physician office visits and hospital admissions. There is lack of agreement on the definition of constipation regarding what ...patients perceive as constipation and what physicians traditionally see as constipation. Constipation is related to multiple factors, and when left untreated or not properly treated, results in complications, such as impaction, even perforation and death. Laxative use increases with age and at times multiple agents are used to relieve symptoms of constipation. Currently the most commonly used laxative is stool softener but it lacks efficacy. From the review of literature, osmotic laxatives are effective in older adults and well tolerated. Psyllium, a bulk laxative, is also effective in the treatment of constipation, while there is limited evidence for stimulants, dioctyl sulfosuccinate, and other bulk laxatives such as calcium polycarbophil and methylcellulose. A new drug, lubiprostone, is a type 2-chloride channel activator and is shown to be effective, safe, and well tolerated in older adults treated for chronic constipation in studies up to a year. It appears to be particularly useful in persons who have recurrent fecal impaction and in those with severe chronic constipation. There is a need for a large-scale trial examining an appropriate cost-effective approach to the management of constipation in the nursing home.
Acute pancreatitis may be the first presentation of pancreatic carcinoma (PaCa). The present study was designed to identify clinical findings suggestive of PaCa in patients with nonalcoholic ...nongallstone-related (NANG) acute pancreatitis and evaluate accuracy of endoscopic ultrasound for diagnosing PaCa in this setting.
This is a retrospective analysis of 332 consecutive patients who underwent endoscopic ultrasound-fine-needle aspiration after acute pancreatitis. Patients with gallstones or common bile duct stones, who were heavy or binge alcohol drinkers, or who had post-endoscopic retrograde cholangiopancreatography pancreatitis were excluded.
Among 218 patients with NANG acute pancreatitis, 38 patients had PaCa. Age more than 50 years (P = 0.008), history of smoking (P < 0.001), weight loss of 10 lb or greater (P = 0.003), serum bilirubin levels of higher than 2 mg/dL (P = 0.035) or serum alkaline phosphatase level of higher than 165 U/mL (in patients with normal serum bilirubin levels) (P = 0.003), and radiological findings of an identifiable pancreatic mass (P = 0.001) or distal pancreatic atrophy (P = 0.006) had significant association with an underlying PaCa on multivariate analysis. Of the 38 patients with PaCa in this cohort, 37 had 2 or more of these findings. Endoscopic ultrasound-fine-needle aspiration had 99.5% accuracy (98.6, 100%) for diagnosing carcinoma in this clinical setting.
The clinical criteria defined previously potentially can help select patients with NANG acute pancreatitis with a higher likelihood of an underlying pancreatic neoplasm for further imaging.
Pharmacotherapy for insomnia Tariq, Syed H; Pulisetty, Shailaja
Clinics in geriatric medicine,
02/2008, Letnik:
24, Številka:
1
Journal Article
Recenzirano
Hypnotics are commonly use in the treatment of insomnia, and hypnotic use among older adults is more prevalent than with younger adults. Unfortunately, the use of hypnotics is not well studied in the ...ever-growing geriatric population and the magnitude of the medication benefit is usually not impressive. Insomnia in older adults is usually treated with benzodiazepines, nonbenzodiazepines, and other agents, such as trazodone, valerian, and melatonin. Using appropriately selected agents and therapy initiated with a low dose and careful monitoring of the patient could minimize common unwanted side effects.
Sensitization to hen’s egg early in life has been proposed as a predictor for respiratory allergic disease during childhood. However, symptomatic egg allergy in infancy has not been studied in this ...context. In 1989, a cohort of consecutive births was recruited. Data on family history of atopy and environmental factors were collected. At 4 years of age, 1218 children were seen of whom 981 were skin‐prick tested with a range of food and aero‐allergens. Of the 1218 children, 29 (2.4%) had suffered symptomatic egg allergy (20 during infancy). Egg allergy in infancy was associated with increased respiratory (asthma, rhinitis) allergic disease (odds ratio OR 5.0, 95% confidence intervals CI 1.1–22.3; p < 0.05) at 4 years of age, with a positive predictive value (PPV) of 55.0%. The addition of infantile eczema to egg allergy increased the PPV to 80% whereas the addition of family history of atopy had no effect. Egg allergy also increased aero‐allergen sensitization (OR 6.1, CI 1.1–37.5; PPV 61.1%; p < 0.05). As a predictor for respiratory allergic disease and aero‐allergen sensitization, it carried a high specificity but poor sensitivity. Hence, egg allergy in infancy, especially when coexisting with eczema, increases respiratory allergic symptoms and aero‐allergen sensitization in early childhood.
A Model for Managing Delirious Older Inpatients Flaherty, Joseph H.; Tariq, Syed H.; Raghavan, Srinivasan ...
Journal of the American Geriatrics Society (JAGS),
July 2003, Letnik:
51, Številka:
7
Journal Article
Recenzirano
Although multiple models of care exist to prevent the development of delirium in hospitalized patients, models for the management of patients for whom delirium is unpreventable or who already have ...delirium on admission to the hospital are needed.
This article describes the development, management, and economics of a new model of care for patients with delirium, called the Delirium Room (DR). The DR is a specialized 4‐bed unit that provides 24‐hour intensive nursing care and is completely free of physical restraints. Another important feature of the 4‐bed DR is that it is an integral part of a 22‐bed acute care for the elderly (ACE) unit. As such, patients in the DR benefit from features of the ACE unit: a change in the physical environment of the medical floor to promote mobility and function and discourage bedrest, comprehensive geriatric care that identifies and addresses problems that can lead to a decline in function, and use of a daily multidisciplinary team meeting.
This article also presents descriptive data on a group of delirious patients managed in the DR with the intention of giving baseline data for other ACE units that are considering opening a DR or for future prospective studies in this area.
Abstract Arterial tortuosity syndrome is an autosomal recessive disorder characterized by severe tortuosity of greater and systemic arteries in affected individuals. In addition, patients display ...connective tissue features which include hyperextensible skin, hypermobility of joints and characteristic facial features. This syndrome is caused by mutation in SLC2A10 gene which encodes for the facilitative glucose transporter, GLUT10. We describe seven patients of two unrelated Saudi Arabian families who display tortuosity, dilatation and stenosis of arteries, pulmonary hypertension and other cardiovascular manifestations. These patients exhibit characteristic connective tissue phenotypes and distinctive facial features. In the single patient of Family 1, sequencing of the candidate gene, SLC2A10 , identified a novel missense c.313C > T mutation encoding a p.Arg105Cys substitution in the second extracellular domain of GLUT10. The Arg105 in GLUT10 is highly conserved across species and its replacement with cysteine is predicted to be pathogenic. In the second family, all of the six affected individuals carry recurrent c.243C > G missense mutation encoding a p.Ser81Arg change in the third transmembrane domain of GLUT10. The present study suggests that there exists an intra- and inter-familial phenotypic variability in arterial tortuosity patients carrying identical or different mutations in SLC2A10 gene. While skin hyperextensibility, small joint hypermobility, and facial features are similarly expressed in these patients, there is a range of other phenotypes which include arterial tortuosity and associated complications, and abnormalities of other organs.
Gastrointestinal bleeding in older adults is a frequent cause of hospital admissions. The presence of multiple comorbidity conditions and greater medication use in this age group influence the ...clinical outcome. The selection of diagnostic and therapeutic maneuvers often depends more on local expertise and availability. This article addresses clinical presentation, etiology, diagnosis, and treatment of upper and lower gastrointestinal bleeding in elderly individuals.
Fecal incontinence is an underreported and underappreciated problem in older adults. Although fecal incontinence is more common in women than in men, this difference narrows with aging. Risk factors ...that lead to the development of fecal incontinence include dementia, physical disability, and fecal impaction. Treatment options include medical or conservative therapy for older adults who have mild incontinence, and surgical options can be explored in selected older adults if surgical expertise is available.
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